Gas station without pumps

2015 January 7

Bait and switch health insurance

Filed under: Uncategorized — gasstationwithoutpumps @ 21:49
Tags: , , , , ,

I just started a new health insurance plan at UCSC this month, one that costs me $549.67 a month in premiums, that I selected specifically because it would let me continue with the family doctor we’ve had for years. Note that this plan is essentially the same as the one that was free 10 years ago—they keep raising the prices to the faculty without improving the product.

Today, I was very surprised and distressed to get the following message:

January 7, 2015

To:  UCSC Academic and Staff Employees
From:  Lori Castro, Interim Assistant Vice Chancellor, Staff Human Resources; Pamela Peterson, Assistant Vice Chancellor, Academic Personnel
Re:  Blue Shield of California and Sutter Health Provider Negotiations – Contract Termination and Transition Period

As you may have heard, Blue Shield of California and Sutter Health were unable to agree on a contract for 2015, which affects many UCSC employees using the Palo Alto Medical Foundation.  On January 5th, 2015, Blue Sheild of California sent letters to more than 140,000 members state-wide who are users of Sutter Health in Northern California, informing them that the Blue Shield/Sutter Health contract was terminated, effective Dec. 31, 2014.  However, there will be a six-month transition period for UC Blue Shield plan members.

University of California employees (and retirees) are affected by this development if they use Sutter providers, including Palo Alto Medical Foundation (PAMF), and if they are enrolled in the following UC health plans:

  • Blue Shield Health Savings PPO
  • Core Medical PPO
  • UC Care PPO

Blue Shield has directly contacted members in the aforementioned plans, but we would like the campus community to be aware of the situation.

From January 1, 2015 thru June 30, 2015 there will be a six-month transition period to allow UC Blue Shield plan members time to find an alternative provider.  During the transition period UC plan members will continue to receive services at the UC Select level at the Palo Alto Medical Foundation.  Blue Shield Health Saving Plan and Core Plan members will continue to have the preferred 80% coverage at the Palo Alto Medical Foundation but can anticipate a higher cost due to the fact the 80% coverage will now be on a non-contracted rate.

Contract negotiations are ongoing, and it is our hope that Sutter Health and Blue Shield will come to an agreement before the transition period ends. If the parties do not come to an agreement, we anticipate the University of California will announce a plan but for now there is no additional information. The UC is not authorizing a special opportunity for employees to change medical plans at this time.

Last year I used a different insurance plan (UC Core instead of UC Care—a confusingly similar pare of names) that cost me nothing, but that had high deductible and co-pays. Because I’m overdue for a colonoscopy, I decided to switch plans this year, though the premiums may still be higher than the expected medical expenses for the year.

Both the plan I was on last year and the plan I switched to this year are saying that I can’t keep my family doctor—when I selected those plans specifically because they would cover that doctor!  UC should be suing Blue Shield for bait-and-switch tactics and refunding the health insurance premiums collected under false pretenses from the faculty and staff.  But I don’t expect UCOP to do a damned thing about it—they’ve taken the attitude that as long as they have their Kaiser plan in Oakland, the rest of the University can pay through the nose for inadequate health insurance.  UCSB got screwed last year, so it is UCSC’s turn this year.

Perhaps the faculty union (the Santa Cruz Faculty Association) could protest the change? No—they have a memorandum of understanding that they will remain toothless about anything UC does to the faculty.  They might write a politely worded note expressing their dismay.

Of course, this game of chicken between Blue Shield and Sutter Health doesn’t affect just the UCSC employees. A Santa Cruz Sentinel article points out

In Santa Cruz County, an estimated 4,500 policyholders who signed up with Covered California last year and picked Blue Shield are affected along with many more who purchased an unsubsidized Blue Shield policy on the open market.

UPDATE January 30, 2015:

To: UCSC Academic and Staff EmployeesFrom: Lori Castro, Interim Assistant Vice Chancellor, Staff Human Resources; Pamela Peterson, Assistant Vice Chancellor, Academic Personnel

Re: Blue Shield of California and Sutter Health Provider Negotiations

The University is pleased to announce that as of late last night, Blue Shield and Sutter Health have settled on a two-year contract.

Blue Shield of California today, January 30, 2015, announced the signing of a new, two-year contract with Sutter Health. Blue Shield is pleased to offer members access to Sutter Health providers and facilities as participating providers through December 31, 2016. Blue Shield apologizes that the contract negotiation took longer than expected and that customers and members experienced uncertainty or disruption. We also regret the worry that this has caused the campus community.

Blue Shield will be notifying all of its members of the development.

Thanks for all of your patience on this matter.

 I’m very relieved.

5 Comments »

  1. This happens all the time here in NY. Usually, what happens is the provider and the payer eventually come to an agreement. How likely that is in your case will depend a lot on the clout of the provider network. In our case, the issue is usually with one provider network that happens to own the only major teaching hospital in the county, the one with the specialized trauma ER, so the plan customers all start screaming, and eventually the payer capitulates.

    Because I have a child who is a cancer survivor, we absolutely need to have Sloan Kettering in our plan, so we actually have made employment decisions based on the coverage offered.

    Comment by Bonnie — 2015 January 8 @ 05:16 | Reply

    • The provider is the biggest medical group in the county, but they don’t have the “big” hospital, only the smaller cream-skimming surgery center that doesn’t have an emergency room. So they may not have enough leverage to make Blue Shield back down. We don’t have a hospital in the county with a real trauma ER. When there are major injuries from road crashes, the victims are often airlifted to trauma centers 45 miles away over the mountains, because the 270,000 people in our county don’t have a large enough number of trauma victims to justify a trauma ER—it is cheaper to have a helicopter ambulance service (particularly since the trauma victims usually get billed the tens of thousands of dollars for the “service”, which the insurance companies are reluctant to pay).

      Comment by gasstationwithoutpumps — 2015 January 8 @ 05:55 | Reply

  2. If Kaiser were available in your location, would that be a satisfactory substitute? I am not sure what you are saying about having the Kaiser plan in Oakland.

    Comment by Rich — 2015 January 10 @ 13:57 | Reply

    • The Kaiser plan is one of the better ones offered by UC, but is not available in our area. Santa Cruz and Santa Barbara don’t have Kaiser facilities, nor do they have UC hospitals, so our campuses are the ones most often screwed by the UCOP’s health-insurance choices.

      Comment by gasstationwithoutpumps — 2015 January 10 @ 16:24 | Reply

  3. Sutter and Blue Shield have finished their game of chicken. I’m very relieved.

    Comment by gasstationwithoutpumps — 2015 January 30 @ 14:41 | Reply


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