Blue Cross PPO Members Could Pay More for Sutter Services
Beginning Feb. 1, Blue Cross preferred provider organization members could receive "unexpectedly high bills" for treatment at Sutter Health facilities due to an ongoing contract dispute between the medical network and the insurer, the Santa Rosa Press-Democrat reports. Sutter and Blue Cross have been unable to reach a new contract because they are "at odds" over reimbursement rates. Last week, Blue Cross announced a proposal that would allow its Prudent Buyer PPO members to continue to use certain Sutter facilities even after the contract expires Jan. 31. But Sutter officials said they "lacked details of Blue Cross' proposal," and are cautioning Blue Cross members to "do some homework" prior to receiving medical services at Sutter facilities. Thomas Gagen, CEO of Sutter Medical Center in Sacramento, said, "Members need to make sure they know how much the service will cost and exactly what the health plan will pay." Dr. David Druker, CEO of the Sutter-affiliated Palo Alto Medical Foundation, added, "While [Blue Cross] claim[s] [it] will authorize members to use our providers, it's very likely that the difference between Blue Cross' reimbursement and what the provider charges will be more than [Blue Cross] members are used to paying." Blue Cross has approximately 45,000 PPO members in Northern California (Rose, Santa Rosa Press-Democrat, 1/16).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.