MENDOCINO Co., 12/7/23 — The Adventist Health hospital network dropped Blue Shield of California patients from its coverage network last week after what the healthcare company said were 11 months of failed negotiations on reimbursement rates.
That has customers in Mendocino, San Joaquin, and other counties scrambling to find solutions after receiving letters from Adventist after their coverage was interrupted.
A Facebook post from Adventist on Dec. 5 announcing the development that occurred on Dec. 1 was met with frustration.
“No excuse for this or for notifying people after the fact,” said a comment from John Redding, who previously sat on the Mendocino Coast Health Care District board and ran for supervisor in District 5.
“This could cost people their lives!” wrote Charlotte Anne Smith.
“This is TERRIBLE NEWS for our rural community members,” said commenter Gina Balassi.
Statewide, Blue Shield has 4.8 million customers. The Oakland-based company generates $24 billion in annual revenue, according to its website.
Blue Shield said it had reached its limit of what it was willing to pay.
“There have been extensive renewal negotiations with Adventist Health for nearly a year to reach a reasonable agreement on reimbursement rates and contractual terms that keep care sustainably affordable for our members. We are disappointed to have not been able to reach a new agreement with Adventist Health following their notice to terminate our existing contract, and we regret the inconvenience this causes our customers and members,” said Aliza Arjoyan, Blue Shield’s Senior Vice President of Provider Partnerships and Network Management.
Adventist stopped accepting the insurance carrier at its 17 hospitals in the state, including Adventist Health Howard Memorial, Adventist Health Mendocino Coast and Adventist Health Ukiah Valley in Mendocino County, and Adventist Health Lodi Memorial in San Joaquin County.
A similar dispute between Adventist and Anthem Blue Cross was resolved last year without patients losing coverage, but that negotiation included two extensions of deadlines set by the company (read our previous coverage here.)
Representatives for Adventist did not respond to questions by the time of publication, but recommended on its website that customers request a continuity of care waiver from Blue Shield for continuing coverage. Blue Shield said it will still cover the cost of emergency services.
In the meantime, negotiations could continue despite the disruption to coverage.
Adventist said it remained open to discussions and would post updates on its website.
Blue Shield also said that it wanted to continue to try to resolve the impasse.
“Our sincere hope is that we can continue the dialogue with Adventist Health leadership and establish a new contract that enables our members to access high quality care at Adventist Health hospitals at an affordable price,” said Arjoyan.
Adventist Health recorded $5.4 billion in operating revenue in 2022, an increase of 3.6 percent, but its operating costs went up by 5.3 percent. The nonprofit entity’s investment portfolio lost $319 million in 2022.
The company said on its website that negotiations are “fluid.”
“We believe you have chosen to receive your healthcare services from Adventist Health because you recognize our high standards of quality and the valuable services we provide to our community,” the company’s statement said.
Editor’s note: this story was republished in partnership with Bay City News.
Adventist Health creates a monopoly in Mendocino County and then pulls the health care rug out from thousands of county residents. Sweet!