Anthem Blue Cross, Stanford in contract fight

September 2, 2011 12:39:44 AM PDT
One of California's largest insurers is in a major contract fight with Stanford and as a result, patients are caught in the middle. As of today, Stanford Hospital and clinics is no longer part of the Anthem Blue Cross network.

Members of Anthem Blue Cross being treated at the hospital right now are not going to get kicked out, but patients should expect some changes to their coverage.

"It's on the pituitary gland, which is if you had three axis straight into your head, it's basically dead center of your head," said Shannon Maxham.

Shannon had a tumor on her pituitary gland that was removed four years ago. She had her surgery at Stanford University Medical Center where she says she had the best care and the best doctor.

"He had pioneered this particular surgery that made it less invasive. If you were to drop this doctor's name anywhere in this particular field everyone would be like, oh that gentleman, yes," said Shannon.

But Shannon and her husband Mark are now worried. They're members of Anthem Blue Cross which as of Sept. 1, no longer has a contract with Stanford Hospital and clinics, which includes Stanford University Medical Center, Lucile Packard Children's Hospital and Stanford Medical Group.

Anthem and Stanford have been negotiating for months, but have been unable to reach a new contract.

"We've got an ongoing relationship with Stanford. My wife comes and gets her regular check-ups, she's had surgery there four times. If they said, 'Sorry, you can't have that anymore, I don't know where I would go,'" said Mark.

Negotiations between the two sides are continuing and for now, Anthem Blue Cross members may still receive care at Stanford. However, a hospital spokesperson says, "...During what we hope will be a temporary and interim period, Anthem Blue Cross HMO members should continue to work closely with their primary care medical group for approval and authorization. Anthem Blue Cross PPO customers may have different co-pays and deductibles but should continue to have access to SHC (Stanford Hospital and Clinics) and LPCH (Lucile Packard Children's Hospital) facilities and physicians."

Shannon and Mark hope Anthem and Stanford come up with an agreement soon. They've grown to trust their doctors and don't want to be forced to find care elsewhere.

"With the relationship I've gotten with them, it would be kind of unnerving to kind of have to start from scratch," said Shannon.

Neither side will reveal details of the negotiations, but the sticking point appears to be reimbursement rates.


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