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.”
