Saturday, August 29 , 2015, 10:20 am | Fair 82.0º




Sansum Clinic Still Negotiating to Be Included in State Insurance Exchange

Officials say they're 'making progress' in ensuring primary and specialty care services are available under Covered California's plans

Sansum Clinic’s primary and specialty care clinics, including this one near Santa Barbara Cottage Hospital at 317 W. Pueblo St., cannot accept insurance plans from the Covered California exchange. Sansum administrators are negotiating reimbursement rates in an effort to be included by next year.

Sansum Clinic’s primary and specialty care clinics, including this one near Santa Barbara Cottage Hospital at 317 W. Pueblo St., cannot accept insurance plans from the Covered California exchange. Sansum administrators are negotiating reimbursement rates in an effort to be included by next year.  (Giana Magnoli / Noozhawk photo)

By Giana Magnoli, Noozhawk Staff Writer | @magnoli |

Sansum Clinic still isn't included in the Covered California state insurance exchange, although officials have been negotiating with Anthem Blue Cross and Blue Shield to get in by next year.

They are “making progress,” marketing director Jill Fonte said Thursday.

Sansum Clinic’s primary and specialty care services handle 61,000 patient visits every month on the South Coast, and neither type of provider is included in the exchange’s insurance plans.

CEO Kurt Ransohoff said Sansum didn’t become aware of it until open enrollment started Oct. 1, but that it had always planned to be in the exchange.

Since those services aren’t included now, that means people who buy plans through the state exchange won’t be able to use their insurance to see doctors at Sansum Clinic next year.

Anthem and Blue Shield are the only two insurance companies with plans on the state exchange for Santa Barbara County, and Sansum is negotiating reimbursement rates — how much the insurance companies would pay Sansum providers for patient visits and services.

Statewide, insurance companies haven’t confirmed their provider networks — which doctors are available for which insurance plans — and patients and providers are still grappling with the issue.

In a recent seminar hosted by CenCal Health, the county’s Medi-Cal administrator, providers said they weren’t sure about their own contracts with insurance companies and whether they will be accepting patients with Covered California insurance plans.

Cottage Health System, which operates three acute care hospitals in Goleta, Santa Barbara and Santa Ynez, has said it negotiated to keep its current reimbursement contracts for next year with the insurance companies. 

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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