Thousands of San Diegans began their new year scrambling for health insurance, after a falling out between Anthem Blue Cross and Scripps Healthcare. Failed contract negotiations led Anthem to drop Scripps as an in-network provider. So what does this mean for you?
NBC 7 spoke with a healthcare attorney and to people affected.
Getting to a doctor these days can be a dizzying mess of insurance denials, long wait times and in San Diego County, sudden lapses of coverage. Just ask Todd Walters, the president of the local 135 United Food and Commercial Workers Union.
“Our office has been getting calls for over a month now dealing with, what am I supposed to do? Where do I go?” said Walters.
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Walters represents thousands of grocery store workers, who just found out that one of the largest health care insurance companies, Anthem Blue cross has dropped Scripps healthcare from it's in-coverage network.
He believes this affects up to 10,000 of his members, that subscribe to health care providers through a third party, contracted with his union.
“Both of these are a billion dollar organizations, and in the middle of this are people in the community trying to get their healthcare done and trying to do it economically,” said Walters.
Local
Contract negotiations between Anthem and Scripps failed over costs and policies. Both sides pointing fingers at each other.
After months of failed negotiations, the health insurance coverage contract between Anthem Blue Cross and Scripps Health has ended and patients who utilize both may now need to make rearrangements to their care.
Providers within the Scripps Health system will, as of Jan. 1, be considered out-of-network for patients covered by Anthem Blue Cross and Covered California. Both sides said negotiations are ongoing.
Patients who wish to receive in-network care will need to switch providers to one covered by Anthem or call the insurance provider at the number on the back of the insurance card to request Continuity of Care coverage, which only applies in certain situations, Anthem said. Scripps Health says 9-1-1 emergency services will always be covered.
Scripps Health says their team was seeking to "change Anthem’s bureaucratic policies that cause unnecessary delays, burdens and barriers to patient care, while ensuring Scripps will receive fair and accurate payments for the high-quality care provided."
Anthem, on the other hand, says Scripps Health was looking to increase prices to patients.
"Agreeing to these demands by Scripps would create a significant financial burden for local families and businesses. These higher costs would lead to substantially higher out-of-pocket costs, deductibles, and copayments for our members and impact local employers and small businesses as well."
Read each side's statement in full here:
Anthem's response to the failed contract negotiations with Scripps Health
“Despite our good faith efforts to reach a new agreement, Scripps has chosen to leave Anthem’s local care provider network effective January 1, 2025. Scripps demanded drastically increased prices for patients covered by Anthem—increases that would have led to higher out of pocket costs for our members and would have hit area employers particularly hard. More than 80% of Anthem Blue Cross members are insured by employers that pay their employees’ healthcare costs directly.
“Members currently receiving treatment for serious and complex conditions may be able to continue care with their current provider for a limited time. To do so, members or their doctors may contact our service center to request Continuity of Care accommodations. Anthem members also continue to have in-network access to several other high-quality partners throughout San Diego County who are prepared to provide care for members currently under Scripps, including UC San Diego Health, Sharp HealthCare, Palomar Medical Center and others. “We want Scripps doctors and facilities to return to our network and remain in active discussions to reach an agreement that offers affordable prices for the employers and consumers we serve. To stay updated, please visit here.
Scripps Health's response to the failed contract negotiations with Anthem
After many months of negotiation, the Scripps Health and Anthem Blue Cross contract terminated Jan. 1. The contract termination means Scripps has been removed from the Anthem network. All Anthem commercial insurance plans and individual Covered California plans are impacted. All providers and services across the Scripps system are impacted and no longer covered on an in-network basis by Anthem, with the exception of emergency care. Medicare supplemental plans are not affected.
Scripps proposed to continue negotiations beyond yesterday, but Anthem provided an ultimatum that was unacceptable. While Scripps remains open to finding a reasonable resolution, Scripps patients should contact their employer’s human resource departments to understand their health insurance options.
It’s important to know that everyone is always welcome at Scripps, regardless of what insurance plan or coverage they have. Emergency care is always considered in-network and is not impacted by this change. Anthem patients who want to continue seeing their trusted Scripps doctors and providers are welcome to continue doing so, too. However, patients are strongly encouraged to contact Anthem before receiving care at Scripps to learn how their coverage and out-of-pocket costs will change moving forward.
Scripps is notifying patients with Anthem coverage of the contract termination, educating them about their right to extended in-network coverage under continuity of care benefits for those who qualify, and ensuring they are aware of Anthem’s legal responsibility to continue to provide coverage for emergency care, without increasing patients’ out-of-pocket costs due to the out-of-network status.
Throughout the negotiation, Scripps’ focus was to change Anthem’s bureaucratic policies that cause unnecessary delays, burdens and barriers to patient care, while ensuring Scripps will receive fair and accurate payments for the high-quality care provided. It is disappointing Anthem was unwilling to reduce those barriers and offered rates below health care inflationary costs. Scripps’ costs are driven by factors such as the new health care minimum wage, escalating drug costs, unfunded government mandates and many other items.
The priority now is ensuring patients know that even though Scripps is out-of-network, they are still welcome here. In particular, no one in our community, including Anthem members, should consider an out-of-network status as a barrier to care during an emergency.
Employers who offer their employees insurance benefits through Anthem also are being notified of the contract termination. Organizations currently offering Anthem health care benefits may consider changing plans or adding an additional insurance plan option for those with employees requesting continued in-network coverage and access to Scripps Health.
More information and resources to support patients during this transition is available here.
