Local Insurance Agent Warns That Individual Anthem Clients Are No Longer Covered in the UC System
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Individual open enrollment for 2022 is coming to an end at midnight on Monday, January 31st. After that date, unless you qualify for a Special Enrollment Period, you will not be able to purchase new coverage or make health carrier changes or plan transfers.At the end of last week my office learned of the termination of the contract between Anthem and the UC System. This affects those enrolled in Individual Anthem Pathway EPO plans. These plans are often purchased through the Covered CA marketplace or privately through Anthem directly.[Background Image from Johnny_Spasm https://en.wikipedia.org/w/index.php?curid=17846103]
This termination was effective 1/1/22. Anthem and the UC System are working to assure anyone who was seen during the month of January have their visits covered according to their plans contract. Anthem and the facilities are working together to provide an opportunity to apply for continuity of care if someone is in the current course of treatment. This is a band aid for anyone who was unaware and did not/does not select a new health insurance carrier before Monday night. It is not a solution if you wish to have the UC System available for new health issues that may arise, including second opinions.
As an agent I received no notice of the termination of contract or change in network. It appears members were not notified or given warning and an opportunity to make an informed decision regarding changing insurance carriers to maintain access to the UC System. Anthem members are just beginning to hear from UCSF that they can no longer accept their insurance coverage and the patients must transfer care. This has been shocking and scary for the people receiving that information.
For many in our community this is a devastating blow and certainly an unexpected event. Many folks enrolled in Anthem with the assurance that they had access to the UC System. I serve clients who routinely seek care within the UC System or would choose UCSF or UC Davis as their option for any specialty care, health crisis, catastrophic diagnosis. It is a loss.
Anthem has added the entire Sutter system to the Anthem Pathway EPO Network beginning 1/1/22. This includes Cal Pacific Medical Center in San Francisco. While there are viable replacement options available for care outside of the immediate area we recognize that for many those options do not provide the reassurance they are looking for.
As an agent serving the north part of the state and representing an already underserved area with a severe lack of options I feel a personal and ethical responsibility to publicly share this information in a manner that will have a large and immediate reach. Had I had the information timely I would have shared it much sooner and certainly with my own clients in better format.
I have been working with Covered CA, Anthem and the administration at UCSF to find answers as to where the fall through was. Unfortunately, regardless of the answers it will not change the situation. What my office is advocating for now is Covered CA to provide an SEP (Special Enrollment Period) to Anthem members affected by, and not notified of the network termination. There are no guarantees this will happen but there are conversation happening to explore that option and evidence of lives affected is being presented.
In conclusion, if this affects you and you are attached to the UC Network, your best option is to make a carrier change. The only other option in our area is Blue Shield which you will find to be higher cost at Silver level coverage and lower cost at Bronze level coverage. Any changes must be made by midnight on Monday the 31st.
My office is working tirelessly to make individual contact with the clients we were able to identify as most vulnerable and in need of immediate plan changes. We know there are many we are unaware of who wish to maintain access to care within the UC System. PLEASE reach out to me directly if you are a current client wishing to make a change before the deadline. If you are without an agent and need someone to help we are happy to assist. If you have an existing agent I recommend contacting them immediately to discuss your options.
Respectfully,
Clover Willison
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My god, we treat animals better than human patients…
Your job, should you live long enough, as a Senior Citizen, is to take the “retirement pittance” called Social Security, and spend it on Medicare B, D, and E, the price of which keeps going up, and be sure to hang onto enough to pay all your co-pays, “donut holes” and “deductibles”… OH, by the way, spend all your other savings on Dental Problems because the fucking government provides no “Dental”, and can’t control the cost of the rampant fraud extant in the system, the cost of “doctor shoppers” who run around collecting prescriptions for marketable (street) drugs like Hydrocodone, Vyvanse, Xanax, and Oxycodone, which are filled and then the pills are sold to dealers, which is a simple business to increase your income…
UC health providers are some of the best available, and, they actually give a damn about you, but you will have to travel to them…
Aetna, on the other hand, is the Black Sheep of the healthcare insurance industry… I was on Aetna for 10 years, and the providers were always going on and off the plan, and often couldn’t tell you accurately if they were “participating” or not… Most recently, I tried the Aetna “Silver (Part D) Scripts” plan, which is the cheapest and which totally sucked… CVS has a monopoly, so if you don’t like CVS, buy as few pills as you can and get them through COSTCO mail order…
COSTCO sucks too, and it’s run by idiots, but they will send the pills to you, and some plans apply…
My advice: Don’t consume medical care at all, if you can avoid it, and, don’t use local provider groups like Providence, MRH, avoid like the plague Jerold Phelps Hospital, and, jump in your pickup and cruise to Redding, Willits/Ukiah, Santa Rosa Sutter, and if you are not bleeding to death, haul your ass to San Francisco for anything else… Forget about Sutter Lakeside and Redbud…
Be safe, guard your health, and consume insurance and healthcare carefully…
Kimaw Medical Center and Trinity Hospital are the hidden stars in the system, if you are out in those areas…
Well said. We are told our whole lives “pay these taxes and we will give you healthcare when you turn 65.” But the fine print says “as long as you support the insurance industry.”
The feds promise the insurers that they will get every person who turns 65 on Medicare part B at $171 a month (it went up). If you decline part B it goes up 10% a year for every year you decline it. At some point you are completely priced out.
I will never have health care again. I am resigned to falling on my sword, or using a pistol if I get really sick. I have the same options as a Roman did.
But if I say the words “single payer” some ass will scream “COMMUNISM.”
Why pay taxes?
“Single Payer” was taken off the table by Hilary and Obama before negotiations even began…Certain moments reveal who people really are. The insurers and Big Pharma were assured their profits would not be threatened and the government and public would continue paying top dollar for prescription medicine. It’s weird how easily people strap on blinders and forget the uncomfortable truths…We are a third world nation masquerading as first world
I would note they took it off the table as they knew that it would not pass Congress. And they did what they could to get a toe in the door for any kind of universal -type insurance they could, in the hopes it could be expanded upon.
Remember that half of Congress (altho likely only 1/3 or less of the American people) think social security , medicare, and most certainly Universal Health Care are socialist programs destined to put us on a slippery slope to communism
“altho likely only 1/3 or less of the American people)”
Half of the American people were stupid enough to vote for Joe Biden (and still don’t see a problem) so the fact that 1/3 are too stupid to recognize socialism devolving into communism is hardly surprising.
Just ignore Biden’s communist pick (literally) for “comptroller of the currency” and the left’s obsession with BLM, CRT, censorship and everything communist. It’s probably nothing.
Inside every liberal there’s a totalitarian screaming to get out!
Do you honestly, in 2022, see communism as a threat to the United States? Talk about obsession, McCarthy never died for some people.
We won’t need to be concerned about UC health services with single payer because rationing won’t ever leave room for little people like us, only powerful elites
Yeah. It’s why so few keep breaking immigration laws to live and work here. ‘Cause we’re so third world…
Yeah, just ignore the armies of tent cities and homeless drug addicts shitting in the streets and pretend like the MILLIONS of third worlders (many of them completely illiterate) invading our country as inflation rages will not pauperize all of us. That should work out about as well as your beloved “vaccine” did.
I thought it was because of our systemic racism.
“We are a third world nation masquerading as first world”
I think if we import millions of people from the third world and pay for their health care, education, ad infinitum, with money contrived out of thin air we should be fine. In fact, it will reduce inflation and grow the economy and it’s double plus good. Liberalism is a mental disorder!
But if I say the words “single payer” some ass will scream “COMMUNISM.”
Why pay taxes? OMG More Socialism, how could they???
Why do Canadiens come to the US for health care? Because socialized medicine rations care meaning only the connected get advanced treatments.
you forgot to mention if you do not add a Prescription Drug plan when you initally sign up for MediCare and decide you need it later there is a monthly penalty fee one will pay as long as you have that RX extra coverage.
Soooo socialized medicine isn’t working out (shocker) and your solution to the problem is more socialism? And the people pointing out that won’t work are the asses? Let me guess, you’re a democrat?
Do you even know what socialism is? America is pretty far from socialist. Ya we have public schools(socialist! Oh no!) Half assed libraries uhh, public roads, border patrol, cops and the military…all of which are technically socialist enterprises, but oh no! How dare we socialize health care of all things?!
Here’s a hint, there’s no pure capitalistic society in the world. And why would you want one?
The cognitive dissonance hurts my brain.
Too many bright flashy lights on screens are a few of the problems we face as a civilized society that sells literal pharmaceutical infused human shit, as a fertilizer.
Not to mention all the slow kill products on the shelves.
Grow your own…
Join a cooperative, teach children how to grow loCal food
Realize the elites will trade you outright for the robots.
Healthcare is a tax on life.
No we don’t treat animals better. Animals are put down because of cost of care issues all the time. Sometimes just for convenience. Try suggesting that for people. And the owner pays a substantial amount for that euthanasia too. As for medicine… no one gets that for free. Sometimes it’s not available at all, paying or not. I hoard one medication for an elderly animal because it has periodically been unavailable for no apparent reason and no one cares.
Universal health insurance works when almost everyone pays taxes, the average age of the population is low, there is no economic recession, little immigration of unhealthy individuals who never paid taxes but use substantially and the government has no other higher priorities . In other words when the government has enough money to cover users. At least as far as paying for it. Medicare, medicaid (Medical here) are already -what?- about 40% of the federal budget. Of course about 7% of the cost is various insurance that actually do the administration of Medicare and Mecicaid. But the there are administrative costs elsewhere too. It’s all complicated and different systems have different problems.
San Francisco has a higher immigration percentage than most places. It’s businesses make much use of them. But if you sit in anyone of the UCSF clinics for long, you will see a substantial number of children and elderly relatives of immigrants there too, care subsidized by the State through its university system. There is defacto universal single payer insurance of sort but you have to live there to access it. It’s not for people who have to travel to get it. Wouldn’t it be great if all state universities had a corresponding health care subsidiary for all of us to use equally no matter where a person lived?
Medicare, medicaid (Medical here) are already -what?- about 40% of the federal budget.
It’s about 15%, projected to rise to around 18% by 2029. According to a quick google of various sources.
“It’s about 15%, projected to rise to around 18% by 2029. According to a quick google of various sources.”
A “quick Google” will also tell you that Social Security is fine and that mRNA “vaccines” are safe. If liberals understood economics, they wouldn’t be liberals. The accounting gimmicks used by the government are lies. We have nearly $100 TRILLION in unfunded liabilities (promises to pay and no idea where to get the money) that like Bernie Madoff, is magically not on the books!!!! The bulk of that is from Medicare and Social Security. We will borrow the money to pay these liabilities at massively elevated interest rates as our currency implodes. We are completely insolvent and the left is not only too fucking stupid to see it, but they want to pile on more “free shit”. The day of reckoning is here. Enjoy your DMV health care.
I’d rather be fucking stupid than racist and fascist. Like the right.
Everything is upside down, and when the border is wide open and you think you aren’t effected, looks like modern education and msm has done it’s job.
Keeping you comfortably numb to open door policy that’s illegal bar none
People who identify as right wing are more likely to be less educated. Literally, the more educated you are, the more likely you are to become more liberal…regardless of your background. With every step you go in your education, high school degree, college, masters, PhD, you tend to become more liberal. Is that the fault of some massive conspiracy of modern education, like you claim, or, like…learning? Facts, about the world? Downvote all you want, keep blaming communism and critical race theory and immigration and other things you don’t understand. We’ll just keep running everything in the country, because we’re smarter than you.
You sound like you are the problem. Of course if we had real accountability, and intelligence we wouldn’t need that black box voting, right?
The fact that you speak from a left right paradigm shows the honest truth about the new liberal wing of the Democratic party.
All hopped up on the finest quality meds.
You don’t have a real argument for the rule of law being broken in so many ways, you just pick what works for your sensibilities..how about we agree that your home can only handle so many people who are living free.
Let’s agree eugenics is a liberal solution to a human problem.
So now you think anonymous balloting is the problem? And…I don’t think I will ever agree with you about anything to do with eugenics. Christ.
Why do you think that the the more educated you are the more liberal you are? Because a Pew study done by the more successful of those who plodded through academia to get degreed said so? These people defined “liberal” or “conservative” as answering a series of questions about corporations, race, government, etc as either liberal- ie having an untraditional viewpoint about who is a problem and who is not. And guess what? People who flourish in academia- that most literally super regulated heirarchical institution in existence other than the military where the definitions of success are called degrees and is incapable of even surviving without a legion of un-degreed support to keep them paid, fed, warm, electrified, mobile, protected etc on other people’s money- think differently than those who do the feeding, warming, powering, protecting, etc and provide the money directly. Who’d a thunk!
But also guess what? Scratch that theoretical optimistic thinking by suggesting that the more academia is given power, the more ruthlessly they eliminate others by means of violence, as in reproducing their own riding heirarchly of paracitism and regulation, the more angry, intolerant and unforgiving they become. Populist find comfort in numbers. Academics find comfort in regulation. And formal degrees. Too bad, like leavening in bread, academic hot air itself, while it provides a useful service to making nourishing bread, has zero nourishment and wouldn’t even exist without the milled grain for which you express such contempt.
Just keep ignoring the help. You’ll be fine.
So long as you’re happy with your choice.
Haha what? Counterpoint: there’s a bunch of liabilities/debt because it’s worth it to invest in our economy…basic economics, come on.
Are you rich because health care is a goddamn nightmare right now in America. Most people I know find it cheaper to save up money for a visit to Mexico for dental work.
I take it you don’t talk to foreigners much, all the ones I’ve talked to are straight up horrified by our Healthcare system and pity us.
Dropped off the Social Security part which I meant to include in the share of budget. Sorry.
If you haven’t been paying attention people are being put down as well.
Cmon man
“My god, we treat animals better than human patients…”
They have free market health care
In actual fact, Veterinarians are a form of Pirate! The difference is, you pay cash for veterinary services! Paying the bill yourself will lead to a different manner of consumption, and it is possible that “health insurance” should be outlawed completely, rather than made into “single payer”…
Single Payer will never exist, because the providers and pharmacies and drug companies would make far less money. Period.
We need a rational approach to healthcare, we need healthier habits (go into the average small hospital and see the sheer size of many of the people who work there)(and how many of them are out back having a smoke), and the terrible condition many hospitals are in…
I recently visited Glenn Medical Center, in Willows, (not as a patient!) which went broke in 2018 and has been shuffled into the hands of a management company called “American Specialty Management”, which runs GMC and Colusa Hospital and a few others. Colusa Hospital, which also went broke in 2016 and closed without paying staff, is a real horrible old hospital…
Both of these awful facilities are physically crumbling, understaffed, and ASM only cares about the bottom line, while dispensing “care” to farmworkers and indigents, who are about all that lives out there…
Pick any 5 employees of one of these places and weigh them together… The scale will tip 1400 pounds…
It is amazing how unhealthy our habits are, but how much we complain about other people’s health.
Mind your own business, consume healthcare and insurance as carefully as you pick almost anything else, and you will be better off, and, if you weigh 280 pounds, eat less for a few years…
This is because all dogs are better than most people.
But what about the “Affordable Care Act? Do we know “what’s in it” yet?
Hmm…I was forced to pay mandatory monthly fees, my taxes were more heavily scrutinized and I lost my primary care physician as they shut down their practice. I have not had a primary care physician or seen one since then but I have piles of paperwork, monthly fees and constant notifications telling me to brush my teeth, etc. That’s what was in it for me! Oh- did I mention the massive federal debt we all have as we keep borrowing to support the extremely complicated multi-level system? That was in it also…
Shut down the border.
I think if everyone who thinks immigration is the big problem would just go down to the border themselves and form a human chain, and just stay down there, forever, a lot of our problems would be solved.
This isn’t a left or right issue.
It affects crime, violence, and drug in our own neighborhoods.
Bad enough big pharmacy has no real challenge from our government watchdogs, and health care has been weaponized against the people who want to speak out.
It’s the fact that you lock your front door, your front gate, your vehicles, while turning your nose to our southern border, which tells your detractors you don’t have much depth to your observations.
Do you honestly think this nation has a drug problem because it can’t secure its borders? Deaths of despair (suicide and drug overdoses) are the leading cause of death among young white people in the US. People growing up in this country just want to die, and you want to blame Mexico?
When Mexico provides the means, of course. And most drug overdoses are not deliberate suicides . And the highest rate of suicide are among American Indians.
This isn’t a ‘vid thread.
I lock my doors and secure valuables from local tweakers Who just make their own meth or know someone who does if “the border gets shut down”.
Most illegals I know stay under the radar, cause as we all know “only break one law at a time”.
How and why?
I’m particularly interested in your master plan for “shutting it down”.
Are you a “government out of my life” person? What makes you soon special in contrast to millions of people fleeing government oppression to come here? Because you were born here and they were not? That’s it? You got lucky and fuck everyone else?
Government is a tool. It can be used in the limited way for which it was designed to make things work better or you can use it to attack people. And yes, recognizing that when you are lucky and standing in the way of those wanting to take it away is a reasonable idea. Most countries do it by deciding who is acceptable and who is not. Only in the US of the moment does that become a big point of contention where early unlimited European immigration is considered evil colonialism but unlimited immigration from other places must never be noticed now.
Like Jerold Phelps Hospital, the ACA is largely dysfunctional, and it was just another ploy to foul up payments while slowing down government reimbursement for care, under an unintelligible plan some government lawyer dreamed up…
Thank you for the information
i believe this is a contract dispute between anthem and the uc system, it easily could have been either that pulled out, nothing to do with medicare, medicaid, or anything else. probably about money allowed for services, or some regulatory requirement to be, or not to be funded for certain services, like no funds if you prescribe certain drugs, or proceedures out of the network.
If you have Medicare, there should be no issues with being able to be seen at a UC facility. I am not sure you meant to imply that – just wanted to make sure people on Medicare would not be worried unnecessarily.
Anthem has a Medicare Advantage presence in California. Or did. I have no idea whether theyvstill do.
Clover has our backs – we’re very lucky to have her working for us. Kudos!
Does this apply to Blue Shield PPO as well?
This only applies to Anthem Pathway Individual policies. Employer sponsored Anthem group plans and all Blue Shield PPO plans do not apply. Also note, that this is for continued care only. If you are rushed to UCSF for an emergency, you are still covered as in network by your individual Anthem plan.
I appreciate the reply. I ask because it’s so confusing, in other states Anthem is Blue Cross/Blue Shield, but I guess in California they are
Competitors, sounds like a rigged system to me. I feel for the people affected, the main reason I signed up for Blue Shield PPO is the direct access to UCSF, hands down the best hospital system in NorCal and away to get out of local care, Providence being almost reprehensible for quality of care. The system in place here where multiple visits to primary for referrals to specialists which take months of wasted administrative costs and time only to get the specialist say, well if we saw you 2 mo the ago, before the bone healed wrong I could have done something. It’s insane. As others said before, any foreigners upon seeing our ‘system’ are horrified. Completely bloated and controlled by for profit Insurance, Pharma, etc.
To those effected can change plan… From Jan 1st thru March 31st OEP, if you changed plans last year during AEP, you can change plan using OEP to another plan. But if this has caused issue with health coverage issue, you can address this with CMS and they will review to give a SEP, Special Enrollment Period. Hope this helps for Medicare