Adventist Health and Anthem Blue Cross have until midnight on Aug. 1 to reach an agreement on reimbursement rates
TULARE – Thousands of people living in and around the city of Tulare may not have access to their local hospital next month.
Adventist Health, which operates the only hospital in Tulare, and Anthem Blue Cross, the largest health insurer in the state, have until midnight on Aug. 1, 2022 to reach an agreement on reimbursement rates. If they can’t, Central Valley residents covered by Anthem won’t be able to afford visits to Adventist medical centers in Tulare, Hanford, Selma and Reedley. Adventist’s Central Valley network of medical facilities sees more than 1 million patients per year. The agreement was originally set to expire at midnight on July 18 but both parties agreed to a two-week extension to continue negotiations.
“This extension will give us time to reach a potential agreement, and we are optimistic that we will make progress to negotiate a higher reimbursement rate – allowing us to keep care local for our Anthem patients in the communities we serve,” Adventist Health announced on its website on Monday, July 18.
Adventist claims Anthem pays them “substantially less” than other hospital systems while enjoying two-straight years of record profits despite rising inflation. “Anthem is one of our lowest paying health plans, and we can’t continue to provide quality care for patients at significantly reduced rates. At Adventist Health, our first concern is always our patients,” Adventist stated.
Anthem boasts more than 8 million members in California and is the largest provider of insurance for those in the Covered California marketplace. It is one of just three providers authorized for Covered California in Tulare, Kings and Fresno Counties. The state estimates more than 400,000 people in Tulare County have access to medical insurance, more than half are enrolled in MediCal and 9,500 are enrolled in Covered California, the vast majority of which are covered by Anthem. About 2,200 people in the Tulare zip code are enrolled in Covered California.
Anthem countered that it has offered rates in line with what other hospitals receive for the same services. The insurance company contends employers across the state are facing the same pressures as hospitals and they are working to “keep healthcare affordable for those we serve.”
“We believe our care providers should be reimbursed fairly, and that has been reflected in our offers during these negotiations,” spokesperson Michael Bowman wrote in a statement released on July 14.
Regardless of reimbursements rates and provider agreements, Adventist reminds residents they should always go to the nearest hospital in case of an emergency as emergency departments cannot turn away patients based on their ability to pay.
Anthem members scheduled to deliver a baby, have a surgical or outpatient procedure, or are receiving ongoing care for a chronic or terminal illness, such as cancer, may be able to receive care for an extended period of time, known as the continuity of care service, but must obtain specific authorization from Anthem for the extension.
Residents covered by Anthem who want to continue seeking care at Adventist Health should contact their health plan’s customer service number to ask about their benefits and out-of-network options for care. The number is located on their health insurance card along with their member ID number. In addition to contacting their provider, residents with Anthem insurance may also contact the Department of Managed Health Care, which protects HMO consumers, at its toll-free number, 888-466-2219 or TDD 877-688-9891, or the California Department of Insurance Consumer Hotline at 800-927-4357 or TDD 800-482-4833.