UCSD Health access for 60,000 Anthem Blue Cross members in San Diego hangs in balance [The San Diego Union-Tribune]

Anthem Blue Cross recently delayed plans to notify thousands of its beneficiaries statewide that they will be assigned different doctors in 2024 because it has been unable to come to a new contract agreement with the University of California's five health systems.

Both sides said Friday that they have agreed to extend the contract, set to expire on Dec. 31, through Mar. 1, 2024. The extra two months provides a bit more runway for negotiations that, if unsuccessful, could affect about 600,000 Anthem members with UC doctors — roughly 60,000 living in San Diego County.

The situation comes at the same time that Scripps Health has announced that its two most popular medical groups will no longer participate in Medicare Advantage plans in 2024, an announcement that will have many shopping for different coverage this fall.

The extension also pushes out notification requirements for those in Anthem health maintenance organization (HMO) plans. State law requires carriers to notify beneficiaries at least 60 days before a contract expires, meaning that letters would have had to go out by the end of October notifying thousands of Anthem HMO members that they would be reassigned to primary care doctors outside the UC system after the contract expired on Dec. 31.

About 9,000 of those HMO patients, officials confirmed, are currently assigned to doctors with UC San Diego Health. The remainder are in preferred provider organization (PPO) plans offered by Anthem. Prior notice is not required for PPO plans, a government official said, because these plans do not generally assign enrollees to specific doctors.

Both sides declined to specify exactly what the sticking points have been that have kept Anthem and UC from signing a new contract, though the carrier said in a written statement that contract discussions began more than a year ago, indicating that they "are a standard, normal and routine part of the health care industry and something we take very seriously."

Anthem and UC said Friday that they are optimistic that a new deal will be reached before the end of the year.

Patricia Maysent, chief executive officer of UC San Diego Health, added that failure to find common ground would be most disruptive for those currently undergoing less common treatment which, in some cases, is only offered in the San Diego market by UCSD.

"We don't want our patients to feel like they have to be worried that they're (not) going to have access to their cancer doctors or their transplant doctors because they get transferred away from us," Maysent said.

Typically, when medical providers and health insurance companies fail to pull together a new services agreement, reimbursement for services rendered and the process for authorization of services are the sticking points.

Anthem's statement indicates that discussions "are broad and include both financial and nonfinancial elements," which Maysent agreed is the case. In addition to trying to make sure that inflation-driven cost increases are covered, the executive said providers are also looking for a more streamlined process of care approvals.

A top-three concern in a recent survey of UCSD doctors, Maysent said, is "dealing with insurance companies to get things approved that they know have to happen."

The contract situation, which UCSD recently noted on its website at health.ucsd.edu/anthem, arrives at a time when Medicare Advantage plans, and many commercial health insurance plans that companies offer for their employees, are entering the annual open enrollment period. This is an enrollee's brief annual chance to switch carriers, or from one plan to another offered by their existing carrier, if they wish.

The question on the minds of many who currently want to continue seeing UCSD doctors, then, is whether they should find a non-Anthem plan that has contracts with university doctors or hold fast and trust that the recent two-month extension means that an agreement will be reached.

Thousands of beneficiaries with the California Public Employees' Retirement System faced just such a situation in recent months as their open enrollment period started on Sept. 18 and ended Friday. An official with CalPERS said in an email Friday that information on how many left Anthem plans over uncertainty with UC contracting will not be available until Nov. 6.

Health insurance broker Craig Gussin, who has served the San Diego region for many years, said he is not too concerned. He said he has seen negotiations devolve to the point where warning letters are sent to members many times in the past, only to quickly resolve.

"Give it a few weeks, or maybe until mid-January 2024, and they will come to an agreement. They have every time in the past," Gussin said.

This story originally appeared in San Diego Union-Tribune.

©2023 The San Diego Union-Tribune. Visit sandiegouniontribune.com. Distributed by Tribune Content Agency, LLC.