Blue Cross to Transfer Sutter Patients Regardless of Contract Negotiations
Blue Cross of California announced yesterday that it would reassign its 16,000 HMO members assigned to Sutter Health physicians regardless of whether the insurer reaches a contract agreement with the provider group by the time the existing contract expires on Dec. 31, the Sacramento Bee reports. If the two organizations reach a contract by the deadline, Blue Cross members may request to "switch back" to Sutter, but the HMO will not "do a wholesale re-enrollment" (Rapaport, Sacramento Bee, 12/21). After three months of negotiations, Blue Cross has been unable to secure a contract with the 25 hospitals that comprise Sutter Health. Blue Cross has already notified physicians to admit Blue Cross patients to an "alternate network" effective Jan. 1 if negotiations have reached no resolution by then (California Healthline, 12/19).
The major sticking point in the negotiations has been reimbursement rates. Sutter spokesperson Bill Gleeson said that the group is seeking a "slight rate increase," but Blue Cross spokesperson Michael Chee said that Sutter's figures "amount to 30% or 35% rate hikes." The loss of Blue Cross patients, who are allowed to transfer from Sutter immediately, could damage Sutter's "bottom line," as Blue Cross accounted for $227 million in gross revenue for the group last year. Blue Cross spokesperson Michael Chee said, "Under the circumstances, we had no choice but to reassign people. These members have contracts with us and we need to ensure continuity of care, which in this case, means making it possible for our members to begin the transition from Sutter now" (Rapaport, Sacramento Bee, 12/21).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.