SAN DIEGO (KGTV) – The clock is getting closer to midnight for Scripps Health and Anthem Blue Cross to strike a deal by January 1 of next year.
"This weekend, I got four hours of sleep. I am really struggling and it's terrifying,” Lisa Schmidt, a Scripps Health patient & Anthem Insurance holder, said.
Schmidt has a genetic condition as she's dealt with lifelong health issues and, after recovering from COVID-19 roughly two years ago, things got worse.
"I developed gastroparesis. So that means that the food in your stomach doesn't move through. So I'm on a liquid diet. I also found out that I have a rare condition where it's called compression of the celiac artery or MALS. And I'm going to have surgery in Cleveland in January,” Schmidt said.
"They need to figure it out soon so patients can have the care they need."
If the dispute is not resolved by the start of January, it could put 125,000 people whom Anthem insures and get health care Scripps could be soon out of network.
"Some of the specialties I'm seeing are the only ones in the County. What am I supposed to do? Go to LA? Drive three hours for care? This is wrong,” Schmidt said.
Scripps Health told ABC 10News it began notifying patients insured by Anthem in mid-October about the negotiations.
In a statement, the healthcare provider says it continues to negotiate in good faith to reach an agreement with Anthem Blue Cross.
It reads, “Scripps Health is dedicated to making a positive difference in the health of the communities we serve, which is why we continue to negotiate, in good faith, to try to reach agreement with Anthem Blue Cross. We understand that contract negotiations between health care providers and health plans can create uncertainty for patients who may be impacted. It is important to know that Scripps is negotiating with Anthem as an advocate for the best interests of our patients. As a health care provider, we exist to take care of people, but we can only do so if Anthem amends their current policies that cause unnecessary burdens and barriers to care. We hope that Anthem shares our sense of urgency. Patients are encouraged to reach out to their human resource or benefits departments, or directly to Anthem, to understand how a change to their health care network might impact their access to care, to learn how it could impact their out-of-pocket costs, and to share their concerns about keeping access to Scripps Health’s high-quality care.”
A spokesperson for Anthem said also hoping to reach a new agreement.
The spokesperson said, “Anthem and Scripps’ contract agreements are set to expire and we are working to extend our members’ access to affordable care at Scripps Health beyond December 31, 2024. We recognize that having in-network access to their facilities is important to our members and their employers in San Diego County. However, we are concerned that Scripps wants to drastically increase its prices for patients covered by Anthem. These increases will lead to higher out of pocket costs for our members and would hit area employers particularly hard. More than 80% of Anthem Blue Cross members are insured by employers that pay their employees’ healthcare costs directly. We will continue to work in good faith with Scripps to reach a new agreement.
In the event an agreement can’t be reached, we are taking steps to ensure our members currently in treatment at Scripps Health may continue care with their current care provider after January 1. In addition, our network in San Diego County includes several other high-quality health systems including UC San Diego Health, Sharp HealthCare, Rady Children's Hospital, Palomar Medical Center and others. Members may call their member service center at the number on the back of their ID card for assistance. They may also visit https://www.anthem.com/ca/scrippshealth/ [anthem.com] for the latest information.”
With the days counting down, Lisa’s ask for both parties is simple.
"I'm standing up for all of us because I'm one of the 125,000. And I'm going to be the one that says, 'This is wrong. Scripps get your act together, Anthem get your act together and stop this,” Schmidt said.
