Frommer Charges Blue Shield with Violating Continuity-of-Care Law in Coverage of Dropped CalPERS Members
Assembly member Dario Frommer (D-Los Angeles) last week "accus[ed]" Blue Shield of California of illegally denying some CalPERS members with chronic illnesses the right to continued care at Sutter Health next year, the Sacramento Bee reports (Rapaport, Sacramento Bee, 12/18).
Officials for CalPERS, the one of the nation's largest purchasers of health care, voted in May to drop some hospitals from its provider networks to control premium rate increases, which have increased 57% since 2002.
Blue Shield indicated that some of the hospitals being dropped had proposed rates for 2005 that exceeded the statewide average by as much as 80%. The move is expected to save CalPERS $36 million in 2005 and $50 million annually after that. Under the plan, 13 Sutter hospitals were eliminated from the Blue Shield network. About 14,500 of the approximately 33,500 Sacramento-area CalPERS members affected by the policy change chose to retain their coverage through Blue Shield (California Healthline, 12/16).
Frommer said a law he wrote requires Blue Shield to continue offering some CalPERS members limited types of care. For instance, about 1,700 CalPERS members with Blue Shield insurance qualify for continued care at Sutter facilities for their children after Jan. 1, 2005.
Frommer in Dec. 17 letters to Blue Shield and state officials, stated, "The Legislature intended to ensure that this vulnerable population of newborns and infant had access to all care and services."
"We passed the continuity-of-care law to protect patients and children. I am outraged that Blue Shield is already violating the law by denying care to newborns and infants whose parents wish to stay with pediatricians they know and trust," Frommer said.
According to Frommer's letters, Blue Shield violated both the "letter and intent" of state law by informing members through letters that their children were covered at Sutter only for "regularly scheduled well-baby/well-child checkups."
Frommer said he became aware of the issue after Geoff Palmertree, an employee at the state Treasury, said he received a Dec. 2 letter from Blue Shield that stated his 15-month-old child could only see his Sutter pediatrician for "well care." Palmertree said that when he sought further explanation from Blue Shield, he was told his son would be covered "only for checkups but not an ear infection or broken arm or anything else that might go wrong."
William Barcelona, deputy director of the Department of Managed Health Care, said regulators have told Blue Shield to send parents new letters that clarify they should receive coverage for "all the normal care you would expect to see a pediatrician for." Barcelona added that any CalPERS member who asks for extended coverage for a child under age three should receive such insurance through next year or until the child turns three.
Blue Shield spokesperson Tom Epstein said that any confusion over continuance of coverage is because of "inartful wording" in the letters and not "any attempt to limit continuity-of-care provisions under the law."
CalPERS spokesperson Clark McKinley said he is "confident Blue Shield will carry out continuity-of-care provisions required by state law" (Sacramento Bee, 12/18).