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.
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.