Anthem signs deal with Sutter, PAMF

Dec. 17--SANTA CRUZ -- A big piece of the health insurance puzzle in Santa Cruz County fell into place with Monday's announcement that Anthem Blue Cross and Sutter Health have reached "a multiyear agreement" for Sutter and the Palo Alto Medical Foundation to remain in the Anthem network.

With the new contract in place, Anthem members will receive a notice saying they can keep their Sutter Health doctors, reversing a letter they received in November.

Among those eagerly awaiting the agreement were 295 Santa Cruz County Office of Education employees who get health benefits through Self-Insured Schools of California, a purchasing pool that works on behalf of school districts in 39 counties.

"I told all our employees, 'Don't panic,'" said Robin Beall, who works in the benefits department. "Every two or three years, some carrier is negotiating with doctors and every time they have settled."

Dr. Larry deGhetaldi, president of PAMF Santa Cruz, expressed relief.

"With so much change under way in health care, it is gratifying to be able to solidify the relationship with Anthem and provide assurance to the patients who choose Sutter and PAMF for their care," he said.

Anthem spokesman Darrel Ng declined to discuss the length of the agreement, but the announcement said the agreement continues coverage for individual, small group, large group, Medi-Cal and Medicare. It noted without elaborating, "All Sutter facilities may not participate in all lines of Anthem's business."

Anthem Blue Cross president Mark Morgan, promoted to that post in mid-November, said slowing the growth of health care costs is a priority and the new contract "includes transparency measures that allow Anthem to inform our members of the bundled estimated costs of scheduled procedures at Sutter hospitals."

Noel Bock, who works at Pacific Elementary in Davenport and has been covered by Anthem through SISC, said the letter she got noted Sutter hospitals cost 60 percent more than others in the state and the Sutter medical groups are in the top 20 most expensive in California.

Santa Cruz insurance agent Drew Miller, who got word of the Anthem-Sutter agreement on Saturday, called it "very good news."

He offered hope for those awaiting a Sutter agreement with HealthNet, saying the HealthNet contract with Sutter has an "evergreen" provision, which means the terms will continue in 2014 if they don't come to agreement.

HealthNet spokesman Brad Kieffer said the company is "hopeful of reaching a mutually agreeable contract in advance of Jan. 1."

Asked about a likelihood of an agreement this week, Mark Riley, Sutter/PAMF spokesman, said, "We remain optimistic, but are still in negotiations."

COVERED CALIFORNIA

The state exchange, Covered California, reported Monday 84 percent of the 30,830 people who enrolled in a health plan in October qualified for a subsidy, correcting an earlier report that 84 percent had purchased an unsubsidized plan.

Enrollment can be done through March 31 but for consumers to obtain individual coverage beginning Jan. 1, their applications must be received by Dec. 23.

In the month of October, 2,400 people from the Monterey Coast region, which includes Santa Cruz and Monterey County completed applications and 668 enrolled, getting confirmation from their insurer, according to Covered California.

November figures are expected Tuesday. Meanwhile efforts are being made to boost enrollment locally.

Nine people came to sign up at the Davenport Resource Center following an information session there, according to program director Stephanie Flores Boyd. She was impressed when presenter Alicia Fernandez of the United Way of Santa Cruz County showed how easy it is to look for Covered California choices on her cellphone.

"The actual deadline might seem unclear," Flores Boyd said, noting there could be uncertainty because of the woes of the federal website, which does not affect California because the state has its own website. "I hope people will come in January and February when their personal lives are more mellow."

Covered California representatives gave presentations at three library branches last week, attracting between 15 and 25 at each site.

"Many people came with highly individual questions," said Santa Cruz Public Library division manager Janis O'Driscoll. "It seemed to us that there are so many moving parts in the Affordable Care Act that it really has to be an individual approach."

She plans to schedule more sessions in January, February and March.

Stephen Hoversten, a Scotts Valley insurance agent, has helped about dozen people, half using the Covered California website and half before the portal was working. Initially the website was so slow he blocked out two hours for each client. But he reports it is faster now and perhaps one hour will suffice.

Covered California informed him Friday that applications going in now will get a welcome packet in one to two weeks.

"I'm preaching a little faith," he said, noting clients who applied in October have yet to get welcome packets from their insurer.

"A lot of people around here have different forms of income, not just W2s," Hoversten added. "Premiums will be based on modified adjusted gross income for 2014. We're supposed to help them guesstimate what that will be."

If a single earner makes $1 more than $45,960, there's no subsidy.

If you're within $500 of that number, one option is to put money into an individual retirement account to lower your taxable income, Hoversten pointed out, noting a single person with income below $28,725 qualifies for a larger subsidy.

"It could cause people to think more about potential income, such as 'Should I freelance or start my own business?'" he said.

Pamela Fugitt-Hetrick of DCD Financial and Insurance Services in Santa Cruz spent her birthday Saturday at work helping 10 people sort through their options. Fifteen people came in the Saturday before that, and she expects to work this Saturday afternoon as well.

"The only thing I celebrated, I cleared the backlog," she said, working until 10 p.m. most weekdays to input data on three boxes full of paper applications that were faxed to Covered California when its website was not working for agents at the outset.

She had programmed her fax machine to send in hundreds of applications at 1 a.m. when the lines were not busy but her strategy was for naught. When she checked on her clients' applications online, she discovered they contained only the name, nothing else, and the online application requested different information from the paper application.

She questions the accuracy of Covered California's enrollment numbers, noting she is reported to have more than 200 applications in process but "only 180 are truly applicants," the rest are duplications where she had to restart applications due to computer issues.

"About half my clients are happy as clams about what they will get, and for 50 percent, it's super painful," she said. County residents shopping for health insurance on www.coveredca.com can get access to PAMF doctors at the in-network rate only by choosing Blue Shield. PAMF has chosen not to participate in Covered California's Anthem or HealthNet plans but has not elaborated why.

Granite Bay insurance agent Kevin Knauss, on his blog, reports Sutter hospitals and physicians may not be offered as a provider because of their higher costs. He noted Sutter plans to launch a new HMO health plan of its own on Jan. 1 in the Greater Sacramento area.

Noel Bock of Davenport said a big part of her retirement plan is to obtain insurance through Covered California until she qualifies for Medicare.

If she were to apply this year, because she lives in Davenport, she would not be able to get the Blue Shield plan, which includes the PAMF doctors and is the least expensive because that plan omits Davenport to comply with a state regulation requiring the entire ZIP code to be within a 15-mile radius of a hospital in the network.

"That is all kinds of crazy-making," Bock said.

Follow Sentinel reporter Jondi Gumz at Twitter.com/jondigumz

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