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Rift between Adventist and Blue Shield could hit California patients – San Francisco Chronicle

Emergency department physician Sarah Dunn examines a patient at Adventist Health Hospital in Sonora on March 28, 2022. Thousands of Californians are facing rising medical costs after contract negotiations between Adventists and California insurance company Blue Shield have collapsed.

Max Whitaker/Chronicle Special Feature

Contract negotiations between Adventist Health and Blue Shield of California, the state's major health care provider and health insurance company, respectively, broke down last week, leaving thousands of Californians unable to get to their nearest hospital. You may have to pay for out-of-network medical care.

Adventist Health and Blue Shield have been negotiating for a new agreement for about 11 months, but were unable to reach an agreement on reimbursement rates by the time the previous agreement expired on Dec. 1. . That means anyone with a Blue Shield plan could have their contract canceled. You may have to pay higher prices for out-of-network hospital services, such as lab tests or imaging tests, or you may have to travel long distances to receive treatment at an in-network hospital.

This development affects all 17 of Adventist's hospitals in California, including Adventist Health St. Helena and Adventist Health Mendocino Coast. This applies to people with Blue Shield Commercial, Medicare Advantage, and Medi-Cal managed care plans.

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Services at most Adventist outpatient clinics will not be affected. These services are covered under a separate contract that is scheduled to expire in March or April 2024.

Blue Shield will continue to cover emergency medical care, the insurer said.

Adventists also have agreements with insurance companies Anthem and Aetna that patients in affected areas who wish to continue covered hospital services can contact those insurance plans.

It is not clear how many people will be affected by the interruption of coverage. But in Tuolumne County alone, more than 6,000 Blue Shield members are no longer eligible for hospital services at Adventist Health Sonora, an Adventist spokesperson told the Union Democrat.

In some rural areas of the state, including Mendocino County, Adventist is the only hospital or the closest hospital for miles, making it difficult to drive further or pay more for in-network care. The situation is particularly worrying for Blue Shield patients, who may have to pay the costs. This is to pay for Adventist treatment, which is currently considered out-of-network.

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Contract negotiations between health care providers and insurance companies are common, and disputes over reimbursement rates often arise. In these cases, both parties may agree to extend the contract by several months to give the patient more time to negotiate without interrupting the patient's insurance.

Nurses walk through Adventist Health Ukiah Valley Hospital on August 25, 2021. Thousands of Californians are facing high medical costs after contract negotiations between Adventists and insurance company Blue Shield of California collapsed.

Nurses walk through Adventist Health Ukiah Valley Hospital on August 25, 2021. Thousands of Californians are facing rising medical costs after contract negotiations between Adventists and insurance company Blue Shield of California collapsed.

Diane Fitzmaurice/Chronicle Special Feature

Adventist and Blue Shield both expressed regret that they were unable to agree on the terms of the new agreement and indicated their intention to continue discussions.

“We are extremely disappointed that we were unable to reach an agreement with Blue Shield,” Adventist said in a statement. “We remain open to discussion and will provide updates if the current situation changes.”

Adventists said in case of emergency, patients should go to the nearest hospital, regardless of insurance or ability to pay.

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Adventist said some people may be able to continue receiving hospital services at in-network rates by applying for “continuation of care” benefits from Blue Shield. This may be granted if the hospital closest to the patient's home is more than 30 miles away from her, or if a provider in the patient's network is unable to provide the needed service.

“It is our sincere hope that we can continue our dialogue with Adventist Health leadership and establish a new agreement that will provide quality care to our members,” Blue Shield said in a statement. “We sincerely apologize for the inconvenience caused to our customers and members.

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