Health Insurance Matters: Blue Cross Anthem vs. Dignity Health

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People who have changed insurance companies will need to stay with the new insurance company until the annual membership period (October 15 to December 7), then any plan changes will take effect on January 1. | Unsplash / National Cancer Institute

Several weeks ago, I reported that contract negotiations between Dignity Health and Anthem Blue Cross were at an impasse and Anthem was forced to replace some of its Medicare Advantage HMO clients with new and different care providers. primary (PCP).

Locally, this meant there was no change for Drs. Customers of Gross and Finstad (and Jim Gutzman, IA). Sienna Wellness has an exclusive contract with Bakersfield Family Medical Center (BFMC) and therefore has not been affected by the Dignity contract.

The Dignity Umbrella has GemCare and QualCare IPA as its vendor groups. The loss of the Dignity contract affected Dr. Sarah Lopez and the Mountain View Clinic differently than Dr. Heather Abrahamson, the Kern Health Center, and the staff at Wofford Heights.

Anthem has two different contracts with the Mountain View Clinic. One with BFMC and the other with Dignity Health. When negotiations with Dignity ended, Anthem transferred all of Dr. Lopez’s patients and staff to the BFMC. The only negative effect is that many specialists with GemCare and QualCare IPA do not participate with BFMC, and the possibility to change your specialists is a possibility.

The situation differs with Dr Abrahamson and his staff, as they do not contract with BFMC. To retain Clinica Sierra Vista (Dr. Abrahamson and his staff) as a primary care provider, many patients had to change insurance companies. We have helped many people get a different policy, saving a lot of money on prescription plans.

As of September 1, the two parties have reached an agreement and Anthem Medicare Advantage clients who have been reassigned to a doctor in Bakersfield and other communities can return to their original medical groups. Call Anthem using the phone number on the back of your ID card to return to GemCare or QualCare IPA. Dr Lopez’s patients will have to do this if they want to keep their specialists. Dr Abrahamson’s patients will need to notify Anthem to reestablish the Wofford Heights clinic as their primary physician along with any specialists they may have.

People who have changed insurance companies will need to stay with the new insurance company until the annual membership period (October 15 to December 7), then any plan changes will take effect on January 1.

My concerns are very much shared with the needs of people with health insurance problems and that of fire. I was on vacation for much of the fire and returned on August 26th. As of this writing, I know the Kernville home and office are safe. My community is in my prayers and I take my hat off to the firefighters who protect us.

Harry Thal, the Medicare Guru in Kernville is available at 760-376-2100 for a free consultation on your Medicare issues.


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