Sansum Gets in Health-Care Exchange

Sansum executive Kurt Ransohoff announced Friday that Sansum Clinic has finally struck a deal with one of the three health-care insurance exchanges selling policies on the Central Coast as part of the troubled Affordable Care Act, aka CoveredCA.com in California. Ransohoff said Sansum negotiated an agreement with the Blue Cross PPO, meaning that individuals purchasing this policy can seek treatment with Sansum medical professionals. Because it’s a PPO policy — as opposed to an HMO — subscribers can also seek treatment outside of Sansum, though the network of health-care providers is expected to be relatively narrow. It remains uncertain which doctors — outside of Sansum’s network — are part of this system. Ransohoff said many of medical professionals might not know themselves.

Until Sansum struck a deal with the Blue Cross exchange, Sansum — by far the biggest medical-care provider in the county — was off-limits to health-care consumers required to obtain new insurance policies by the Affordable Care Act. When enrollments began October 1, it came as a shock to the community at large that none of the three exchanges offered in Santa Barbara by Covered California had signed service agreements with Sansum. At that time, Ransohoff disclosed he’d been notified by the exchange providers that Sansum was not included, in part because Sansum had not responded to letters of inquiry the exchanges had sent. Ransohoff noted that there was no record of such letters ever being mailed to Sansum.

Far more problematic in terms of subsequent negotiations has been the issue of reimbursement. Ransohoff said that the exchange providers serving Santa Barbara — Blue Cross and Blue Shield — were offering to reimburse Sansum at unacceptably low rates. Then as now, Ransohoff has shied away from divulging actual numbers, but others at the clinic have suggested the exchange providers were offering to pay Sansum 40 percent less than what the clinic takes in from insurance providers now. Ransohoff said he was not at liberty to reveal the terms and conditions ultimately agreed to with Blue Cross, but said, “We found a point in the middle we could agree to.” No deal, however, was arrived at with either of the two other exchanges, Kaiser or Blue Shield. Kaiser does not provide care to Santa Barbara, so its loss will not be felt.

Sansum’s Ransohoff warned that the news is sufficiently fresh that it will take the Covered California website a couple weeks at least to reflect this. He noted that in District 12 — Santa Barbara, Ventura, and San Luis Obispo counties — 1,500 individuals enrolled in one of the three exchanges during the month of October. What the projections were for that month, he did not know. Of those, he said 80 percent needed no subsidy.