Covered CA snags irk Anthem customers

By Lacey Peterson, The Union Democrat

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.

The Union Democrat
This image is copyrighted.

Reach all of Sonora, Calaveras County, Tuolumne, Angels Camp, Twain Harte, & Jamestown with your items to sell.

Ads appear Online and in Print

View Classifieds Place an Ad

Connect with The Union Democrat

Union Democrat Newsstand

Saturday October 22, 2016

Read digital interactive editions of our publications

Read Today's Edition Take A Tour

More Publications by The Union Democrat

View All Publications
Columbia Elementary board ousts superintendent


Five days after receiving a 2 percent raise, Columbia Union School District ... more

Paying the price


Chris Lusardi, of Sonora, is one of thousands of Tuolumne County residents ... more

Sheriff details investigation of Marshall murder-suicide


Philip Marshall acted alone in killing his two teenage children, a pet ... more

Mudslide knocks out a portion of TUD’s ditch system


The Columbia ditch will be closed until Saturday, following a mudslide that ... more

County wants changes on wildfire risk assessment


Tuolumne County officials are preparing to fight in Sacramento for local residents ... more