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Sansum Clinic Reaches Agreement to Treat Patients Covered Under Insurance Exchange

Anthem Blue Cross will add Sansum's providers and 23 medical clinics to its health plans starting Monday

Sansum Clinic announced an agreement Friday with Anthem Blue Cross that will allow patients who buy insurance through the Covered California state insurance exchange to use its 23 medical clinics.

Anthem’s website should show Sansum Clinic and its providers included in the exchange network by December, Sansum CEO Kurt Ransohoff said.

Sansum Clinic discovered it wasn’t a provider for the Covered California state insurance exchange when enrollment started Oct. 1, which means local patients with exchange plans wouldn’t be able to use their insurance with Sansum doctors.

Ransohoff and his staff have been negotiating with Anthem Blue Cross and Blue Shield, the only insurance companies offering exchange plans in Santa Barbara County, to be included by next year.

The agreement was made this week and was finalized Friday afternoon.

Sansum Clinic did agree to a decrease in reimbursement rates, which is what negotiations centered on, but it found a common ground with Anthem, Ransohoff said.

“We’re happy to be able to take care of the patients, our existing and the ones who want to be our patients in the future, and we wanted to be sure that the community had a robust network of providers,” he said. “Everywhere you look, there’s a desire to reimburse less, so we need to adjust and make sure we can meet the community’s needs.” 

There are many independent doctors in the community who are accepting exchange plans as well, he noted, but Sansum represents 23 primary-care and specialty clinics on the South Coast that serve 61,000 patients per month.

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.

“It’s been extremely confusing I know for patients and providers,” Ransohoff said.

Anthem's website should add Sansum Clinic and its providers in early December, and Anthem says patients can start signing up this Monday.

“While we cannot confirm when Covered California will update its website to add Sansum Clinic, people should rest assured that those who purchase the Anthem PPO product will have access to Sansum Clinic,” President/COO Vince Jensen said in a statement. 

Blue Shield will not be listing Sansum Clinic as a provider, at least as of now.

“We’re thrilled to be the only insurer to have Sansum Clinic in our exchange network,” said Ernie Schwefler, Anthem’s regional vice president of provider contracting, in a statement Friday.

Sansum still hopes to get Blue Shield plans, but hasn’t been able to come to agreement yet, Ransohoff said.

The Patient Protection and Affordable Care Act, also known as Obamacare, provides for an expansion of Medi-Cal benefits and a statewide insurance exchange with subsidies available based on income, gender and age.

California residents who want health insurance coverage starting Jan. 1 must sign up by Dec. 23, which was pushed back from the previous Dec. 15 deadline.

Sansum Clinic had a “big week,” and in addition to getting an agreement with Anthem, will become a Tier 1 provider for UC Santa Barbara employee insurance, the UC Care PPO plans, Ransohoff said.

There has been public outcry over the “restructuring” of the health plans and concern since the insurance couldn’t reach agreements with South Coast providers.  

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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