Sutter seeks extended transition period with Blue Shield

Sutter Health has suggested giving Blue Shield of California members continued access to their Sutter doctors throughout 2015 by extending a transition period while contract negotiations continue.

Sutter’s proposal would stretch the transition through the end of 2015 under the same rates and terms of its previous contract with Blue Shield. An agreement between Sutter and the insurer expired Dec. 31, threatening to block access for affected consumers to Sutter hospitals and clinics in Northern California.

People with Blue Shield HMO coverage in Stanislaus, San Joaquin and Merced counties will need to change doctors the first week in April if the parties do not agree to terms of a new contract. The transition period runs until June 30 for those with PPO plans.

“Our proposed longer-term transition agreement would help ensure patients have continued access in 2015 to the doctors Blue Shield promised them during open enrollment,” said Dr. Stephen Lockhart, chief medical officer of Sutter. “We believe employers and Blue Shield members deserve the network they purchased.”

A spokesman said Blue Shield is reviewing the offer. “In these matters, the details are always more complex than what was stated in Sutter’s press release,” said Steve Shivinsky of Blue Shield. “We remain hopeful that we can negotiate a contract that will allow us to provide our customers affordable access to Sutter providers under fair and reasonable terms.”

Sutter said it proposed extending the transition period during talks with Blue Shield on Monday.

This month, Blue Shield sent contract cancellation notices to 280,000 members who are possibly affected in Northern California, explaining the transition process. No patients will need to make changes if a new pact is negotiated and signed before March 31.

Sutter Spokesman Bill Gleeson said Blue Shield easily could agree to a yearlong transition by locking in the 2014 rates and terms. “I am surprised they did not respond immediately with an acceptance,” Gleeson said, noting that cancellation letters create anxiety among patients.

Kathy Hamstengel of Ceres was not happy with the cancellation letter she received. She has gone to Sutter Health physicians for many years. “If they can keep us with our doctors, that is fine, but it would be nice if they would negotiate a contract and have it set in stone,” Hamstengel said.

Blue Shield charges that Sutter has driven up rates in the past 14 years and its prices are higher than those of other hospital chains in California.

Sutter has countered that Blue Shield wants significant reimbursement cuts that would devastate Sutter’s ability to provide medical services patients need. The Sacramento-based nonprofit health system is affiliated with Memorial Medical Center of Modesto, Sutter Gould Medical Foundation, Sutter Tracy Community Hospital and Memorial Hospital Los Banos.

This story was originally published January 20, 2015 at 6:53 PM with the headline "Sutter seeks extended transition period with Blue Shield."