Enloe Medical Center issues contract termination notice on Medi-Cal Managed Care contract with Anthem Blue Cross

09.18.2020

CHICO, Calif., Sept. 18, 2020 Enloe Medical Center recently sent a contract termination notice to Anthem Blue Cross in order to renegotiate its Medi-Cal Managed Care contract. The contract specifies the rates that will be paid to Enloe for services received by patients insured through Anthem’s Medi-Cal plan. The contract is unrelated and separate from the Anthem Blue Cross commercial insurance contract with Enloe Medical Center.

Although Enloe’s preference is to remain contracted with Anthem for Medi-Cal Managed Care, without an equitable agreement, the contract’s last effective date will be Oct. 31, 2020. In the event of contract termination, many patients in active treatment and insured through Anthem Blue Cross may be able to continue through their pre-authorized care plan at Enloe. That determination is made by Anthem Blue Cross.

“Enloe Medical Center is a critical piece of the health care system for our region, and the current rates paid by Anthem for Medi-Cal Managed Care patients do not fully cover the cost of care,” said Enloe President and CEO Mike Wiltermood. “Enloe is asking only for reimbursement rates on par with like insurance payors.”

To open contract negotiations, Enloe submitted a proposal for a fair rate increase. Anthem countered with a rate reduction and a one-time COVID-19-related payment, which all together would result in a lower reimbursement rate for Enloe Medical Center, during the next contract period. Before receiving Enloe’s response to this offer, Anthem rescinded the one-time payment, further reducing the overall proposed contract rate. Based on Anthem’s lack of cooperation in negotiating a fair and equitable agreement, Enloe expects the contract will terminate as scheduled at 11:59 p.m. on Oct. 31, 2020.

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

“Anthem Blue Cross is a for-profit insurance company that posted significantly higher quarterly earnings during the COVID-19 pandemic,” Wiltermood said. “Anthem’s earnings exceeded $2.3 billion in Q2 of 2020, up from $1.1 billion for the same period last year. Reaching parity among insurance payors is important for the medical center, our patients and our community.”

Enloe patients who have questions related to insurance and billing may contact Anthem Blue Cross directly by calling the number on their insurance card. While Enloe Medical Center is unable to make changes to patients’ insurance coverage, Enloe’s Patient Financial Services representatives can answer questions at (530) 332-6300.

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Enloe Medical Center is a local, nonprofit health care organization. For more information, please call (530) 332-7300 or visit us online at www.enloe.org. Enloe Medical Center is located at 1531 Esplanade Chico, Calif. 95926.



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