Enloe threatens to terminate Medi-Cal contract with Anthem Blue Cross

CHICO » Enloe Medical Center could terminate its Medi-Cal contract with Anthem Blue Cross if an agreement on reimbursement rates is not reached.

In Butte County, approximately 22,500 people are covered by the Anthem Blue Cross Medi-Cal Managed Care plan. For 2020, Enloe Medical Center negotiated a contract for Medi-Cal Managed Care services with California Health & Wellness with fair payment for hospital services.

The current contract specifies the rates that will be paid to Enloe for services received by patients insured through Anthem’s Medi-Cal plan, separate from the Anthem Blue Cross commercial insurance contract with Enloe Medical Center.

Without an agreement, the contract’s last effective date will be Oct. 31.

Many patients in active treatment insured through Anthem Blue Cross may be able to continue through their pre-authorized care plan at Enloe — but that will have to be determined by Anthem Blue Cross.

Enloe president and CEO Mike Wiltermood said the current rates paid by Anthem for Medi-Cal Managed Care patients do not fully cover the cost of care — “Enloe is asking only for reimbursement rates on par with like insurance payors.”

As part of contract negotiations, Enloe submitted a proposal for a fair rate increase. Anthem proposed a rate reduction and a onetime COVID-19-related payment, which all together would result in a lower reimbursement rate for Enloe Medical Center, during the next contract period, the hospital said.

According to Enloe, Anthem then rescinded the one-time payment offer. Enloe expects the contract will terminate as scheduled Oct. 31.

“It’s disappointing that in the midst of an ongoing pandemic Enloe Medical Center would signal its intent to terminate its hospital contract with us. Consumers need stability and continued access to affordable health care services,” Anthem Public Relations Director Michael Bowman said.

“Anthem Blue Cross remains committed to working in good faith to negotiate a new agreement that will help safeguard quality of care and access for consumers, and we hope Enloe shares that commitment and will put the needs of consumers and the community first. Given Enloe’s action, which is similar to our past dealings with them, Anthem is acting now to ensure that in the event a new agreement is not reached before Oct. 31, there will be a seamless transition to other providers for our members.”

Enloe patients who have questions about insurance and billing will have to contact Anthem Blue Cross directly by calling the number on their insurance card, and Enloe’s Patient Financial Services representatives can answer questions at 332-6300.

There is still support offered by Anthem for health plan members who are fire survivors. Effective Aug. 18 until further notice, Anthem offers revised services to affected members, including a 30-day emergency prescription refill of maintenance medication, replacement of durable medical equipment and supplies and a 30-day leniency period for affected members to make their premium payment due dates.

Anthem members and emergency personnel affected by the wildfires can access Anthem’s Employee Assistance Program that provides free support services to help with crises and financial or legal concerns, at the crisis line tollfree at 1-877-208-8240. Free access to Anthem’s telehealth service LiveHealth Online provides 24/7 video access to health providers for non-emergency health conditions and access to licensed psychologists on personal mobile devices, at www.livehealthonline.com or 1-888-548-3432.

Contact reporter Natalie Hanson at 530-896-7763.