Though negotiating deadlines were extended for an additional three months in the fall, Anthem Blue Cross and the University of California health system still do not have a contract, and now patients are starting to face the reality that they may soon need to begin looking for new doctors.
Anthem confirmed Wednesday that it began sending notices to enrollees in its health management organization (HMO) plans this week, providing state-mandated 60-day warnings that they will be assigned to different primary medical providers outside the university system starting March 1.
That’s about 9,000 patients in San Diego County, though the number of potentially affected patients is much larger.
According to a fresh accounting Wednesday, 98,000 “unique” patients with Anthem coverage — most covered by preferred provider organization or “PPO” plans — received general or specialty care at a UCSD Health facility in 2022 and 2023.
Unlike HMO plans, which assign each beneficiary a primary care provider, PPO plans, the state Department of Managed Health Care confirmed in the fall, do not have to provide 60-day notice of changes to the list of “in network” providers available to policyholders.
Statewide, about 600,000 Californians are affected according to a tabulation provided by UC in October when details on stalled contract talks first surfaced.
UCSD Health said this week that it has begun reaching out to some patients with scheduled appointments who are on PPO plans and would not have received a notice of reassignment from Anthem.
Among them is Karen Allen of Temecula who said she has been receiving cancer care at UCSD since she was diagnosed, and learned the illness had spread to her liver, in 2022.
She was surprised, she said, to receive notification from UC San Diego Tuesday that there could soon come a time when she would have to find another cancer team to work with or pay more to continue seeing her current set of cancer specialists out-of-network. More galling still, she added, is the fact that her insurance broker assured her in December that switching to an Anthem PPO plan would save money while also maintaining access to the UCSD cancer team that had helped her through grueling chemotherapy sessions and surgery.
“We went through and we listed all of my doctors, and I was assured that they were all covered,” Allen said. “Ethically, I think they should have told me that this was a possibility, and if they had, I never would have switched.”
She predicted that changing to different doctors will be painful for many, especially those currently in treatment.
“You become so reliant on them, they are like your family, because they’re with you when you have your worst moments, and they help you through them,” she said. “To have to go and explain the whole thing and try to get a rapport with someone else, it’s just devastating.”
Dr. Sonia Ramamoorthy, chief of colon and rectal surgery at UC San Diego Health, said that the possibility of a shift in providers is particularly difficult for those who are older and traveling precarious medical journeys.
“There is a fear that we’re putting this on people that already have a lot going on in their life,” Ramamoorthy said. “We’re adding to that anguish and frustration and uncertainty.”
There is solid finger pointing in both directions as to why the two giant organizations could not broker a new contract in time to avoid such trauma.
Anthem said in a statement Wednesday afternoon that it remains “optimistic that a deal can be reached,” negotiations are “about our responsibility to simplify the system and to keep costs affordable and predictable for the consumers and employers that pay for health care.”
“We have offered reasonable payment increases that protect affordability and are in line with increases accepted by other health systems in California,” the company said. “We have asked UC Health to work with us to simplify administrative and payment processes, lowering costs for all involved, speeding and simplifying the delivery of patient care, and giving healthcare providers more time to spend with patients.”
“Unfortunately, UC Health has refused to accept reasonable payment rate increases or to modernize administrative systems that would eliminate paperwork and burdensome administrative process.”
In its own emailed statement, UC San Diego Health indicates that a deal was nearly complete only to unravel suddenly.
“We have been negotiating in good faith and making concessions to enable a new contract,” the UC statement said. “We believe we had reached a fair agreement.
“However, Anthem backed out on that agreement and added last-minute provisions that would have negatively impacted our patients’ ability to access care in our networks. UC would never sign an agreement that put those values at risk. Even at this late date, we remain committed to negotiating a fair deal on behalf of our patients and our providers who care for them every day.”
The impact if a contract does not come together is quite broad.
Of the 98,000 “unique patients” who received care at university health system facilities in 2022 and 2023, about 60,000 were seen in primary care clinics with more than 6,400 in orthopedics, 6,200 in neurology, 5,000 in oncology, 4,100 in cardiology, 3,700 in surgery, and 2,000 in behavioral health.
Those undergoing treatment for complex conditions or chronic diseases, and those with appointments scheduled beyond March 1 can apply for a “continuity of care exception. More information is available online at health.ucsd.edu/anthem or by calling (800) 926-8273 for assistance. Callers should dial 8 or say “Anthem” to be transferred to a specialist.
