Blue Cross and Sutter Health Contract Negotiations ‘Collapse’
Contract negotiations between Sutter Health and California Care, the Blue Cross HMO, have "collapsed," forcing several thousand Northern Californians wishing to receive care at Sutter hospitals to switch medical groups, the Santa Rosa Press-Democrat reports. The contract dispute affects all 27 Sutter Health hospitals in Northern California, but is "especially crucial" in Sonoma County, where Sutter Medical Group is the largest physicians group. The Press-Democrat reports that negotiations failed because of reimbursement issues and the "contract language on resolving disputed claims." Sutter Health spokesperson Bill Gleeson said that although Blue Cross had increased premiums for businesses and employers, providers were not seeing increased reimbursements for medical services. He added that while PacifiCare, Blue Shield, Health Net and Aetna had cooperated, Blue Cross was the only HMO to "balk" at raising reimbursements and working out contract language on claims denials. Gleeson said, "We are not asking for anything other than what the other HMOs are doing. Blue Cross is simply not paying its fair share."
About 16,000 Northern California Blue Cross HMO members will be affected by the contract dispute; some may be required to find new primary care physicians. The contract between Sutter Health and Blue Cross expired Jan. 1, but most HMO members will be able to continue using Sutter hospitals and physicians through Jan. 31. Blue Cross spokesperson Michael Chee said Blue Cross began transferring members out of Sutter medical groups several weeks ago when "it became apparent there would be no agreement." He said, "We have notified all of our membership that this will happen. Under the circumstances, we felt the switch was the best way for us to ensure continuity of care" (Rose/Wang, Santa Rosa Press-Democrat, 1/3).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.