Premera's November 2 notice, November 5 payment-policy update, and revised rehabilitation payment policy
OT clinics preparing for a December payment cut can take one date off the calendar. Premera has paused its planned Always Therapy Multiple Procedure Reduction, removing the December 4, 2026 start date while it studies the effect on care. The revised policy, published November 5, lists implementation as undecided.
In brief
- The December 4 start date has been withdrawn; Premera has announced no replacement date.
- Premera promises at least 90 days' notice before implementation after it reaches a decision.
- The planned reduction concerns the practice-expense component of secondary eligible therapy procedures.
The pause is now in the policy
In its November 2 announcement, Premera said feedback from physical therapists and other clinicians prompted the pause. It is gathering information and evaluating the potential impact. Its November 5 policy bulletin records the date change, and the accompanying PDF carries the same revision in its November 3 approval history.
The reduction language remains in that document. Premera has announced a suspension with further notice promised; it has given no new start date or notice of permanent withdrawal.
What the suspended provision would do
The written provision addresses two or more eligible therapy procedures furnished to the same patient by a provider on the same date. It would retain the highest per-procedure allowance, subject to the billed-charge limit, and reduce the practice-expense component of other applicable procedures by 50%. That percentage applies to one payment component; it does not describe a 50% cut to the entire visit.
The policy lists Premera Blue Cross, its Alaska company, LifeWise Health Plan of Washington, LifeWise Assurance Company, and Premera Blue Cross HMO lines and products. Employer-group benefits can create exceptions. A clinic still needs to match the patient's plan and its contract to the applicable payment rules.
Correct the December billing instructions
For a practice that already budgeted for this reduction, the immediate task is to remove the December 4 assumption from its forecast and tell its billing vendor about the pause. Keep the dated notice beside the revised policy so staff can resolve any conflicting instructions.
The notice concerns this particular payment provision. Continue checking member benefits, authorization requirements and the applicable coding rules. Review December remittances for an unexpected reduction, and ask Premera to explain any adjustment against the current policy. Assign someone to watch for the next notice before changing the forecast again.