Adventist Health’s Contract Termination with Blue Shield Leaves Mendocino County Patients Stranded
Adventist Health Ukiah Valley
Adventist Health sent letters to patients over the weekend, informing them that its contract with insurer Blue Shield of California was set to expire on December first. Cathleen O’Roke got her letter, which was dated November 29, the day after all the hospitals in the county were no longer available to her.
“I do use Adventist,” she said. “It’s the only hospital around.” She also uses one of the Adventist clinics and the pharmacy, “so it was a little shocking,” to suddenly be out of network. She can’t easily travel to another county to meet her medical needs. She added that early in November, “I just renewed my Covered California, after calling Adventist and making sure that Blue Shield was a legitimate option. They said yes, I renewed, and now I get this letter.”
Adventist did not respond to questions about how it chose to notify patients. A press release states that Blue Shield patients “may be able to receive care for a period of time as a continuity of care service;” and advises them to call the customer service number on their insurance card for details.
According to the California Department of Managed Healthcare, patients must ask their health plan for continuity of care, and the doctor and hospital must agree to keep them as patients. Continuity of care can be available for as long as an acute condition or terminal illness lasts; within 180 days of a surgery or procedure that’s already been scheduled; during pregnancy and the post-partum period, and for up to a year for the care of a child under three years old. Patients can also get a year of treatment for a serious chronic condition.
In July of last year, Adventist complained that another insurer, Anthem Blue Cross, didn’t pay enough. Contracts were extended as Adventist warned patients that they could soon be out of network.
Most of the public workers in Mendocino County, employed by local governments and the school districts, are insured by Anthem. Adventist has repurposed a link for frequently asked questions from that dust-up and is now using it for a page with similar information about the current situation.
The Blue Shield contracts expired this year at 17 Adventist hospitals in the state, as far south as Simi Valley and as far north as Howard Memorial in Willits where O’Roke, the Blue Shield patient, is assessing her options.
“When I got this letter, I wondered if this is just them playing hardball with Blue Shield, or do I really have to worry about this,” she recalled. “Should I wait a couple weeks and see if it shakes out, or should I go and change my insurance, or look for a doctor that does take Blue Shield?”
Mendocino County is in bad shape when it comes to health metrics. According to Partnership Health Plan, which administers Medi-Cal, Mendocino County ranks 45th out of 58 counties in the state for health outcomes. Drug overdose deaths are almost three times the state average. Child mortality is a third higher, with 60 deaths per 100,000 people to the state’s 40. Life expectancy is two and a half years lower than the state average, though it matches the national average, and adult smoking is six percentage points higher.
Meanwhile, contract panics between insurers and healthcare providers are endemic across the country. The UC Health System and Anthem Blue Cross have extended negotiations, while the state’s public employees retirement system advises members about what to do in the event that the contract is terminated.
Advocates for a single-payer healthcare system believe that if their plan, CalCare, becomes law, insurance disputes will no longer be a regular feature of the healthcare landscape.
Robin Sunbeam is a retired nurse who now volunteers with the California Nurses Association. She’s been part of an effort to bring single payer healthcare to California for thirty years.
“Since 1992, I have been on this project,” she said. “And we have put up so much legislation and initiatives on the ballot. People are really afraid to have their taxes go up. People ask me, how will we pay for CalCare? Will our taxes go up? And it’s true. There’s a possibility that 93% of CalCare will get paid for by the federal waivers and state funds, and there might be a slight increase in state taxes. But the increase in taxes will be far less than only a small fraction of what you would pay for premiums, co-pays and deductibles.”
Sunbeam is aghast at what she calls healthcare profiteering. “Personally, I think it’s criminal to commodify people’s health,” she opined. “In the past, they always said that private is more efficient than public, due to competition. And so competition makes everything better. What we’ve seen instead is that competition leads to buy-outs, which leads to fewer and fewer providers, and one single provider that buys out all the other providers. And there goes all your competition.”
According to a study by the California Healthcare Foundation, titled, “Markets or Monopolies,” “the preponderance of evidence suggests that hospital consolidation leads to higher prices… Furthermore, workers bear the burden of these increased premiums as employers depress wages to pay more for health insurance coverage.” The MediCare Payment Advisory Commission told Congress in 2018 that “hospitals with large market shares have the leverage to negotiate relatively high prices from commercial insurers.”
Becker’s Payer Issues, a medical industry trade magazine, reports that, “Adventist operates 26 hospitals and 400 clinics across California, Oregon and Hawaii.” Blue Shield of California is the third largest health insurer in the state, with 4.8 million members.
O’Roke says she can meet her immediate needs, by filling a prescription at the nearby Safeway pharmacy. But she doesn’t know yet what she’ll do about things like regular lab work or an ER visit.
“If I go to emergency, of course they’ll see me, but it could be very very expensive,” she reflected. “Really, Adventist is everywhere in Mendo. So it’s hard.”
She says she’ll give it a week before making any big decisions. Sunbeam, the single payer advocate, knows what she thinks. “The system we have is broken,” she said bluntly. “And people are suffering because of it.”
Join the discussion! For rules visit: https://kymkemp.com/commenting-rules
Comments system how-to: https://wpdiscuz.com/community/postid/10599/
My spouse received one of these letters, although I have not to this point. What is not made clear is that if Medicare is your primary insurer, and your supplement is with Blue Shield, you are still covered.
Adventist should know what an individual’s coverage is and not scare people unnecessarily. Just another issue we have with the way Adventist is “administered.”
what it sounds like is you were on a Medicare “Advantage” plan, being promoted like crazy by huge, for profit insurance companies. They must make a fortune with all those costly TV ads ! You now will have to pay the usual 20%. Rising medical costs,I’d hate to see the bill today for a simply Gallbladder removal !
!…reminds me of how my Grandpa got sick during a huge snowstorm. The ambulance took him to the closest hospital. This was around 2003. In the dark ages, I guess. A well trained, highly paid doctor confidently assured us his gallbladder had to be removed. We had to point out that despite a thing called computer networks, & phones, in the richest country on earth, that back when we were third graders, he had his gallbladder removed already. I’m sure they would have been disappointed, but sent a bill anyway.
Sutter Health just dumped everyone in Alameda county. Including our 93 year old grandmother. That’s cool though, she’ll enjoy shopping the Health Care Marketplace around Christmas time.
Penguinn, O got one of those letters too, even though I’m on Medicare and get my supplement through a different insurer. If you are on Medicare part B, and your Blue Shield policy is just a supplement to cover the 20% copay, you’ll continue to be covered because Adventist is legally required to. Those policies are federally regulated and aren’t negotiable.
If you are on any private insurance through Blue Shield, including the Medicare “Advantage” scam which is just private insurance by another name, then you would be affected. And the fact that Adventist doesn’t make that clear just shows how lame their administration is.
Another nail in the coffin of dwindling health care services for the NorCal coast and beyond. Don’t feel bad. Del Norte patients have to get dental services in Medford Oregon. Lawmakers should have stopped this void in health care before letters went out.
It’s a big subject that justifies an explanation from our elected officials.
check out what’s happening on the East Coast ! Security in knowing we’re not alone !
And so, if you are covered by Blue Shield, and you are just passing through a response area that takes you to an Adventist Health Hospital in Mendocino County, or passing through any other of the 16 AH response areas in the State , what then…???
How will your coverage and costs be affected…???
(I suspect that it was maybe Blue Shield that dumped Adventist Health, and not the other way around…)
??,
I also suspect that POM will have a word or two to say about this, when he sees it…
Should be interesting, honestly…
?
Blue Shield/Blue Cross is the 3rd largest for profit healthcare provider in our Nation. If they don’t get what .. well, USA Today covered it, “These private plans rejected nearly one in five claims allowed under Medicare coverage rules and denied 13% of authorizations for medical services that government-run Medicare would have allowed, the U.S. Department of Health and Human Services inspector general investigators found.” Does that help ?
A friend of a friend was a Forester who’s job obviously included driving all over the State on mountain roads. He got in a car wreck, was transported like normal to the closest hospital…
“Oh you’re out of network!” Sorry not paying for the back surgery. But that’s ok, since now you can’t work, just give us your house, and stuff and “You suck”.
He shouldn’t have been born lazy and poor like that.
Not much better in Humboldt.
I couldn’t find any Blue Shield-covered Primary Care doctors taking new patients.
There are very few primary care doc’s along the 101 between Ukiah and gold beach Oregon. Most are “rent a docs” who never stay long in the area.
Well, as the “Radical Left”, yes that’s me, said all along, this is NOT going to get better ! As painful as this is for some, we NEED a standard healthcare FOR ALL.
Robin Sunbeam, not surprisingly, has a fantasy that government health care is automatically going to be better. The fantasy is that someone else is going to fix it. What is going on IS government health care. It’s just the bad parts of government mandates while avoiding the responsibility to pay for it. Every time government attempts to fix the mess they made of the last fix, it gets worse.
It would be great for people who expect the government to fix their health care problems to spend some time reading about health care around the world and not just parrot what various social lobbyists say. There are always problems, single payer or not. Everyone loves the idea of not worrying about hospital bills but the real test is not whether they can access services in ordinary health matters but whether they can access services in chronic or difficult illnesses. It varies and the problems it has varies. There is universal coverage based on mandatory buying of insurance from private companies, tax funded health care for citizens and legal permanent residents (only Brazil cover all people), private insurance or a mix of the previous. All struggle with paying for it.
Some is centralized, most are decentralized. The US is probably one of the countries with the most limited ability to run a centralized health system. And before demanding it, people should examine the various results of government so far. If the government was able to easily resolve the issues, they would have done it by now. They should tailor their expectation on that fact. And good luck with that.
Eliminate healthcare parasitism. If someone – anyone – can rip off the system and make an obscene profit they’re going to do it and certain members of Congress are going to support and lobby for it. You know which ones. The U.S. is no longer at the top of the quality healthcare list worldwide, and it is certainly not in line with the rest of the free world as far as benefits go. Unless, of course, you’re a member of Congress or in one of the similar protected classes that the rest of us all pay for. For life. And no, I don’t mean Medicaid.
Congress buys Obamacare, AND other insurances they can afford. There is the difference. They can afford the extras.
They have done it. And they are good at it. VA
The simple fact is that Obamacare is a disaster. It was the beginning of the end.So what makes anyone think a single payer total government system will work well. The country simply has too many unproductive people it wishes to coddle for free. And the borders have been wide open for years. We are paying for that bigtime. The drug problems alone that contribute to mental illness are overwhelming the ERs. And the doctors in low income areas cant make enough income from govt. payments alone to justify staying. Overly socialistic policies although utopian in thought are unrealistic. The ironic thing is that all federal employees including congressional members have lifetime Cadillac care.Something is wrong with that picture.
Yeah, American homie who works here with employer coverage, moving out of the country. I asked him, how would your insurance deal with it if you broke your leg kite surfing in Mexico? He said, doesn’t matter, it’s free.
The lack of knowledge about what happens outside the US is everywhere. ” I think what I kind of wanted to show with the film is how government dysfunction and government corruption, we kind of think about in these really abstract ways. But as it trickles down to people like the Ochoas, it’s life and death on a daily basis.”
https://www.npr.org/2019/12/12/787552789/midnight-family-shows-how-family-run-ambulances-give-emergency-care-in-mexico-c
Eliminate the parasites at the top of the insurance and healthcare administrations. They feel they have a right to obscene salaries and benefits. There. Just saved you billions. Big hand for GWB whose administration set up the “Medicare Advantage” system as well. The whole industry has become focused on profits for certain players. Medicare “Part C” or “Advantage” has been statistically shown to deny coverage for various benefits considerably more regularly than plain old Medicare. So if you got a “Part C” plan and you go to, say, Florida this winter and get in an accident odds are you’re not covered there, either. Great big privatization scam. Just remember this mantra “. . . regular Medicare parts A, B and maybe D only with a supplement (medigap) plan.” Don’t buy into the privatization scam. Societal parasites.
Sounds like you expect hospital administrators to take a pay cut.
Good luck with that. They are the real maggots dragging the system down. Sure don’t do much for the huge salary and perks they get.
Health insurers and health care providers in the United States spent approximately $812 billion on administration in 2017, amounting to $2497 per capita (34.2% of national health expenditures) versus $551 per capita (17.0%) in Canada, according to a study published in 2020 by David Himmelstein, MD, and Stephanie Woolhandler, MD…
That includes $844 versus $146 for insurers’ overhead; $933 versus $196 for hospital administration; $255 versus $123 for nursing home, home care, and hospice administration; and $465 versus $87 for physicians’ insurance-related costs.”
Notice that insurer’s overhead is smaller than the hospital administration cost. Frankly much of both is the result of government regulations, not insurance company requirements. Congress writes horrendously pettifogging laws which are then turned into even worse regulations. Which evils are then compounded by lawsuits up the yin-yang. But of course we keep churning out more lawyers from colleges to write more laws and sue more people. This is the true American Obsession. Yet that same system of government regulation is seen by some (yes that’s a euphemism) as the fix.
https://journals.lww.com/em-news/Fulltext/2022/01000/Special_Report__U_S__Health_Care_Administrative.6.aspx
“Medicare fraud in the U.S. is a huge and costly problem. Taxpayers are losing more than $100 billion a year to Medicare and Medicaid fraud, according to estimates from the National Health Care Anti-Fraud Association… Who commits this fraud? It’s a range of perpetrators, including unscrupulous medical providers, healthcare facilities, contracted billing services and even patients themselves.” My first contact with this fraud was when a veterinarian told me he had a fellow vet in LA who could get me a real discount on medication that was too expensive for me. This vet had people who sold him the drugs their doctors ordered for them and were covered by Medicare or MediCal. Of course the vet here said he found it hard that some old lady in LA had to do without her medication. Where upon I rolled my eyes and declined the offer.
https://www.forbes.com/sites/forbestechcouncil/2023/09/20/how-medicare-and-other-fraud-in-the-us-can-be-prevented/?sh=1296b0b73c46
Insurance companies. Biggest scam on America for 200 years. Home ins. canceled? Med. ins. canceled? What’s next, car ins.? I hope they don’t cancel my burial ins., or stinky.
A major part of the problem is the extension of liability for negligence to essentially 20-20 hindsight and obscenely high verdicts. And California is a special problem. It’s an administrative disaster and severely overpopulated in fire prone and drought areas. This causes accidents and fires.
Socialized medicine would be great, but our government can’t manage our borders, so how would they do with that?
As a 72 year old on Medicare, I would not use Adventist Health for any reason.
They only care about money, profits, and fat salaries for Admin, and patients be damned…
Medicare provides minimal benefits at best, supplemental insurance from blue shield is bare bones, Part D is the worst ripoff in history, inserting itself between Pharmacy and Patient in indecipherable ways, but, Adventist threatens to cancel the agreement every year, and then renegotiates…
Adventist has a monopoly in Mendo, which is something needing investigation, Adventist tried to buy St Joseph’s and Redwood, along with Queen of the Valley, but the AG office shut them down, and it has gotten so bad that Adventist is backing out of deals with other facilities:
https://calmatters.org/health/2023/12/madera-hospital-california-emergency-loans/?utm_source=newsshowcase&utm_medium=gnews&utm_campaign=CDAqEAgAKgcICjCbvYILMJ-8_wIwz_ToAQ&utm_content=rundown
You are lucky if you can find a provider that actually attended Medical School anywhere North of Ukiah, or anywhere in Lake County at all, where Adventist has to compete with Sutter and Tribal Health…
I told Sutter Health that I wanted a white, male MD, and it took 2 years to get one, in Yuba City, which used to be crawling with Doctors…
Remember: Nobody wants a healthcare job, any more…
Don’t get old, and protect your health, because Social Security is not too secure, and Medicare does not care…
Adventism is a cult. They spend more money in the 3rd world than in the USA. Very good liars in the name of their God/ leaders/ land holdings.
Well, to an Adventist, a lie is not a lie if it benefits the organization…
Adventists refer to the general public as the “worldly people”, and non-tithing members are just there to give funding to the organization…
Remember, Faith-Based Corporations do not belong in Healthcare…
Worked for the money-obsessed Providence at the sleezy St. Joseph’s Hospital in Eureka for a few years before leaving the organization and California in 2019 – main reason was healthcare and getting older. As a physician observed to me concerning the lack of access and deplorable quality of healthcare (including dental care) on the North Coast: Your health is in danger living there. I agreed. Providence and Humboldt County are the analog to Adventist and Mendocino County. Bad for all but Providence and Adventist.
DISGUSTING. The big britches finger waggers at the top pulling well over base 6 figure incomes. What exactly do they do? Make much more than the doctors yet rarely leave their cushy offices. No blood, guts, death or sorrow. Drain people’s money that they beg stole or borrowed. Not looking ahead, drive all healthcare out um HELLO. How many total employed in healthcare in the county? If the majority split because there is no work its not going to be a good thing. Mendocino County management is living in some alter dimension. Yet, another tragic situation unfolds without as much of a blink of an eye.
We all knew tis was going to happen when Adventis took over. Shame on the the previous owners for doing this to are cumminity. The names and photos of the people responsible for this action should be posted so when we see them we can expose them to the public that they have attacked. This are is full of older people that will not be able to travel over the hills for medical care. Dopn’t forget. If you know these people resposible, please expose them.