SANTA CRUZ — Two weeks after Blue Shield announced a agreement stop with Sutter Health inspiring 280,000 Californians, Sutter Health urged Blue Shield to extend a 2014 agreement to forestall “tens of thousands of patients being replaced from their doctors.”
Sutter Health’s proclamation forked out that Blue Shield sole skeleton final tumble with Sutter doctors and hospitals. Now, Sutter Health claims, Blue Shield is collecting rate increases of adult to 23 percent.
“We trust employers and Blue Shield members merit a network they purchased,” pronounced Dr. Stephen Lockhart, Sutter Health arch medical officer.
Steve Shivinsky, Blue Shield clamp boss of corporate communications, responded, “The sum are always some-more formidable than what was settled in Sutter’s press release.”
Shivinsky pronounced he hopes for a agreement “that will concede us to yield a business affordable entrance to Sutter providers underneath satisfactory and reasonable terms,” observant a offer is underneath review.
Santa Cruz word representative Pamela Fugitt-Hetrick likely Blue Shield will not pointer a agreement given of a “unprecedented language” about contracting arbitration.
“Do we wish to be hold warrant by a provider whose categorical regard is that they don’t wish to be sued for antitrust and overcharging?” she asked. “Both sides are equally during fault.”
Aaron Neinstein, an endocrinologist during UC San Francisco Medical Center, compared a brawl to a “game of chicken.”
Said Brett McFadden, business arch during Pajaro Valley Unified School District, that has 2,700 employees, “We feel like we’re a victims.”
A year ago in April, he offering 3 health plans, with 95 percent of employees picking a Blue Shield devise with entrance to doctors during Palo Alto Medical Foundation, dependent with Sutter Health.
“We sole it formed on that access,” he said, advising a dual sides to “stop trashing any other and start talking.”
Both Sutter Health and Blue Shield are absolute entities with practices that have spurred accusations and investigations.
United Food and Commercial Workers’ advantage trust sued Sutter Health final year alleging a hospitals had overcharged millions of workers by bootleg anti-competitive conduct, allegations Sutter deemed inaccurate.
In November, a state Department of Managed Health Care found Blue Shield disregarded state law by dubious consumers about a distance of a provider networks, a anticipating Blue Shield disputed.
In Santa Cruz County, Blue Shield is offering by vast open zone employers: UC Santa Cruz, Cabrillo College, county government, a City of Santa Cruz, Santa Cruz City Schools, San Lorenzo Valley Unified School District and a Pajaro Valley propagandize district.
Employees tend to collect health skeleton with doctors during PAMF, that has been expanding facilities, such as a new three-story bureau on a Santa Cruz Westside.
County administrator Zack Friend and his wife, partner Santa Cruz city manager Tina Shull, are first-time relatives of a baby delivered during Sutter Maternity Surgery Center, that has a studious knowledge measure of 88 percent compared to a state normal of 68 percent.
Friend and Shull have to possibly compensate PAMF’s aloft rates to see a PAMF pediatrician they chose or switch doctors.
The same goes for new county administrator Ryan Coonerty and his wife, Emily, who chose Sutter Maternity for smoothness of their newborn.
Blue Shield warned devise members they would face aloft out-of-pocket costs from Sutter and PAMF. The member’s cost-share commission is a “in network” turn though given a agreement was terminated, Sutter’s charges are higher.
City of Santa Cruz orator Keith Sterling estimated 50 percent to 75 percent of a city’s 339 employees with Blue Shield have a PAMF doctor.
“We are operative with CalPERS to see if they will concede a employees to switch to a opposite devise that accepts PAMF,” he said, observant coverage runs by Mar 31. “If an agreement is not reached, they will be reserved a new provider in a Physicians Medical Group.”
Physicians Medical Group has some-more than 300 providers; PAMF had 175 full-time providers final year.
Local residents will have fewer options as Harbor Medical Group, a Santa Cruz obstetrics use with 4 doctors, will tighten Jan. 30 due to state cuts in reimbursements for saying MediCal patients.
Two doctors are retiring. One will join Dignity Dominican Medical Group, another will invert to El Camino Hospital in Mountain View and 20 employees will be out of work.