Sunday, February 14 , 2016, 8:00 am | Fair and Breezy 74º

Sansum Clinic Not Included In State Exchange Insurance Coverage

Major local provider of primary and speciality medical care says it is negotiating over rates

Sansum Clinic, one of Santa Barbara County’s major providers of primary and specialty medical care, is not currently included in the Covered California insurance exchange plans, but officials say they are in negotiations.
Sansum Clinic, one of Santa Barbara County’s major providers of primary and specialty medical care, is not currently included in the Covered California insurance exchange plans, but officials say they are in negotiations.  (Tom Bolton / Noozhawk photo)

By Giana Magnoli, Noozhawk Staff Writer | @magnoli |

Sansum Clinic — one of Santa Barbara County's major providers of primary and specialty medical care — is not signed up to be a provider for any of the Covered California exchange medical plans, even though officials there say they fully intend to be included. 

“We were unaware if we were in or out until I think the last month or so,” CEO Dr. Kurt Ransohoff said Friday. “That was news to us. We had operated under the assumption we would be in the network.”

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

That means, if nothing changes, people who buy plans through the state exchange won’t be able to use their insurance to see doctors at Sansum Clinic next year.

“Trust me, we’re every bit as frustrated as anybody with the uncertainty and the possibility of a disruption of service,” Ransohoff said.

Sansum is negotiating with Anthem Blue Cross and Blue Shield – the only two insurance companies with plans on the state exchange for Santa Barbara County – to agree on the terms of participation.

The issue is over reimbursement rates – how much the insurance companies will pay Sansum providers.

“We’re aware that there’s a need to lower health-care costs, so we have offered to take a significant discount to participate,” Ransohoff said. “Our definition of a significant discount and their definition of a significant discount are different.

"We’re a nonprofit community organization with a very narrow margin; They’re a very large multi-billion-dollar insurance company.”

He hopes to have an agreement in place by January, but says the current offerings are unacceptable.

“We would be unable to offer the services that we offer to the community at the rates that they’re suggesting,” he said.

“Our board has authorized us to try and work it out, to be willing to cut into our very thin margin to be able to serve the needs of the community. If we cut all the way through our margin and go into an unsustainable financial situation, that’s not going to help anybody.”

The exchange goes into effect in January, and group plans aren't expected to change; The coverage issue is with people who will buy on the exchange or have individual policies now. 

The exchange opened for pre-enrollment this week, along with the government shutdown as a result of a budget stalemate after Republican legislators in the House of Representatives tried to defund the Patient Protection and Affordable Care Act, which Democrats in the Senate and the White House said they would not accept.

People can start browsing plans and benefits on the website.

There is a lot of uncertainty about what providers will be included in the exchange plan networks, which are expected to be “very narrow,” Ransohoff said.

“What we don’t know is, will the people with individual policies now continue to have access to the broader network, or will they only have access to this narrow network? We don’t have the answer to that.”

It’s still early, and there may be more clarity even a few weeks down the road, Ransohoff said.

“It might be good to shop and look around now, but if I were encouraging someone, I would tell them to wait to purchase until they have a better idea of what they’re purchasing.”

Sansum Clinic started in the 1920s, and has been taking care of patients through every kind of insurance change.

“Whatever kind of insurance the community wants to get, we figured out a way to provide it. That’s our intention, but this is new terrain,” he 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.

» on 10.04.13 @ 09:43 PM

This is a disaster. Good luck to the people on the exchange trying to find a doctor.

» on 10.05.13 @ 06:06 AM

I’d like someone to explain the difference between a corporate monopoly on medical services and a government run plan.  The costs of coverage under Obamacare seem to be about the same as under Medicare, both Sansum and Cottage provide services for Medicare (have they merged yet?. 

Is it the insurance company? Is it the pharmaceuticals? Is it the bean counters?  Is it the doctors, I don’t think so…my primary at Sansum called me on a Sunday afternoon…has your concierge doctor done that?  In the meantime we, the 99%‘ers are left in the lurch.  Canada anyone?

» on 10.05.13 @ 07:47 AM

Come on!

After two years of non-stop conversation about national health
reform plans, Sansum’s director didn’t know until recently if
they were going to participate, or when the new system kicks in?

Unless this gentleman has been on extended leave training to be among NASA’s first astronauts to Mars, it sounds like maybe
he is speaking with a forked tongue.

Obviously, they are privately arguing about money.

That’s what it always comes down to in the hyper-inflated
world of health care, isn’t it?

Why not just man-up and admit it?

» on 10.05.13 @ 09:06 AM

of course they are arguing about money.  And Anthem just raised my group plan rate by 15%.  There are no saints in this discussion. Sansum is EXTREMELY profitable, although as a nonprofit it doesn’t call it ‘profit’ - it’s ‘addition to reserves’ or some such BS.

» on 10.05.13 @ 10:01 AM

My comment doesn’t pertain to this article directly, but more of a suggestions for an article that no one seems to be talking about. If you are a family of four in Santa Barbara and have an adjusted gross income of over $94,000, you are going to get screwed by this so called Affordable Healthcare Act. My family is in that category and I would call us very middle class. I received a letter from my insurance carrier last week notifying me that my new rate come January 1st would be a 100% increase from my existing rate and that my deductible would go from $3,500 to $5,000 and maximum out of pocket would go from $7,000 to $12,000. I knew my rates would go up some and I was ok with that in the spirit of healthcare for those more needy, but little did I know that I would have to pay more for less. I voted for Obama and Capps and have sent them emails about this as well and crazy me, I actually believed Obama was not going to screw the middle class on this. So please Noozhawk, do a story about the people that will be paying for this. The health professionals and the middle and upper class taxpayers are taking it in the shorts, while the Insurance companies are making out like bandits.

» on 10.05.13 @ 02:44 PM

Talk about being disingenuous - a middle class Obama / Capps voter claiming to not have anticipated that he would pay more for lower quality care under Obamacare?  Then again - an Obama / Capps voter.  Welcome to the real world.

Socializing medicine inevitably exercises the premise of any socialist policy - each gives according to his means, and takes according to his needs.  Unless you believe that somehow medical professionals can be coerced into working more for less pay, the net effect must be that the result of forcing tens of millions of uninsured into the health system would be lower quality and higher cost for those previously in the system.  Of course Sansum is going to resist lower reimbursement for the same services.

As with most of the country’s social programs, the US congress has exempted itself from provisions of Obamacare - even for congressional staffers, much less the elected officials themselves.

And I don’t think we’ve even begun to see the full impact of this - now that illegal aliens can get drivers licenses and serve on juries in California, can entitlement to Obamacare be far behind?  As a health premium paying, productive, responsible American citizen I’ll get to compete with hordes of illegal immigrants when I try to see my primary care physician, instead of merely when I try to use urgent care.

» on 10.05.13 @ 04:29 PM

So this is like selling someone a membership to gym & afterwards telling them that “we don’t have a gym in your area.”  What good is having the insurance if big clinics like Sansum are going to opt out.  Why are people who are self-insuring i.e. buying their own insurance considered unimportant when compared to Medicare patients and people w/ employer coverage.  I have been self-employed my whole life & finally could catch a break only to find that Sansum won’t admit me.  What’s next, Pueblo Radiology won’t either?  Basically, the Silver Plan or above in Santa Barbara is just catastrophic insurance w/ the Cottage Hospital as the only place where the coverage is honored.  At least Cottage (which is merging w/ Sansum) has agreed to accept AHA insurance.

» on 10.06.13 @ 07:15 AM

Congress and unions are exempt from this Demorat mess, vote the welfare food stamp hand out party out.

» on 10.07.13 @ 10:17 AM

The ACA was sold on the idea it was “healthcare for every one”. It was at best coverage for those who didn’t have whether they wanted to or not. It was never about health care, since it never addresses the actual supply of care. Only now is our sleepy, dullard population waking up to the second biggest hoax since the great financial ponzi scheme.

Yes people, the government you voted to “protect” you not only allowed the financial markets to engineer the grand gambling casino, but actually participated in it and if that wasn’t enough they, the government you voted for, want to take over your healthcare system first by doling out insurance it can’t afford and then when all is chaos telling you its taking over.

When will people ever learn that the best form of democracy is one where government’s power is limited? Answer: when it’s gone and they are slaves to the tyranny.

» on 10.07.13 @ 11:57 AM

Well, folks, this just shows how much this country needs Universal Single-Payer Healthcare for ALL.  It figures thar the private insurers will now try to gouge our health care providers of our healthcare for a bigger piece of the pie. 

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