Children’s Hospital Oakland Might Eliminate Contracts With Some Insurers for Behavioral, Psychiatric Services
Children's Hospital Oakland earlier this month notified families of some children that they might have to pay cash or find alternative care beginning June 1 if the hospital does not reach an agreement with insurers over reimbursement rates, the San Francisco Chronicle reports (Colliver, San Francisco Chronicle, 5/14).
The conflict could affect 630 children receiving care for developmental or behavioral conditions, as well as almost 500 children receiving psychiatric care at the hospital. About 60% of children treated by CHO's psychiatry and childhood development departments would be affected (Vesely, Oakland Tribune, 5/15).
CHO's contracts with insurers for psychiatric services expired April 1, and its pediatric development contracts expire June 1 (San Francisco Chronicle, 5/14).
Dr. Leonard Kutnik, who oversees physician contracting at CHO, said the hospital lost more than $1 million in both 2003 and 2004 in those departments (Oakland Tribune, 5/15). CHO officials said insurance reimbursement rates are inadequate to cover the cost of treatment (San Francisco Chronicle, 5/14). For example, an office visit for a child already receiving treatment costs about $280, but most insurers reimburse the hospital $90 and Medi-Cal reimburses $28, CHO officials said.
Kutnik said the hospital plans to eliminate contracts with about 30 health insurers unless agreements on reimbursement rates are reached (Oakland Tribune, 5/15). Kutnik said CHO is negotiating with insurers and hopes to resolve the issue by June 1.
The situation would not affect patients who receive treatment through Hill Physicians Medical Group or have private health insurance coverage through Aetna or Blue Cross Prudent Buyer PPO plans.
Kutnik said Medi-Cal beneficiaries in Alameda County likely will retain coverage.
CHO earlier this month sent a letter to parents urging them "to advocate for [their] child's right to access to developmental and behavioral care" by contacting insurers, state agencies and lawmakers (San Francisco Chronicle, 5/14).
The Tribune reports that Senate President Pro Tempore Don Perata (D-Oakland) and Assembly member Wilma Chan (D-Oakland) are "getting involved in the issue" (Oakland Tribune, 5/15).