Service interruption

Enloe, Anthem cut ties; patients caught in limbo

Mike Wiltermood, Enloe Medical Center’s CEO, says Anthem was not willing to negotiate a fair contract.

Mike Wiltermood, Enloe Medical Center’s CEO, says Anthem was not willing to negotiate a fair contract.

CN&R file photo

Questions answered:
For information about coverage at Enloe with Anthem insurance, go to Medi-Cal and Medicare patients are still covered, as are some procedures and ongoing care.
For info on Anthem’s coverage locally, call the number on the back of your insurance card.

Many of Chico’s largest employers offer health insurance plans through Anthem Blue Cross—Chico State, Chico Unified School District, the city of Chico, Sierra Nevada Brewing Co. And starting Nov. 1, those employees—plus the thousands of others insured through work at smaller companies or through Covered California—can no longer seek most services at Chico’s largest hospital, Enloe Medical Center. At least not if they want those services to be billed as “in network.”

“We have 900 lives on our insurance plan—that includes dependents, retirees, etc.—so this is having a huge impact on the city of Chico,” said Jamie Cannon, human resources and risk manager for the city. “Of our four plans that we offer, one of them is now inoperable with Enloe. The other three have become out-of-network benefit payments only.”

The reaction Cannon has seen, she said without hesitation, was “panic.” To add to that, the city’s open enrollment ended Oct. 31, a day before the announcement that Anthem and Enloe had cut ties. She immediately sprang into action. “We reopened open enrollment through Nov. 16 and scheduled meetings for four different information sessions, in addition to fielding individual phone calls.” All of the city’s plans are with Anthem and go through 2020.

Panic is a word that worries Enloe.

“We want to make it clear that if you’re in an emergency, we will take care of you,” said Mike Wiltermood, Enloe CEO. “We’ll do what we can to make sure nobody gets a surprise bill at the end of their stay or experience with us.”

He was speaking to the CN&R by phone two days after sitting down with Anthem representatives to work out a contract and a day after announcing no deal had been reached. “Anthem Blue Cross has historically underpaid,” he explained. “They pay us 40 percent less than Blue Shield, and the disparity is getting bigger and bigger.”

But Enloe didn’t cut ties with Anthem overnight, Wiltermood stressed. The hospital had sent a letter to the insurer in May requesting revised rates, with an expiration date of Nov. 1. It wasn’t until Oct. 30 that Anthem agreed to sit down and discuss the matter with Enloe, he said.

“For Anthem to just say, ‘Oh well, I guess we’ll give you an hour two days before the deadline’ shows that they care more about their stockholders than they do about their enrollees,” he said.

Everyone who carries Anthem Blue Cross insurance and relies on Enloe for care is getting caught in the crosshairs. In speaking with people for this story, the overall reaction has been worry—and anger.

One woman, who had a planned hysterectomy coming up at Enloe, feared a huge bill. “Should I even go to my pre-op appointment?” she wondered. (Procedures that were planned before Nov. 1 will still be covered by Anthem, up to 180 days out.) Another woman expressed frustration that she’d have to find a new OB-GYN and, if she planned to have a child, look elsewhere for delivery. (Women who were pregnant before Nov. 1 and were on an Enloe birth plan are covered through pregnancy.)

The scenario forces some patients to look elsewhere for care. Others will put off care due to the inconvenience.

Wiltermood regrets the impact this decision is having on the community, but for him it’s about standing up to a bully. As a regional—but rural—medical center, Enloe doesn’t see the same reimbursement rates that facilities in bigger cities like Sacramento or San Francisco do. Because of that, he argues, Chico hasn’t been able to attract physicians from those areas. In fact, Chico is about 25 to 30 primary care doctors short for an area its size, Wiltermood said.

“Physicians in major metropolitan areas are getting two to three times as much as physicians here in Butte County,” he said. “They’ve squeezed primary care doctors until there’s nothing left to give.”

There’s data to back him up. According to statistics compiled by the Rural Health Information Hub, overseen by the U.S. Department of Health and Human Services, rural areas tend to have fewer health plans available, pushing premiums—the amount enrollees and employers pay for coverage—up due to lack of competition. Meanwhile, reimbursement rates tend to be low.

Anthem provided a statement in reply to multiple requests for an interview.

“We are negotiating in good faith to bring Enloe back into our network of care providers as soon as possible,” it reads. “In the meantime, consumers can access care at one of the many providers in the area who remain in our broad network.”

Wiltermood contends that the negotiators he met with last week were unfamiliar with Butte County specifically and did not understand how far some people may have to travel for certain types of care without access to Enloe. For instance, Enloe is one of only two Level II trauma centers north of Sacramento. “They should take that into consideration when looking at access,” Wiltermood said.

Anthem did not reply to questions clarifying the breadth of its network in Chico currently, and its website was not up-to-date regarding in-network providers at press time.

Wiltermood urged people to call Anthem if they are concerned about access. He said Enloe also welcomes feedback.

“The difference is, we have to live in this community; Anthem doesn’t,” he said. “The more they hear about the struggles, the more likely they might be to work something out with us.”