23/05/2024

Care Health

Prioritize Healthy life

Anthem Blue Cross vs. UCSF Health

Anthem Blue Cross vs. UCSF Health

An epic health insurance versus medical provider battle could affect untold number of UCSF medical patients in about a month as the two behemoths part ways. 

In January, as required by law, Anthem Blue Cross notified some of its HMO members who have UC Health primary care physicians, that they will be reassigned to a new physician, effective March 1, 2024.

This is the worst kind of medical insurance versus medical provider standoff. 

“It’s very important because, you know, if you don’t believe in the doctor, there’s really no use to go,” said UCSF Parnassus patient Sammy Brown. 

UC Health sees it quite another way, saying: “Anthem Blue Cross has terminated its agreement with UC Health, effective February 29, 2024, jeopardizing in-network access to care for millions of Californians.” UC Health went on to say there is a ray of hope: “UCSF Health is working toward a new agreement with Anthem Blue Cross that covers the exceptional care we provide to Californians covered by Anthem Blue Cross.”

This isn’t the first time Anthem or many other health insurers have been mixed up in contract disputes like this. The problem is the patients are the ones who are always affected the most. 

UCSF Benioff Childrens Hospital Oakland via google maps.

“Oh, I think they would be in total shock. I think it’s hard enough to have medical care and even with the costs and stuff and to let you know in 30 days you won’t have any,” said Brown.

Patients affected by this include those covered by CalPERS, employer Medicare Advantage, and Medicare patients managed through Medical and UCSF Residents and Fellows. 

Anthem send out a statement saying: “Our commitment stands firm to establish an agreement before March 1st, and we remain optimistic about shared dedication to this objective.”

But, Anthem seems prepared to end the deal. “In an event where an agreement is unfortunately not reached, we can assure our members that we have a substantial network of partners throughout the state prepared to provide care for members currently under UC Health.” 

Tom Carman of Carman and Fairbanks Insurance Services is pretty sure of what’s going on. “Most of the time, we tend to see these things get resolved. From where we sit, we’ve seen it happens pretty much every year with various hospital systems. There’s always going to be a contract dispute whether it’s gonna be Anthem or Blue Shied or United Healthcare. It happens constantly,” said Carman.

There’s also a so-called “continuity clause” that allows some patients getting long-term treatment to stay with the doctor and hospital until that treatment is concluded.