Sutter-Anthem contract dispute means 20,000 patients must find new doctors

Anthem Blue Cross and Sutter Health are still trying to resolve their Medi-Cal contract disagreement, representatives of the companies told The Sacramento Bee this week, but as of Feb. 1, roughly 20,000 patients around Northern California have had to seek new doctors.

Through a prepared statement, Sutter leaders said: “We have been negotiating in good faith for months and made compromises to reach a timely agreement. However, we will not agree to terms that compromise patient access and option, or that give the insurer authority to second-guess doctor and patient treatment plans.”

Anthem spokesman Eric Lail also gave The Bee a written statement: “We continue to actively negotiate with Sutter Health on a new contract. Any time we enter into negotiations we are working on behalf of our consumers and customers to not only protect affordability, but to modify contractual relationships to respond to recent changes in the marketplace that will allow us to offer flexible networks and innovative, more cost effective benefit designs.”

State regulations require that patients be given prior notice of changes in doctors, and Lail said the company began alerting patients in December and January that they would be shifted to new providers.

Consumer advocate Anthony Wright, executive director of Health Access California, said these sort of contract stalemates can be particularly disruptive for patients, and Sutter has a large network of doctors

“When you have something based on negotiations, there are times when health plans and providers can’t make an agreement, and unfortunately, that can mean a disruption in care for patients,” Wright said.

There are some protections in the law, he said. In addition to laws requiring advance patient notification, patients also have the right to request to continue ongoing treatments with current providers.

“If the patient asks for it, they can stay with their provider for up to 12 months in the middle of a course of treatment,” Wright said. “The most common one is pregnancy. If you’ve been working with a doctor on a treatment or care – if you’re in the middle of chemotherapy, if you’re in the middle of dialysis – then you can stay with them and plan for the handoff for up to a year. It does require some agreement on the provider’s part to stay, to keep getting the old rate, whatever that is.”

Anthem has said Medi-Cal members can call the toll-free line on the back of their cards to discuss their care transition, and they are providing more detailed information at www.anthem.com/sutter.

At that site, the company noted that Anthem also has not reached an agreement with the Sutter health maintenance organization, or HMO. If no contract is reached, thousands of other Anthem Blue Cross customers would have to find new providers as of April 1, and the company has been sending out notifications of that as well.

This story was originally published February 6, 2019 at 3:30 AM.