Sansum/Sutter and Anthem Reach Agreement on Health Insurance Contracts for 2025

Agreement Allows Patients to Keep Their In-Network Doctors and Care Centers Through Sansum

Sansum Clinic Corporate Office | Credit: Courtesy

As a contract deadline approached on December 31, 2024, negotiations between Sansum Clinic/Sutter Health and Anthem Blue Cross reached a new agreement that could affect more than 129,000 patients. Sansum is the largest nonprofit medical group for outpatient care in the Santa Barbara area.

The agreement allows patients to keep their in-network doctors and care centers through Sansum. The new agreement covers patients enrolled in Anthem Blue Cross HMO (health maintenance organization), PPO (preferred provider organization), and EPO (exclusive provider organization) health-care policies, as well as Medi-Cal and Medicare Advantage insurance. Had negotiations failed, the patients would have faced higher out-of-network costs or the need to change care providers.

Both Sutter and Anthem executives expressed their pleasure in having reached an agreement at the first of the year. Sutter CEO Warner Thomas, who presides over the Sacramento-based group, which absorbed Sansum in October 2022, said the new agreement “continues to ensure patients’ access to the doctors, nurses and clinicians they trust and the care they depend on.” He added that the nonprofit Sutter planned to open “dozens of new care centers and adding clinicians to our network — approximately 1,400 clinicians over the past two years — and investing in community clinics and organizations to improve overall community health.”

Previously, the Independent had reported on Sansum’s similar negotiations involving Blue Shield of California’s Medicare Advantage HMO clients. The talks fell through, and insureds would have had to switch policies by December 7. Patients who had not sought alternate Medicare coverage are to be reassigned to non-Sansum doctors this year. Other Blue Shield policies — HMO, EPO, and PPO policies — were able to continue. A Sansum representative stated, “While we look forward to being able to care for Blue Shield members with commercial HMO, EPO and PPO products, we are disappointed that Blue Shield opted to no longer include Sansum Clinic in-network for members with the Blue Shield Medicare Advantage HMO, effective Jan. 1, 2025.”

While the Anthem Blue Cross insurance appears unchanged, a press release from Sutter and Anthem offered these links for up-to-date information:
https://www.anthem.com/ca/sutterhealth/
https://www.sansumclinic.org/patient-information/billing-and-insurance/insurance-plans-healthcare-networks/health-insurance-plans
https://www.sutterhealth.org/anthem