It’s open enrollment season for health insurance plans, which means checking for price increases and network changes.
Sansum Clinic, which merged with Sutter Health last year, will not be in-network for Blue Shield Medicare Advantage HMO members going forward, the organization said earlier this month.
It’s also still negotiating with Anthem Blue Cross for in-network coverage on plans for next year, and if no agreement is reached, some of those contracts would end in January.
Blue Shield Plans
Blue Shield and Sutter Health did reach a renewal agreement to serve commercial HMO, EPO and PPO plans in 2025, according to a statement from the health care organization.
However, “we are disappointed that Blue Shield opted to no longer include Sansum Clinic in-network for members with the Blue Shield Medicare Advantage HMO, effective Jan. 1, 2025,” representatives said.
“Members with that plan have four other options and they will need to select a different plan during Medicare’s Annual Enrollment period, which ends on Dec. 7, in order to continue seeing their Sansum Clinic doctors.”
Sansum Clinic, which operates primary care, specialty and urgent care clinics on the South Coast, has a health insurance information website here.
Ongoing Negotiations with Anthem Blue Cross
Sansum Clinic is still negotiating with Anthem Blue Cross over insurance contracts for next year, representatives said in a statement.
“It is our hope that Anthem will agree to fair and reasonable contract terms that prioritize patients and preserve access to their community-based physicians and care centers,” they said in a statement.
However, there’s no agreement as of Monday.
“The current agreement with Anthem is set to terminate on Jan. 1, 2025 for commercial EPO and PPO products, and on March 1, 2025 for commercial HMO and POS products,” Sansum Clinic officials said on its health insurance website.
“If the parties do not reach a timely agreement, Anthem may begin sending letters to their commercial HMO and POS members notifying them that they will be reassigned to non-Sansum Clinic doctors effective March 1, 2025.
“Additionally, the Sansum Clinic agreement with Anthem for commercial EPO and PPO products is set to terminate on Jan. 1, 2025. If we have not yet reached an agreement with Anthem by Dec. 31, 2024, Sansum Clinic will no longer be in-network for Anthem’s commercial EPO and PPO members. We anticipate Anthem will send notices to their EPO and PPO members notifying them of network changes next month. While EPO members will no longer have access to their Sansum Clinic doctors, PPO members can continue to see their Sansum Clinic doctor at their out-of-network cost share, which may be significantly higher than an in-network cost share.”
Sansum Joined Sutter Health Last Year
In the year since Sansum Clinic partnered with Sutter Health, the organization has hired staff, added outpatient operating rooms at the Foothill Surgery Center, and made other investments to expand services, says Dr. Kurt Ransohoff, former Sansum CEO who is now president of Sutter Health Greater Central Coast Division.
“Sutter committed over $30 million to expand ambulatory care in the community to improve access and affordability for patients” in that first year, according to Sansum Clinic.
“Our investments demonstrate our commitment to making sure more patients in the region — including those with Anthem insurance coverage — can better access care when and where they need it.”