RE the Blue Shield/Sutter issue – Jut got off the phone with my insurance agent. She says that Sutter was asking foa 140% increase in compensation from Blue Shield. So that’s the crux of the problem – Blue Shield obviously can’t cover that level of increase based on existing premium structure, and it’s too late to increase premium levels for the coming year.
Sutter asked for 140% increase??? The crux of the problem, to me, is not that Blue Shield couldn’t pay two and a half times more than they paid last year. The problem is Sutter buying up a huge percentage of doctors and hospitals, and then trying to extort customers. They want to more than double prices over a year? More than double? That’s preposterous.
OK, that’s a good question for me to ask the agent – we only had a brief conversation because of her time constraints, but she asked me to call back later. I interpreted 140% to mean a 1.4x increase – that is, that the new rates would 140% over and above the old. (i.e., a $100 charge would be a $140 charge)
You’ve introduced an alternative interpretation - that Sutter wanted to add 140% over and above the old charges … I didn’t get that impression but I could be mistaken.
Either way I don’t see how its economically feasible, because given Sutter’s dominance and the fact that they were generally excluded from the Blue Cross networks, I’m assuming that a significant percentage of Blue Shield customers are there precisely because of their dependence on Sutter. This isn’t just an ACA issue – it pretty much begins with Blue Shield’s employer policies, with the Covered California policies just being a casualty of an across-the-board impasse.
Calmom, if the charge was $100, then a 40% increase would make it $140, and a 140% increase would make it $240.
If you think that a 140% increase would make the total $140, then a 40% increase would be a decrease. That’s not the way we normally talk.
In any case, a 40% increase is already outrageous. Medical costs are barely growing at all, and they want a 40% increase? Scum.
Calmom, I understood that Blue Shield was dropping Sutter for individual and small group policies only. Do you have information to the contrary?
Actually, I don’t think you can tell me how my insurance agent “normally talks”. I had a 5 minute phone conversation and she said to call back later. I said I’d clarify with her.
Here’s the announcement posted on the “Employer Connection” Blue Shield web site:
https://www.blueshieldca.com/employer/knowledge-center/features/sutter.sp
All of the news reports seem to say that it includes ALL Blue Shield policies – I’ve seen nothing to suggest that it was limited to small group of individual policies. Where did you get that impression (link if you have it?)
“140% increase” has a particular meaning in English. It means you multiply the previous amount by 2.4. Nobody who understands numbers thinks that a 40% increase and a 140% increase are the same thing, because that does not make sense.
Returning to the Sutter-Blue Shield divorce, I’ve read several articles that suggest that the divorce only applied to individual plans, but apparently those articles were incorrect.
The fact sheet says that among those people affected are:
Fully Funded Large Employers (51+ employees): PPO, HMO, POS-HMO Tier, POS-PPO
Tier
Self-Funded/ASO Large Employers (51+ employees): PPO and EPO
@CardinalFang – I am glad to know that you have been appointed to be the universal judge of what people you have never met mean to say in casual conversations. I will try to remember to never share such information with you in the future, lest I cause your head to explode.
To anyone else who read this: I related the words I heard from my insurance agent in a brief telephone conversation, and when questioned I said that I would call back my agent to verify. I have not been able to reach my agent since. It is very possible that when my agent said “they wanted a 140% increase” that the insurance agent meant that they were asking for an increase that would amount to 140% over the original cost I am interested in conveying accurate information to the best of my ability. That includes a recognition of ambiguities in language when I see them.
Here is what I know about Sutter…
I compared the negotiated rates for a number of CPT codes across providers in my area. I did this about 5 years ago. It all started when my provider at the time was converted/absorbed/eaten up by PAMF/Sutter. A very simple in office procedure billed out at a NEGOTIATED rate of $350. I found that to be out of line with what was actually done during the visit. So, I took that CPT code and called several local non-Sutter providers. Their billing rates ran from $75 to $115. Then there would be a 33% contracted reduction in those rates. So, a simple in office procedure at the Sutter facility cost me $350 and would have cost me $63 - $75 elsewhere (it all went toward the deductible). I ran a few more CPT codes through this check and found Sutter to be up to 4.5X as expensive as other providers.
The facility cost for a colonoscopy at Sutter was around $3750 (that’s just the room), the surgery center down the road charged $1200, and then applied the negotiated reduction. Sutter is horribly, unjustifiably expensive and destructively predatory.
You can try this yourself. Take your latest Sutter EOB and call any other provider and ask for the billed rate for that code. It will be shocking and infuriating.
Unfortunately, Sutter’s practice seems to have been to buy out or absorb the best quality private hospitals – so you are right, they charge too much— but there’s not going to be a whole lot of choices if Blue Shield doesn’t include them.
I’m going to hang on for now to see what shakes out… but I’ll switch to Kaiser before open enrollment closes if there is not a change. My insurance agent has the same issues - she’s in Marin county and recently had surgery with a Sutter provider, and she is not a fan of Kaiser at all – so her plan is to find a new doctor and then hold her breath until her 65th birthday–which, fortunately for her, is less than a year away.
Part of the problem is that with Sutter’s high rates, the out-of-network thing is too expensive.
It’s true that Sutter bought up the best hospitals and practices. But Stanford Hospital is not four times as good as the next best hospital. And the fact that Stanford Hospital is now a Sutter facility isn’t making Stanford any better; all it means is that they advertise a lot now.
I like my doctors, but Kaiser is looking better and better. I’m sure they have plenty of good rheumatologists and internists there too, and I won’t have to put up with Sutter crap.
Yeah, great. World leader in raising prices to maximize revenue. Just the kind of leadership we need.
This is the position in which my family now finds itself:
*Existing coverage (which we are not allowed officially allowed to keep but have been grand fathered/grand mothered for political gain) has increased in price by 40% over the last two years.
- The existing coverage now has a much smaller network. It excludes some of the top facilities such as Stanford (now Sutter) and UCSF.
- Our coverage options have shrunk and costs are considerably higher.
•Several local providers are now no longer taking new patients. (this will only get worse as the Sutter folks scramble for new homes). So, you can keep your doctor, you just can’t SEE your doctor.
•A policy similar to the one we have – PPO with a countrywide network of providers, is simply not available for purchase – at any price – in the individual market.
• Kaiser is not available
•The only insurance carrier on the individual market that offers ANY PPO option in our area is Blue Shield and – well what’s the point, they don’t include most of the local docs. Healthnet withdrew it’s PPO offering this year.
• Compared to our policy of 2 years ago, anything available now has a higher deductible, higher OOP costs and has considerably higher premiums. - Nope, no savings here.
Going forward we are looking at all creative options. Such as bringing on an employee who will decline coverage, accept the absolute minimum pay and thus qualify for group. A friend on Medicare would be perfect. See if our management company in another State will ‘hire’ hubby and put him on their group policy. We just increase their pay based on what he costs them. D, who now has a great plan says there are ways to declare parents as dependents and put them on her policy (that’s interesting but off the table as far as I’m concerned). Have one of us move our official address to a different county where there are better options.
We have until July to figure this all out.
Remember the much maligned and now banned Goldenpooch? This is exactly what he predicted. And, remember…as goes California, so goes the nation.
From the article in #232
D’s SO’s mom is doc in a somewhat rural CA county. They had a discussion about the ‘new’ environment over the holidays. Basically the Medical/Medicare funding is about to implode. There were teaser rates offered to get the docs into contracts, these teaser rates are going away. So, once again - coverage will not equal care.
Hopefully things crumble fast enough to make a major rework top priority. We are, through luck, grace and hard work, able to cover what comes. That let’s me sleep. But while I’m awake, I will be working every angle of this absolutely ba$tarded system.
BlueShield has dropped Sutter from all plans including medicare amd employer backed plans.
Group plans thru Blue Shiels aren’t going to help you with coverage at Sutter unless a new contract is signed.
Sutter charges too much. The chain was highlighted in the NY Times. 
Sutter will eventually have its own
plans. You will be able to purchase a Sutter plan and then you can pay thru the nose.
Also from the article in #232:
Sutter is a world leader in figuring out how to maximize revenue. They don’t provide more care to indigent people. They just charge more.
@dStark: The nice thing about being a group is that you get more options from ALL insurance providers. I can go with Aetna (not available on the individual market in my area), I can go with a Healthnet PPO (not available on the individual market in my area), I can go with an Anthem PPO plan that has networks in all 50 States. I can choose a group plan which includes the UC hospitals. So no, I wouldn’t stay with Blue Shield…
And FWIW, as per my broker…this type of peacock strutting, chest puffing, elephant trumpeting behavior between insurers and providers happens on a regular basis. He predicts an agreement will be reach in the nick of time. The difference is this time BS has made the nitty gritty ugliness available for public scrutiny.
And frankly, I knew about Sutter charging too much years ago and have thus avoided them out of philosophical reasons whenever possible. None of us should be shielded in anyway from knowing how much something costs. Everyone should know the FULL cost of what they are consuming…even if they are forcing someone else to pick up the tab. Be that someone an employer or your fellow tax payer. AND, this should be imputed income at the end of the year and it should be taxed.
I talked to a broker too. Mine said that after the press release by Blue Shield, he did not expect Blue Shield and Sutter to come to an agreement. Maybe they will, maybe they won’t. Brokers are just guessing and so are we. I don’t see how an agreement could be reached “in the nick of time,” though. The nick of time was nine days ago.
BTW, Health Net just reached an agreement with Sutter.
http://www.santacruzsentinel.com/general-news/20140108/health-net-sutterpamf-reach-agreement
But going to Health Net wouldn’t save the Fang family any money. We’re keeping COBRA for now. We have a ridiculously good vision & dental plan. I just went to the eye doctor yesterday, and she informed me that I’m entitled to THREE pairs of new glasses every year.
Yes.
The dispute between Anthem and Sutter was also disclosed last year.
Sutter charges too much. Those that want upscale surroundings will get a chance to purchase insurance policies that provide coverage at these surroundings.
I wonder how how much it is going to cost to have coverage at Cal Pacific? I have had good past experiences there. I think the doctors there are fantastic. I think the cost of coverage is going to be through the roof. Some people will pay.
I saw a name on the board at Cal Pacific. There are lists of donors and there he was on the list. This is a few years ago. Somebody I used to work with was on the list. Really we were competitors. His career is a little better than mine. 
I like him. I know he can pay.