Blue Cross, Sutter Contract Collapse Leaves Patients Searching for New Providers, Insurers
After the collapse of contract negotiations between Blue Cross of California and Sutter Health, patients "are scrambling to learn" if they will continue to be covered by the insurer if they visit a Sutter-affiliated hospital or doctors group, the San Francisco Chronicle reports. After negotiating for months, Blue Cross' contract with Sutter Health ended on Dec. 31, terminating coverage for thousands of patients who use Sutter's 27 hospitals and seven doctors groups in Northern California. Blue Cross said yesterday that it is trying to "retain members" and continue to cover "special cases." Blue Cross spokesperson Michael Chee said, "We're in discussions about what we can do to make things easier for our members." Blue Cross officials said that the company is considering options including extending coverage for rural patients and "helping to expedite hospital privileges to doctors who do not work near a non-Sutter hospital," the Chronicle reports. In addition, Sutter Health and Blue Cross have created a "transition agreement," providing special concessions for pregnant women in their second and third trimesters and patients who have surgery scheduled before Jan. 31. The Chronicle reports that Blue Cross HMO enrollees have been "[m]ost affected" by the contract's end. Blue Cross has shifted 16,000 HMO members to medical groups with contracts at non-Sutter-affiliated hospitals. However, for some members, going to a non-Sutter hospital is not "always an acceptable alternative." For example, Sutter Coast Hospital is the only hospital in Del Norte County. Blue Cross members living in Del Norte County now must either "change plans, change doctors, pay higher out-of-pocket costs or travel 60-70 miles to other hospitals," the Chronicle reports.
Blue Cross also has been unable to reach an agreement with Mount Diablo Medical Center in Concord and the John Muir/Mount Diablo Health System. About 9,200 Blue Cross members are seen by John Muir/Mount Diablo Health System providers (Colliver, San Francisco Chronicle, 1/5).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.