Napa Valley Health Insurance Guys: No health care scare

Dear Tom, Kyle and Alan:

My wife and I are both on the Anthem Blue Cross Medicare Supplement plan through CalPERS. It has worked very well for us over the years and we've been able to go to specialists and hospitals pretty much whenever and wherever we needed.

We just received a rather startling letter from Anthem with a big headline: "Adventist Healthcare is leaving your plan's network." It goes on to say:

"Beginning July 18, 2022, Adventist Healthcare doctors and hospitals will no longer be in your plan's network. This means you may pay more out of your pocket if you receive care from them."

Our plan is very comprehensive, but we pay quite a bit for it. They sent a list and St. Helena Hospital and doctors are now out of network. Are we going to have to pay more "out of pocket" if we go to them?

Worried

Tom: No, dear reader, you should not have to pay any more than you currently pay for care from the Adventist network. By the way, for a good part of the 1990s St. Helena Hospital was not contracted with Blue Shield of California.

So, anyway, when you have a Medicare supplement plan, you only need to go to a provider that accepts Medicare.

Kyle: We double-checked with our regional representative from Anthem and confirmed that you are still good to go with your Anthem coverage. You probably received the letter sent to all CalPERS beneficiaries because some of them are on a Medicare Advantage plan through Anthem. In Napa County, the Advantage plan is Anthem MediBlue Access (PPO).

Al: I got a call from a long time customer who was told by her doctor's office that she should switch to the United Healthcare Advantage plan because the doctor was no longer contracted with Anthem.

She would have to leave her MediBlue plan and enroll in the "AARP Medicare Advantage SecureHorizons (HMO)" through United Healthcare.

Kyle: Of course that brings up the question if she would have to wait until the Annual Enrollment Period (AEP) beginning Oct. 15 and ending Dec. 7 for a Jan. 1, 2023 effective date.

There are Special Enrollment Periods (SEP) when a change occurs so that the subscriber does not have to wait for the AEP to change plans. I'm pretty sure she would qualify since her Primary Care Physician (PCP) no longer accepts her plan.

In Napa County we have a shortage of doctors who are accepting new patients; it's worse for Medicare Advantage patients looking for a PCP. The main players in our area are Kaiser Senior Advantage, SCAN, MediBlue and SecureHorizons.

Al: Our reader's original letter from Anthem listed the different California counties that have Adventist Health facilities. Sonoma was on the list but not Solano. Lake, Menocino, Kern, Fresno, Tulare, Ventura, Kings, San Joaquin, and L.A. are now out of contract with Anthem. You can bet negotiations are ongoing and may even be settled by the time this column comes out.