Enloe Medical Center has issued contract termination notices to Anthem Blue Cross in order to renegotiate its commercial managed care insurance contracts. These contracts set the rates that the insurance company pays Enloe and affiliated physicians for services provided to patients Blue Cross insures. For patients, the contracts determine which providers are in network.
Although Enloe’s preference is to remain contracted with Anthem Blue Cross, without an equitable agreement, termination would be effective Nov. 1, 2018. In the event of contract termination, many patients in active treatment and insured through Anthem Blue Cross may be able to continue through their pre-authorized care plan at Enloe.
“Anthem Blue Cross has not responded to the rate proposal we presented to begin negotiation on behalf of the medical center and physicians,” said Mike Wiltermood, president and CEO of Enloe Medical Center. “Enloe Medical Center is a critical piece of the health care system in Northern California, and we must reach contractual agreements that allow us to continue to serve the needs of our patients.”
Blue Cross pays Enloe rates that are substantially below the commercial rates it pays other North State hospitals and physician networks that deliver comparable service, according to data available from the State of California’s Office of Statewide Health Planning and Development (OSHPD). Yet if Anthem Blue Cross will not agree to a contract with Enloe, patients with Anthem Blue Cross may need to leave the area for in-network care. This means Anthem Blue Cross would be inconveniencing patients while also sending them to a provider it pays higher rates than Enloe.
Enloe Medical Center is a Level ll trauma center and a nationally recognized leader in quality, safety and patient satisfaction. Approximately 17,000 inpatients visits, 300,000 outpatient visits and 70,000 emergency department visits take place at Enloe Medical Center annually. People from a six-county area rely on Enloe Medical Center for their health care.
“Blue Cross is a for-profit company whose net income has increased year-over-year and it continues to raise rates for its customers. Consumers and business owners are paying more for health insurance premiums, co-pays and deductibles. Blue Cross has also benefited from the recent corporate tax restructuring. With all of these additional sources of income, Blue Cross has not invested in our area’s health care infrastructure by paying the medical center and affiliated physicians rates that are comparable with other communities.” said Myron Machula, chief financial officer at Enloe Medical Center. “Many area physicians have not received a contract rate increase in 9 of the last 12 years.”
Patients with insurance and billing-related questions may contact Blue Cross directly by calling the number on their insurance card or by contacting the benefits administrator of their company’s insurance plan. While Enloe Medical Center is unable to make changes to patients’ insurance coverage, its patient financial services representatives are happy to answer questions at (530) 332-6300.■