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Insurance contract disputes: when the odds are not in patients’ favor

A California payor and provider are in a contract dispute. And patients are in the crossfire.

They say all’s fair in love and war. Well, not when it comes to health insurance contract disputes.

At least, such is the case for one local community in California.

Adventist Health is a non-profit health system that owns and operates more than 20 hospitals and medical facilities in states including California, Oregon, and Hawaii. Adventist Health Sonora also happens to be the only hospital for residents of Tuolumne County, California.

According to a recent article, patients in Tuolumne County, California now find themselves in the crossfire of contract negotiations between their only local provider and Anthem Blue Cross. Their first extension occurred after a contract between Adventist Health and Anthem Blue Cross was set to expire in late July.

“It all comes down to money,” County Supervisor Anaiah Kirk said in a statement. “I’ve heard Blue Cross has had record profits the past couple years, and that’s off the backs of people dealing with COVID. It’s just ridiculous.” Kirk – who receives Anthem Blue Cross coverage through his employer – also described the residents of Tuolumne being “used as negotiation chips.” (Sounds like most contract disputes if you ask us.)

Patients are now receiving another extension – through August 16 – amid the dispute, but the odds (surprise, surprise) don’t appear to be in their favor. If neither party can come to a resolution, nearly 13,500 families seeking care from Adventist Health Sonora, located within county lines, will be without coverage. This includes approximately 550 county government employees and their family members — which is a large reason why employees like Kirk are urging the hospital and health insurer to come to an agreement through a series of letters, sent by the County Board of Supervisors.

At that time, per the article, they put out the bat signal:

“County administrative staff were preparing the letter Wednesday and checking with other local government entities and employers, including the U.S. Forest Service and tribal governments, to see if they want to join the board and the superintendent’s office in pressing Anthem Blue Cross to come to terms on a new contract.”

At the end of the day, it’s sad, really. Defeating, even — especially in a local dynamic, where one insurer plays such an outsized role in the health of a community. With another two weeks, other entities (those which are yet to be seen) may need to put the pressure on — before thousands of people lose coverage and are forced to travel for basic health services.

So far, Bruce Wayne hasn’t left Gotham for Tuolumne, but we’re keeping our fingers crossed.

Original Article:

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