Sonora Regional Medical Center this week inked an agreement with Anthem Blue Cross for people who enrolled in the Covered California Exchange that, effective Tuesday, will retroactively cover disputed claims filed since Jan. 1.
The agreement clarifies a contract between Sonora Regional, its doctors and Anthem that runs through 2016. It should put an end to confusion among some Anthem customers who have gotten mixed messages about whether Anthem would or wouldn’t cover care by various doctors, explained SRMC CEO Andrew Jahn.
“While Sonora Regional Medical Center has had contracts in place with Anthem Blue Cross, uninterrupted for the last 15 years, there has been some confusion around specific products offered on the Covered California Exchange,” Jahn said. “Anthem Blue Cross and Sonora Regional Medical Center reached an agreement late last month with an effective date of July 1, 2014, that covers these new products.”
In a nutshell, when Anthem joined the Covered California exchange, the plans offered were included in the hospital’s existing contract. Then, after Jan. 1, when the new plans were activated, Anthem came back and said it would no longer include earlier negotiated services.
“We said, ‘yes you can, we have a contract,’” Jahn explained.
“The short of it is, we finally reached an agreement with them,” he said. “They have agreed to process and pay all the claims that have come through Jan. 1 to now. Going forward, there’s an amendment in place to cover those plans.”
Sonora resident Tammy Vann is one of the patients affected by the dispute.
When she enrolled in an Anthem plan last year, the Covered California website said Sonora Regional was in Anthem’s “Preferred Provider Network.”
However, just months and two doctor visits later, she who was told by Anthem that her February and March visits to Sonora Regional were considered “out of network.” As a result, she was billed for nearly $500 when an in-network visit would have only cost her $5.
Vann said she hasn’t paid the bill and Sonora Regional’s finance department is supposed to resubmit its claim to Anthem.
“There are people out there that may have paid the bill not knowing they were being billed out-of-network. Some people are elderly and don’t understand and say ‘oh there’s a bill, I’ve got to pay it,’” Vann said. “You pay considerably more for out-of-network visits.”
People who received similar bills should contact the hospital’s finance department at 536-3900, Jahn said.
The dispute could affect several of the 1,912 Tuolumne County residents who enrolled in an Anthem plan.
For the full story, see the July 3, 2014, edition of The Union Democrat.