California’s largest health insurance provider reaches deal with Advnetist Health allowing thousands of Tulare residents to continue to use their local hospital
ROSEVILLE AND WOODLAND HILLS, CALIF. – Those covered by California’s largest health insurance provider won’t have to worry about the Tulare hospital accepting their insurance anymore.
On Aug. 11, Anthem Blue Cross and Adventist Health announced they had reached a new contract agreement that provides Anthem health plan members with continued coverage for hospital-based services at Adventist Health facilities in California, including hospitals in Tulare, Hanford, Selma and Reedley.
“We are pleased to continue our long working relationship with Anthem Blue Cross,” Adventist COO Todd Hofheins said. “Our mission calls us to provide high quality care to patients in our communities and we’re excited to continue caring for Anthem Blue Cross members.”
The new agreement is effective immediately meaning Anthem Blue Cross insurance will continue to be accepted by Adventist Health hospitals and physicians throughout California. That’s good news for Tulare residents and those living in southern Tulare County who seek care at Advenstist Health Tulare, the city’s only hospital. 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 codes are enrolled in Covered California.
“We are pleased to have reached a mutual agreement with Adventist Health that provides our members with continued access to care at Adventist Health facilities,” Anthem regional vice president John Pickett said. “The successful resolution of our discussions builds on our long-term partnership and shared commitment to providing access to high-quality care for those in the communities we serve.”
If the two entities had been unable to strike a deal, Central Valley residents covered by Anthem wouldn’t have been 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 between the two was originally set to expire on July 18 but both parties agreed to a two-week extension to continue negotiations. On Aug. 1, they agreed to extend the negotiations again through Aug. 18.
Negotiations had originally stalled after Adventist claimed Anthem was paying their hospitals “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 on its website.
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.”