Although negotiation deadlines were extended an additional three months in the fall, Anthem Blue Cross and the UC Health System are still without a contract, and now patients are starting to face the reality that they may soon need to start looking for new doctors. the doctors.
Anthem confirmed Wednesday that it began sending notices to enrollees in health management organization (HMO) plans this week, providing state-mandated 60-day warnings that they will be assigned to different primary medical providers outside the university system starting March 1.
That means about 9,000 patients in San Diego County, although the number of patients potentially affected is much larger.
According to new calculations Wednesday, 98,000 “unique” patients with Anthem coverage — most covered by preferred provider organization or “PPO” plans — received general or specialty care at a UC San Diego health facility in 2022 and 2023.
Unlike HMO plans, which assign each beneficiary a primary care provider, PPO plans, which the state Department of Managed Health Care confirmed in the fall, do not have to provide 60 days’ notice of changes in the list of “in-network” providers available to policyholders. .
Statewide, about 600,000 Californians were affected according to a table provided by the University of California in October when details of the stalled contract talks first emerged.
UCSD Health said this week it has begun reaching out to some patients with scheduled appointments who are on PPO plans and will not receive a reassignment notice from Anthem.
Among them is Karen Allen of Temecula, who said she had been receiving cancer care at UC San Diego since her diagnosis, and learned the disease had spread to her liver in 2022.
She said she was surprised to receive notification from UC San Diego on Tuesday that there may soon come a time when she must find another cancer team to work with or pay more to continue seeing her current group of out-of-network cancer specialists. Even more troubling, she added, was the fact that her insurance broker assured her in December that switching to an Anthem PPO plan would save money while also maintaining access to the UC San Diego cancer team that helped her through grueling chemotherapy and surgery sessions. .
“We went through and listed all my doctors, and I made sure they were all included,” Allen said. “Ethically, I think they should have told me that was a possibility, and if they did, I would never have converted.”
She expected that switching to different doctors would be painful for many, especially those currently undergoing treatment.
“You become so dependent on them, they are like your family, because they are with you when you are going through your worst moments, and they help you get through it,” she said. “Having to go and explain the whole thing and try to have a relationship with someone else is devastating.”
The possibility of switching providers is particularly difficult for those who are older and on risky medical journeys, said Dr. Sonia Ramamurthy, chief of colorectal surgery at UC San Diego Health.
“There is a fear that we are imposing this on people who already have a lot going on in their lives,” Ramamurthy said. “We are adding to this pain, frustration and uncertainty.”
There are strong fingers pointing in both directions as to why the two giant organizations were unable to broker a new contract in time to avoid such a shock.
Anthem said in a statement Wednesday afternoon that it remains “optimistic that an agreement can be reached,” and negotiations “are about our responsibility to simplify the system and keep costs affordable and predictable for consumers and employers who pay for health care.”
“We have offered reasonable payment increases that protect affordability and are consistent with increases accepted by other health systems in California,” the company said. “We asked UC Health to work with us to streamline administrative and payment processes, lower costs for all participants, accelerate and simplify the delivery of patient care, and give health care providers more time to spend with patients.”
“Unfortunately, UC Health has refused to accept reasonable increases in payment rates or modernize administrative systems that would eliminate cumbersome paperwork and administrative processes.”
In its email statement, UC San Diego Health notes that the deal was close to being completed only to suddenly collapse.
“We have been negotiating in good faith and making concessions to enable a new contract,” the UCLA statement said. “We believe we have reached a fair agreement.
“However, Anthem backed away from that agreement and added last-minute provisions that would have negatively impacted our patients’ ability to access care in our networks. UC would never sign an agreement that put these values at risk. Even at this late date, we remain committed By negotiating a fair deal on behalf of our patients and the providers who care for them every day.
The impact if the contract is not reached is very wide.
Of the 98,000 “unique patients” who received care at University Health System facilities in 2022 and 2023, about 60,000 were seen in primary care clinics with more than 6,400 in orthopedics, 6,200 in neurology, 5,000 in oncology, and 4,100 in cardiology, And 3,700 in surgery. and 2000 in behavioral health.
Those undergoing treatment for complex conditions or chronic illnesses, and those with appointments scheduled after March 1, can apply for a “continuity of care exception.” More information is available online at health.ucsd.edu/anthem or by calling (800) 926-8273 for assistance. Callers should dial 8 or say “Anthem” to be transferred to a specialist.