Has Sutter Health seen the light and adopted a friendlier face ?
It might seem so according to a letter sent out to PERS members residing in Del Norte County which outlines a new health care offering to PERS members as a result of collaboration between Sutter Health Corporation and PERS/Anthem/Blue Cross. An open enrollment period began Jan.26,2015 and extends toFebruary 20,2015. The plan offered to PERS members first requires that one live and/or work in Del Norte County to be qualified for the DEl Norte County Exclusive Provider Organization. An important stipulation that could give one pause before enrolling is that all health care providers must be Sutter Affiliated or Sutter Pacific Medical Foundation affiliated.
The offering includes the same benefits as a standard CAL PERS/Anthem/ Blue Cross HMO except the member need not select a Primary Care doctor. Also a $15.00 co-pay per office visit, no out-of pocket cost for hospitalization and access to online health management resources sweeten the pot.There would not seem to be any conceivable reason not to enroll since there are no additional fees , costs or effort involved other than simply signing up.
So far so good.
It might behoove the potential enrollee, however, to call the PERS phone number (1-877-737-7776) and request a list of network providers or online go to www.anthem.com.ca.calpers and click and download“find a doctor.” It is not exactly what might be termed a pretty picture when one sees the list of specialists that, although Sutter Affiliated, are excluded from the list of eligible specialists. For instance, if under this plan you find yourself in need of a urologist you’re out of luck. Or if you find yourself in need of the services of an orthopedic surgeon you may consider yourself lucky to be served by a hoped-for replacement of the soon exiting orthopedist. There is, of course, a long established resident orthopedic surgeon and although Sutter affiliated he was DE-selected as a provider. It is the same story for the optical specialists who, though a stone’s throw from Sutter Coast are out of network, and therefore unavailable for the EO. Unless special provision exists the unexpected need for medical providers while traveling may be a cause for dismay when billing time rolls around and the Del Norte EPO member opens the envelope from the out of network provider. One is foolish to take it for granted that EPO Del Norte covers your travels.
The bigger picture, however, lies in the fact that once Sutter Health squeezes out the local independent providers they will eventually be forced to close their doors and move away. Crescent City Walmart clearly demonstrates what happens when a mega corporation gains a foot hold in a community. The generous inclusion of PERS non-Medicare members into the EPO Del Norte plan turns out to be an investment for the corporate giant and besides the tax write-off it will have attained near total dominance in health care in the county. That is spelled MONOPOLY.
Crescent City, Ca