If Cottage Health and Anthem Blue Cross do not reach agreement on a contract soon, the Santa Barbara hospital facilities’ non-emergency care will be out-of network for some Anthem customers starting Wednesday.
That applies to Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital, and Santa Ynez Valley Cottage Hospital.
“Cottage Health has contracts for 2020 with all major health plans except Anthem Blue Cross,” spokesman Bob Behbehanian said in a statement Monday.
Anthem said in a statement that Cottage Health terminated the contract earlier this year.
Behbehanian said Cottage has been negotiating since August to reach a contract “that will allow uninterrupted coverage to its HMO/PPO plan members.”
No agreement had been reached as of Monday afternoon, he said.
“If an agreement is not reached by Jan. 1, Cottage Health will be out-of-network for Anthem Blue Cross. We have put plans in place to offset the financial impact this would otherwise create for our patients with Anthem coverage,” he said.
Cottage Health is contacting patients directly who have Anthem coverage and are scheduled for care at their facilities in January, Behbehanian said, and will help them continue care at the in-network benefit level.
Patients who have Anthem insurance can call Cottage Health with questions, at 805.879.8909 from 8 a.m. to 4 p.m. on weekdays, or by emailing firstname.lastname@example.org, he said.
Emergency care, which is available at the three hospitals’ emergency departments, is always covered as an in-network benefit by insurers, according to Anthem and Cottage Health.
According to Anthem, without an agreement, non-emergency care from Cottage Health facilities would not be covered as in-network benefits for individual or employer-based PPO, EPO, HMO and POS health insurance plans.
“Anthem members with Medi-Cal or a Medicare supplemental policy for Part A and Part B (Medigap) are not affected by this contract termination,” Anthem said in a Dec. 18 statement.
People who are already receiving medical treatment may be eligible to continue receiving in-network benefits, including members who are in-patient at one of the Cottage hospitals at 11:59 p.m. Tuesday, the day before the contract ends, Anthem said in a statement.
Anthem members who started a course of treatment at Cottage before Jan. 1 (including pregnancy, a serious chronic condition, a terminal illness, or with a surgery authorized by Anthem before Jan. 1) can request continuity of care by calling the insurer’s customer service department, according to a statement.
The closest hospitals to southern Santa Barbara County are in Ventura and Lompoc.
Anthem Blue Cross left the Santa Barbara County Covered California market for two years, before returning recently to offer EPO plans for 2020.
During that time, Blue Shield was the only insurer offering individual plans through the state exchange, which about 15,000 Santa Barbara County customers used to purchase health insurance for 2019.