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Questions Remain Over Sutter’s Exclusion of Local Physicians

In an effort to clear up the confusion surrounding the Sutter Health/Anthem Blue Cross/CalPERS Del Norte County EPO health plan, this article provides the history and current status of the plan’s roll out, whereby local physicians not affiliated with Sutter were excluded from the plan.  As of now, my office is not a participating provider, but we have contacted Sutter and Anthem several times in an effort to learn about the plan.  To date, neither Sutter or Anthem has sent us any plan information.

The background:  Three weeks ago, several patients approached our office with letters from Sutter Health/Anthem Blue Cross/CalPERS, offering a new health plan in our area.  We were not offered to be plan providers.  Prior to patients bringing in their letters, we were not aware that a new health plan was being offered locally.

The list of participating doctors included only Sutter affiliated providers (two of whom had already left the area).  None of the non-Sutter doctors, nurses, or physician assistants I contacted in Crescent City or Brookings were offered to be on the plan’s provider panel.  (The plan is an “EPO,” or Exclusive Provider Organization. The plan restricts hospital care to Sutter Coast Hospital, and requires office care to be coordinated by providers on the approved list, except for emergencies).

Why were the non-Sutter physicians left off the provider panel?  According to a senior Anthem Blue Cross official, Sutter Health was “taking the lead” on the provider list.

Yesterday brought a sudden turnaround.  Following articles detailing the facts of Sutter’s new plan published in Crescent City Times and The Del Norte Triplicate, a Sutter official sent us a very unusual email.  Sutter advised that unless we notified them of our objection, Sutter would begin advertising independent physicians in the local paper as participating providers.  (Remember, Sutter has still not answered my questions about the plan or sent a contract explaining how the plan will affect patient care).

So as of today, we are still awaiting information from Sutter.  We are interested in participating in the plan, but we need to know about the plan, including its restrictions on where patients may receive treatment, before we agree to participate.

Many thanks to the friends and patients who brought us their information about the new health plan.  Please keep your ideas coming on how we can expand and improve local healthcare.

 

Sincerely,

Gregory J. Duncan, M.D.

Diplomate, American Board of Orthopedic Surgery
Crescent City, Ca

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