Edhat Staff
Patients with Blue Shield Medicare Advantage HMO will not be in-network, All Anthem Plans in Negotiation
In the midst of the current open enrollment season for health insurance plans, notable changes are on the horizon for patients of Sansum Clinic, a key healthcare provider that merged with Sutter Health last year.
Sansum Clinic has announced significant updates regarding its in-network coverage with Blue Shield Medicare Advantage HMO and is in the midst of negotiations with Anthem Blue Cross for plans in the coming year.
For Blue Shield Medicare Advantage HMO members, a critical change comes as Sansum Clinic will no longer be a part of the in-network providers effective January 1, 2025.
This decision comes despite a renewal agreement between Blue Shield and Sutter Health to serve commercial HMO, EPO, and PPO plans in 2025.
Sansum Clinic representatives expressed their disappointment, urging affected members to explore other plans during the Medicare Annual Enrollment period ending December 7, to maintain continuity of care with their Sansum doctors.
The situation is similarly unsettled with Anthem Blue Cross. Although negotiations are ongoing, there has not yet been a resolution, and the current contracts for commercial EPO and PPO products are slated to end on January 1, 2025.
Should these negotiations fail, Sansum Clinic patients covered under Anthem’s commercial HMO and POS products would see their contracts terminate by March 1, 2025, necessitating a shift to non-Sansum Clinic physicians unless an agreement is reached beforehand. Anthem is expected to inform its members of these potential changes in the near future.
For those whose insurance plans will be affected, it’s recommended to contact other nearby clinics such as UCLA Health, CenCal Health, Neighborhood Clinics, or your insurance company for verified in-network providers.
I am so sick of the way healthcare is approached in the US. And for all of you who are so happy Sutter Health has descended down upon Santa Barbara, you will see for yourself sooner or later what that corporation is made of.
I wish for a functioning., balanced and stable healthcare for all in the new year and all coming years that is not decided by some of the worst corporate profitability…I know.it is just wishful thinking, but I might as well put it out there…
Capitalism wins again! This time at the expense of elderly’s healthcare. Way to go America.
Behold the state of healthcare in America today. Announcement of these changes during open season is irresponsible, short-sighted, and stupid. Just sayin’.
Health insurance companies do a good job of negotiating down outrageous medical charges.
Yet another stunningly clear example of how the rube doesn’t understand very much about the subjects he chooses to pontificate on.