This is Bullshit: Local Adventist doctors refusing Obamacare patients… [Updated]



Official Statement Regarding Covered California Anthem Blue Cross Pathways PPO

Good afternoon,

An article was published in today’s Ukiah Daily Journal (see below) about Covered California Blue Cross Individual Pathway PPO insurance plans and its impact on patients in our clinics and hospital. Many of the facts included in the article were inaccurate. So, it is our intent to clarify the facts and make you are aware of our next steps. The attached statement helps to provide answers to many of the questions being asked by patients.

All of us at Frank R. Howard Memorial Hospital and Ukiah Valley Medical Center and our clinics are committed to helping patients receive access to quality care. We are making sure our physicians and staff are well versed on this issue so they can address questions from patients. We are also reaching out directly to affected patients who are enrolled in these plans and who sought services at the clinics during the affected timeframe from January 1, 2014 – April 1, 2014. In turn, Blue Cross is also re-issuing an accurate list of providers that do have contracts under this plan.

As many of you are aware, this situation is not exclusive to Ukiah. It is happening in many other communities throughout California. We will continue to keep you updated as this situation works toward a resolution.


Nick Bejarano, Frank R. Howard Memorial Hospital, Ukiah Valley Medical Center Regional Corporate Development and Communications Manager, Ukiah

See also UDJ followup article

From Ukiah Daily Journal 

Reimbursement not enough according to Adventists…

[What To Do? Call and give them a piece of your mind about their greed at the top! ~DS]

Adventist Health clinics aren’t accepting the Anthem Blue Cross Pathways PPO issued through Covered California – the state’s arm of President Barack Obama’s Patient Protection and Affordable Care Act. Covered California says patients must wait until the fall for the release of a new list of doctors who will accept it.

Anyone who signed up for the plan and has visited a local Adventist Health doctors group, or who wants to see their regular doctor at one of them, should do so knowing they will need to wait until fall to find out whether insurance under Covered California will be accepted, according to Nick Bejarano, spokesman for Ukiah Valley Medical Center, which is owned by Adventist Health.

A local business owner who purchased the Anthem Blue Cross Pathways PPO under Covered California said she got a bill in the mail for nearly $500 after being told her provider was covered for the plan, and was told when she called to question the bill that the clinic she visited wasn’t “on the network.” Hillside Health Clinic in Ukiah, she noted, does take the plan.

The hospital, Bejarano said, accepts the private-payer plan, but until further notice, Adventist Health’s network of clinics don’t.

“We want people to know that the clinics are not accepting that insurance, and we’re holding billing till we know who is not an accepted provider,” Bejarano said, adding that Adventist Health is in negotiations with Blue Cross in the meantime.

The clinics that don’t accept Covered California’s Anthem Blue Cross Pathways PPO include the Ukiah Valley Rural Health Center across from UVMC on Hospital Drive, one of the largest groups of doctors in Ukiah. The list also includes the UVRHC location on Dora Street in Ukiah; the Ukiah Valley Women’s Health Clinic on North State Street; the Adventist Heart Institutes in Ukiah and Lakeport; the Ukiah Valley Medical Specialties-Gastroenterology; Ukiah Valley Medical Specialties-Orthopedics; the Advanced Wound Clinic; the Redwood Medical Clinic in Willits; the Fort Bragg Rural Center; Fort Bragg Medical Specialties; and Mendocino Family Care.

The doctors at those clinics were originally on a list of covered providers Blue Cross provided during the Covered California enrollment period at the beginning of the year, according to Bejarano, but Adventist Health found out at the beginning of April that the clinics were removed.

“When they first released a map of doctors that were covered in certain geographical areas (for that plan), our clinics were on that list,” Bejarano said Monday. “Later on … Blue Cross removed that list and said it was a mistake.”

Bejarano said in late April that the reason the clinics couldn’t accept the Blue Cross plan is that the offered reimbursement for it “changed abruptly” and was “slightly less” than what was originally understood.

“As part of Adventist Health’s mission to help our community gain access to care, we will be reaching out directly to affected patients who are enrolled in these plans and who sought services at the clinics (above) between January 1, 2014 and March 31, 2014,” according to a statement Bejarano issued Friday.

Anyone who has been a patient at any of those clinics between January and the end of March, or who would like to keep seeing their regular doctor at one of them, may call the Department of Managed Health Care at 1-888-466-2219; Covered California at 1-800-300-1506; or Anthem Member Services for Individual Plans at 1-866-791-5538.


Well, there’s small bullshit and Big Bullshit.

That we were going to get the later was obvious as soon as former Democratic Senator from Montana, Max Bacaus, had the single payer advocates dragged out of the pitiful Affordable Care Act hearings. The rules were essentially written by lawyers for the so-called Health Care Industry, and now we’ll all be drowning in the fine print of the former. We were told to Hope for Change. We have it.

One doc emailed me today to say that he is seeing patients anyway and feels this story unfairly maligned local doctors. He said the decision not to accept the insurance was made at some higher Adventist level. He says lots of the Adventist docs are seeing patients and assuming the reimbursement will get worked out at some point. If I was a patient I’m not sure I would feel very comfortable with that. What if the Adventist decide they won’t ‘eat’ these charges at the end of the day?

The headline makes it sound like this is the Adventists idea. It might be more accurate if it said, “Blue Cross refusing to cover treatment at Adventist clinics.”

How it starts: Insurance perceives losses of income.(They need to pay that CEO 1.6 million a year) They change their mind about prices so ACA doesn’t go for increased charges, so coverage is changed. So called non-profit Hospitals see a decrease in profits, um, income, so they back off on insurance. This is happening across the US, by the way, with many major hospitals.