A contract spat between Anthem Blue Cross and Dignity Heath has left thousands of members scrambling to find new providers.
The contract between the two firms expired July 15 after negotiations failed.
That means that as of July 16, Dignity facilities no longer coordinate with Anthem health plans for members enrolled in Commercial PPO, EPO, HMO and POS benefit plans as well as some Medicaid and Medicare Advantage plans, Anthem said.
Those affected include University of California PPO Plans members enrolled in CORE, UC Care and UC Health Savings Plan, according to the University of California PPO Plans website in a warning to members about the dispute.
“Occasionally, negotiations to find mutually-beneficial terms can be challenging. This is the case with Dignity Health,” the UC PPO Plans website added.
Dignity Health hospitals include Marian Regional Medical Center in Santa Maria, French Hospital Medical Center in San Luis Obispo and Arroyo Grande Community Hospital. Also included are St. John’s Regional Medical Center and St. John’s Pleasant Valley Hospital in Ventura County.
Anthem has identified a number of alternate hospitals that clients should use, including Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and Lompoc Valley Medical Center in Santa Barbara County.
The dispute means that Dignity hospitals, medical groups and clinics will not be deemed in-network for those seeking care.
Anthem Blue Cross claimed that Dignity Health “has become one of the more expensive health systems in California.”
“Anthem’s intent is to reach agreement on reasonable contractual language and reimbursement rates that will help protect affordability for consumers,” Anthem said in a statement. “We cannot, and will not, agree to excessive rate increases that will make care at Dignity even less affordable for those we serve.”
Anthem contended that Dignity’s rate is nearly 30% more expensive than other health systems in the state.
“If we were to give in to Dignity’s demands for excessive rate increases, it would result in higher out-of-pocket and premium costs for our members,” it said. “That’s something we just can’t do.”
Dignity Health offered its own take on the issue, saying patients deserve access to high-quality health care.
“Because of Anthem’s unwillingness to negotiate a new, responsible contract, more than 1 million patients lost in-network access to care at most of Dignity Health’s California facilities on July 16, 2021,” the firm said. “Dignity Health is committed to reaching a new agreement as quickly as possible to protect patients’ access and choice. We are doing everything we can to restore our in-network status, including offering Anthem a proposal with rates that do not even cover hospital inflation costs and are below increases included in our prior agreements.”
Anthem reminded members that emergency medical services are always considered a covered benefit and therefore do not require pre-authorization, regardless of where they are delivered.
Transition assistance to ensure in-network continuity of care remains available for Anthem members who are pregnant, undergoing treatment or who have obtained a prior authorization for services.
For more information, those covered by Anthem can call the member services number on their Anthem insurance ID card to find out whether they are eligible for continuity of care, the company said.
— Noozhawk North County editor Janene Scully can be reached at jscully@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.