Saturday, October 3 , 2015, 8:35 pm | Fair with Haze 68º

Sansum Clinic Won’t Accept Blue Shield Patients Under Covered California

By Giana Magnoli, Noozhawk Staff Writer | @magnoli |

A week after the national health-care reform law went into place, Sansum Clinic confirmed it will not be accepting Blue Shield insurance patients at its 23 clinics.

“It’s very important for patients to know that if they want to come to Sansum Clinic through the exchange, they need an Anthem Blue Cross plan,” marketing director Jill Fonte said.

The primary- and specialty-care clinics, including urgent-care facilities, are scattered along the South Coast from Carpinteria to Goleta and in Solvang and Lompoc.

Sansum Clinic providers are in-network providers for Anthem Blue Cross individual plans sold on the Covered California insurance exchange or off-exchange for people who live in San Luis Obispo, Santa Barbara and Ventura counties.

Providers are out-of-network for all Blue Shield individual plans, both through the exchange and off-exchange (plans sold directly through brokers and insurance companies).

Sansum Clinic learned it was not included in any state exchange plans in September, just before the open enrollment period started. In late November, Sansum reached an agreement with Anthem Blue Cross to accept those exchange patients, but negotiations never went anywhere with Blue Shield.

There are no changes to employer-sponsored health plans, and small group plans are unaffected for now, Sansum CEO Dr. Kurt Ransohoff said.

“At some point in the future they will be (affected), but in light of the fluidity of the ‘rules’ (note the many changes over the final weeks of November and December) I would not want to guess when and how groups will move into the exchanges,” he said.

Anyone with individual plans through Blue Shield will have much higher health-care costs if they go to Sansum Clinic doctors and specialists since they are out-of-network providers. 

As of last year, the hundreds of providers handled 61,000 patient visits every month.

Sansum has also reached an agreement with the University of California system for certain employee health plans. Read more about that here.

Before Obamacare, about one in 8 patients with commercial insurance had individual plans, and those numbers will likely increase, Ransohoff said.

The two sides could not come to agreeable terms during negotiations so the clinic system won’t be accepting individual plans through Blue Shield, bought on or off the exchange.

“We are certainly open to contracting with Insurance companies who insure patients who want to come to Sansum Clinic. We have dozens of contracts with many companies. We are always willing to revisit things with Blue Shield who has been a long time partner with Sansum,” Ransohoff said.

Noozhawk staff writer Giana Magnoli can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

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