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Patients covered by Anthem Blue Cross will be able to return to El Camino Hospital for care following a monthslong standoff between the two parties over a new contract, the hospital announced this week.
El Camino Health has sparred with Anthem over health care prices this year, reaching an impasse that put the hospital out of network for those insured by Anthem starting in June.
Anthem customers received a letter in the mail directing them to other hospitals including Stanford Hospital in Palo Alto and Good Samaritan in San Jose, with no clear timeline for when they could return to El Camino.
El Camino, like many Bay Area health care providers, has had a strained relationship with Anthem in recent years. In July, El Camino Health officials said Anthem was using aggressive cost-cutting tactics and offering reimbursement rates well below what other insurance companies provide. Anthem, the country’s second-largest insurer, argues that hospitals in Northern California charge exorbitant amounts for services that are cheaper elsewhere, and that doing so has fed into rising health care costs for customers.
Negotiations ran aground in 2010 as well as 2015, both due to similar concerns over reimbursement.
Carlos Bohorquez, El Camino’s chief financial officer, said in a statement Friday that they have reached a three-year agreement with Anthem that will begin on Oct. 1, and that the extension “validates” El Camino’s role in serving patients at its hospitals and clinics across the region.
“We are pleased to renew our partnership with Anthem and look forward to continuing to work with their team to provide the best care and patient experience in Santa Clara County,” Bohorquez said.
During the three-month period in which patients were out of network, those with pressing health care needs — including cancer treatment, pregnancy and serious chronic conditions — were advised to stay at El Camino and told they would still be covered by Anthem. More broadly, El Camino officials said Anthem customers are not obligated to pay more than the in-network rates between June and the end of September.
When asked whether El Camino was required to pay for uncompensated services as a result of the arrangement, hospital officials said the renewed contract has “considerations” that ensured patients weren’t negatively impacted during the lapse in the contract.
Anthem said in a statement Friday that its customers, both individuals and employer groups, were the “number one” priority while negotiating with El Camino to find common ground. The agreement balances costs and the quality of care, the insurer said in the statement.
“We value the relationships we have with the providers in our network, which are important to creating choices for our consumers and fulfilling our mission of improving the lives of the people in the communities we serve,” said John Pickett, Anthem’s regional vice president of provider solutions.
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