Sansum Clinic and Anthem Blue Cross are still negotiating for health insurance contracts, and more than 30,000 people were recently notified that their coverage could be affected if no agreement is reached soon.
Santa Barbara-based Sansum Clinic, which joined Sutter Health last year, operates primary, specialty and urgent care clinics and an outpatient surgery center.
Sutter Health’s agreement with Anthem for commercial EPO and PPO health insurance plans is set to terminate as of Jan. 1, 2025, and the contract for commercial HMO and POS plans expires on March 1, 2025.
If the two sides don’t reach an agreement in time, Sansum Clinic won’t be in-network for patients with those health insurance plans.
No agreement has been reached as of Friday, but they are still negotiating, according to representatives from Sansum Clinic/Sutter Health and Anthem.
“Sutter’s goal is to reach a fair and reasonable agreement that protects patient access to their community-based physicians and care centers,” spokespeople said in a statement this week.
During the week of Dec. 11, the organization sent notices to more than 30,000 Anthem members who came to Sansum within the past two years, telling them about potential impacts, like not having access to their doctors.
Some of those patients may have changed coverage or moved out of the area, but the widespread notification was so people wouldn’t be caught off guard, Sansum Clinic officials said.
“We want you to know that we are committed to reaching an agreement with Anthem under fair and reasonable contract terms that will allow you to continue seeing your Sansum Clinic doctors.
“Unfortunately, Anthem’s current offer does not support our commitment to the community and cannot cover the cost of care for our patients. The terms they have offered include inadequate increases that do not meet the inflationary trends in wages and supplies for services we provide our valued patients like you,” Sansum Clinic wrote in notification emails.
In a statement, Anthem representatives said: “Anthem remains firmly committed to reaching a new agreement that maintains member access to affordable care at Sutter doctors’ offices and facilities, including Sansum Clinic. Our members and customers remain at the core of these negotiations, and we are focused on keeping costs affordable and predictable for the consumers and employers that pay for health care, now and in the future.”
The contract for PPO and EPO members expires on Dec. 31, less than two weeks away.
“While we remain optimistic about establishing a new agreement, if one cannot be reached before our current contracts expire, we will assist our members in transitioning care to one of the many other in-network care providers in the Santa Barbara area,” Anthem said in a statement.
“We are also assuring our members who are currently in treatment at Sansum Clinic for serious and complex conditions that they may be able to continue care with their current provider for a limited time even if a new agreement is not reached.”
Sansum Clinic has more information about health plans and contract negotiations on its website here.
Anthem Blue Cross has more information about the Sutter Health negotiations here.