Amid negotiations with Anthem, the Hazel Hawkins Memorial Hospital board announced Oct. 14 that its Chief Executive Officer Steve Hannah had been released from his contract. BenitoLink spoke to Hannah in September about the status of Anthem Blue Cross PPO. BenitoLink has requested more information from the Hazel Hawkins Hospital board and will report more on the situation as soon as possible.
In mid-August, after lengthy negotiations had broken down, the hospital mailed out letters to patients signed with Anthem Blue Cross PPO stating the hospital would no longer be in business with the company. The parties failed to reach an agreement on a new contract, eliminating the existing contract which ended Aug. 10.
However, “negotiations are still open,” Hannah told BenitoLink.
The termination affects only the Anthem Blue Cross PPO and Anthem Medicare Advantage plans. The Anthem Medicare Supplement, Anthem Medi-Cal and Blue Shield plans are not affected.
However, the termination will not prevent Anthem members from receiving emergency care or continuity of care at Hazel Hawkins, according to HHMH Chief Operations Officer Mary Casillas.
“We treat everybody regardless of their ability to pay,” she said.
Anthem sent a letter to its PPO members with a list of “alternate participating general acute care hospitals” that are in-network: Natividad Medical Center and Salinas Valley Memorial Health Care District, both in Salinas, and Saint Louise Regional Hospital in Gilroy.
Anthem has to cover continuity of care at Hazel Hawkins, such as ongoing treatments for conditions such as cancer, pregnancy, terminal illness or physical therapy. However, to receive continuity of care, patients need to complete a form in conjunction with their physician, and submit it to Anthem for approval.
The contract termination comes after the hospital sought for 10 years to receive increased reimbursement rates from the anthem, according to Hannah.
“What’s happened is that over the years, we don’t get increases from Anthem that correspond with our increases to deliver care,” Hannah said. “Our costs just go up, up, up. The payment we receive for providing care for Anthem covered patients has not.”
Hannah said there are a number of variables that are crucial to Hazel Hawkins’ financial viability, and Anthem “is one that we would consider a must; we’ve got to get this one resolved.”
A spokesperson for Anthem Blue Cross who asked not to be identified told BenitoLink the “increases being sought by Hazel Hawkins will lead to cost increases for healthcare consumers in San Benito County and result in higher premiums, deductibles and copays for local employers and families.”
Though Anthem Blue Cross said it has “offered reasonable increases that are in line with what other provider partners receive for the same services,” Hannah said Anthem pays the least of Hazel Hawkins’ commercial insurers, which also include United Health, Cigna, Valley Health Plan and Blue Shield.
The impasse affects not only patients, but also employees by threatening to affect their wages.
According to Hannah, Anthem hasn’t kept up with the increases the hospital has incurred in terms of labor and supplies.
“That’s all we’re asking, we’re not asking to be special,” Casillas said. “It’s hard on our patients, foremost, but it’s hard on our front line staff, too. This isn’t a decision that was made lightly by the board or administration, but our responsibility to this community is to keep the doors open in this hospital and if we are providing services where we continue to have to subsidize, the outcome could be much worse later, which would be even more destructive.”
Casillas encourages patients with Anthem Blue Cross PPO to be their own advocate.
“Call Anthem and see what the difference is going to be,” she said. “Sometimes it’s a percentage difference on their cost of share. If [patients] find that out and they need a procedure or they need something, we can work with them through our business office. We will bill Anthem.” Casillas suggests patients contact the Hazel Hawkins business office if they are unsure about what their plan will cover.
“[The business office] will research plans and can explain to patients what they are responsible for. For one of the patients, there was no difference,” she said. “There are payment plans, there are options that we can work with people on.”
For hospital procedures such as lab work, Anthem patients will be billed out-of-network, which may lead to customers having to pay more out-of-pocket, said Charity Duran, associate director of the HHMH Business Office.
“But we are working with patients on the back end after your insurance pays to work with you to lower that cost,” she said.
“This is not an easy situation,” Hannah said. “We understand it. We’re not doing this with light hearts. This is a very serious situation and we want the community to know how much we are doing on our side to soften the blow.”
“We remain committed to continuing in-network access to Hazel Hawkins, but only at rates that remain affordable for the employers and consumers we serve,” Anthem said.
In its letter to members, Anthem suggests members to log into Anthem and select Find Care to search for doctors and hospitals, or call (877) 737-7776 with any questions. Anthem said members can also call the toll-free member number listed on their Anthem member ID card.
Hazel Hawkins encourages patients to visit its web page for updates on the Anthem negotiations. Patients may also contact Hazel Hawkins Business Office at (831) 205-5710 to speak with a benefits manager.
Reasons for Hannah’s release are not known to BenitoLink at this time, but we will continue to report on this situation.
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