Covered, but Expensive

Your article is somewhat misleading. The statement that on January 1, “7,000 Sansum patients could find themselves without a carrier” is not accurate. Former Blue Cross patients who are automatically enrolled in comparable Blue Shield plans will still be able to go to Sansum providers. However, unless an agreement is reached, those services would be considered the dreaded “Out of Network,” with those benefits costing the patients significantly more due to fewer covered services as well as much higher deductibles and out of pocket max. In short, you’ll still be able to see your Sansum provider, but it will cost you a lot more.

Blue Shield does have its own network of providers, but the very real concern will be, can they handle some portion of those 7,000 Sansum patients looking for affordable in network care? Your choice could end up being paying more to stay with your Sansum doctor or waiting weeks or months for an appointment with a new Blue Shield provider. Not an ideal situation.

It is these new high deductible Blue Shield plans — when you consider the out-of-network benefits — that were exactly the type of plans proposed during the unsuccessful Congressional attempt to “repeal and replace” the Affordable Care Act. It was the opposition to these plans — that provided very few covered benefits until the deductible was satisfied — that was one of the main reasons the attempt failed. How ironic that despite that failure, we’re facing that same situation.

Editor’s Note: Sansum spokesperson Jill Fonte states that it remains important for people to be insured. Blue Shield coverage does not lapse until January 1, 2018. Though a contract is not in place at the moment, Sansum is actively working to secure one.

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