Mountain View Voice

News - December 31, 2010

El Camino, Anthem agree on rates

by Nick Veronin

After a dispute over the terms of their contract, El Camino Hospital and health insurance provider Anthem Blue Cross have reached an agreement.

Earlier this month, El Camino CEO Ken Graham announced in an open letter that his hospital might discontinue its contract with the insurance provider at the beginning of 2011, due to what he and others in his organization called "inequitable" reimbursement rates from Anthem.

In the letter, which was published on the hospital's website, Graham wrote that reimbursement rates — the money paid to the hospital for procedures for patients covered by Anthem — were "significantly lower than all the major HMO/PPO plans with whom we contract."

Representatives from Anthem, however, disputed that claim.

Aldo De La Torre, Anthem's vice president of contracting in California, called El Camino's demands "very excessive."

"We are being asked by our clients and members to control cost," De La Torre said. "The request of El Camino works counter to that request and demand."

If no agreement had been reached, patients covered by Anthem would no longer have been able to receive insured care — other than emergency care — from El Camino.

Yet, in a joint statement issued Dec. 22 from the two organizations announcing that an agreement had been reached, both Graham and De La Torre struck a decidedly different tone.

"The agreement we have reached with Anthem Blue Cross ensures that patients will continue to have the choice of receiving care at El Camino Hospital and that we will be reimbursed for that care at a fair rate," Graham said in the statement. "We are glad that we have reached a positive resolution with Anthem Blue Cross — one that benefits our physicians and patients by emphasizing high-quality care."

"We are pleased that by working with El Camino Hospital we have reached agreement on a contract that will continue to fairly reimburse the hospital for the fine medical services they provide each day, while allowing Anthem to help control the escalating costs of health care for our members," De La Torre said in the statement.

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