Our own health insurance confusion

Written by Adam Spencer, The Triplicate January 27, 2014 04:07 pm

Contrary to some reports, Sutter Coast, Anthem are in accord

When Melissa Blackburn was told last week by her local broker that the health insurance plan she had just enrolled in through Covered California was not going to cover treatment at Sutter Coast, the only hospital in Del Norte County, she was shocked to say the least.

Blackburn would have plenty of concerned company, as the Anthem Blue Cross plan she enrolled in has been popular for Del Norters signing up through the state exchange.

“The bulk of our people are on Anthem Blue Cross,” said Steve Hendricks, an insurance broker at Western Valley in Crescent City.

But the information was wrong, one more sign of the confusion swirling around health insurance right now. Sutter Coast is in the network of providers for Anthem Blue Cross plans acquired through the exchange, even though this is not reflected on Covered California’s website.

“We’re pleased to be able to say that our doctors and hospital are able to provide high quality services as part of the Anthem network,” said Jeremy Davis, associate administrator for Sutter Coast Hospital.

The Covered California website should soon reflect that Sutter Coast is in network.

“Keep in mind our directory is a guide only and consumers should really check with the doctor, hospital or clinic to be sure they take the coverage they purchase,” said Roy Kennedy, a spokesman for Covered California, in an email.

The fact that contract negotiations between Anthem Blue Cross and Sutter Health were not finalized until Dec. 16 could have contributed to the confusion on Covered California’s website, according to Anthem representatives.

The inherent hiccups that come with enrolling thousands of new consumers caused Anthem Blue Cross to extend the payment deadline for the first premium to Jan. 31.

Even though many new enrollees have not yet received their insurance card or been able to successfully pay their first premium, they still have health coverage if they signed up before Dec. 24, according to a representative of Anthem Blue Cross.

“We’re working to get people through the system as quickly as possible, and if they need medical care and they haven’t received their card they should contact us at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it or call 1-855-634-3381,” said Darrel Ng, public relations director for Anthem Blue Cross.

Millions of Americans are signing up for health insurance through state and federal exchanges, many for the first time.

The customer service lines of insurance companies have been swamped, with many people requiring explanation of health insurance terms and protocol, increasing the length of an average call, Ng said.

“Adding several hundred thousand people on the same day is challenging for any organization, but we’re working with Covered California to get everyone enrolled as quickly as possible,” Ng said.

Marian Mulkey, an Affordable Care Act expert with the California Healthcare Foundation, a philanthropic group that advocates to improve health care in the state, said that the complications of health insurance aren’t new — just new for some enrollees.

“There were real issues before the ACA was passed and suddenly a lot more people are trying to make an informed choice,” Mulkey said. “Many of the people looking at these options didn’t have insurance at all, they couldn’t buy individual products or they couldn’t afford it and now they’re looking at this with a different lens.”

One of the concerns of new Anthem Blue Cross enrollees is if Valley Emergency Physicians, which operates Sutter Coast’s emergency room, are in the Anthem network. But since all Anthem plans cover emergency care, regardless of the facility, it becomes moot.

“Regardless of what plan you have we cover emergencies,” Ng said. “If you’re unconscious, you can’t request that the paramedics take you to an in-network facility.”

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