Sue Kumar, a Partnership HealthPlan Medi-Cal recipient who receives surgical site infection treatment and sees a rheumatology specialist at the Woodland Health Clinic for her rheumatoid arthritis, is a single mother at risk of losing coverage Monday.
Kumar and her 10-year-old, who she noted has an "awesome pediatrician" at the Bronze Star Drive Dignity Health location in Woodland, are two of thousands of Californians and many Yolo County residents ensured by either Partnership HealthPlan or Aetna at risk of losing coverage at Dignity Health locations due to contract negotiations that end March 31.
"I recall these negotiations once – maybe twice now – since I've been a rheumatology patient," Kumar stated. "However, and obviously, the negotiations have always been resolved and my care continued without any disruption."
Yet, this time feels different for her because of a letter sent to her by Partnership HealthPlan informing her that Dignity Health had dropped all of its members.
"I called Partnership right away because I was freaked out," she emphasized. "They gave me the run-down about the contract negotiations. It wasn't as horrible as the letter led me to believe, but yet still not feeling too great about the possibility of the contract ending and not being picked back up."
Worse, Kumar said the Rinvoq prescription she takes for her arthritis has been delayed for the first time ever. As of Thursday, she had been off it for over a week. Although she is not sure if the negotiations had anything to do with this, she is worried about her ability to access this medication if negotiations fail.
"My [rheumatoid arthritis doctor] is amazing and she doesn't miss a beat," Kumar remarked. "She has always been on top of her stuff. I've been with her for almost 10 years, if not longer. I feel very well-cared for and feel very safe and comfortable with my visits with her.
"It is terrifying to me to think of having to start anew with a whole new place with people who do not know me."
Lindsay Leszczynski, a Dignity Health spokesperson, explained that Dignity Health has been working with Partnership HealthPlan over the last several months to "reach a new, responsible contract agreement that puts patients first and keeps Dignity Health doctors and hospitals in-network for Partnership HealthPlan members."
"Our goal is to have new contracts in place before your current agreement expires on March 31, 2024," she stated in a March 25 email. "We know Partnership HealthPlan shares our goal of protecting patients' access to care. We encourage patients who have questions to visit our informational website, DignityHealth.org/PartnershipHealth, to stay informed."
Impacted providers will include several hospitals, physicians, surgery centers, and home health services, including Woodland Memorial Hospital, Mercy General Hospital, Woodland Clinic and Woodland Healthcare Home Health, according to the website.
"As a nonprofit, mission-driven organization, fair agreements with insurance companies give us the ability to continue investing in our employees, caring for patients and ensuring access to essential care and all payers must pay their fair share," Dignity Health stated on its website.
If negotiations fail, Dignity Health said patients will be directed by Partnership HealthPlan to other hospitals or health providers for no non-emergency care beginning April 1.
If patients have treatments scheduled at a Dignity Health provider on or after April 1, Dignity Health recommends contacting Partnership HealthPlan to discuss if they qualify for Continuity of Care, which would allow them to continue receiving treatment with their current provider.
For questions or to discuss care needs, contact Partnership HealthPlan at (800)863-4155.
Following a previous article highlighting negotiations between Dignity Health and Aetna, Yolo County resident Michele Bowman stated in an email that she is currently enrolled in an Aetna Medicare Advantage plan and that she and two other family members who have Aetna received no notification of this issue by Aetna or Dignity Health.
"I called Aetna several times," Bowman recounted. "On the first call, I was told that Woodland Clinic was an IPA provider and that Aetna contracts with Medicare to provide a certain number of doctors in their plans so coverage would be continued."
She then called the Woodland Clinic to verify this and was informed that this was not accurate. After calling Aetna again, she said their response changed to confirm that her doctors and hospital would no longer be in network after March 31 if negotiations fail.
"I guess I could do nothing and hope that an agreement is reached," she stressed. "However, there is an open enrollment window for my Medicare Advantage plan that ends March 31 and I am looking into other companies to switch to. I am just dismayed that neither Dignity Health or Aetna kept us informed."
Bowman noted that without the previous article, she would've never known about the negotiations and could be facing a "potential significant increase in out-of-pocket costs."
When asked about this, Leszczynski explained in a Feb. 29 email that the organization has been working with Aetna to reach a new contract agreement that "puts patients first and keeps Dignity Health doctors and hospitals in-network for Aetna members."
"Our goal is to have new contracts in place before our current agreements begin to expire on March 31, 2024," Leszczynski said in an email. "We know Aetna shares our goal of protecting patients' access to care. We encourage patients who have questions to visit our informational website, http://www.dignityhealth.org/aetna to stay informed."
When asked about details of the disagreements being negotiated over and the number of Dignity Health patients in Yolo County who will be affected by this, Dignity Health said it preferred not to comment.
However, a statement from Alex J Kepnes, communications executive director for Aetna, stressed that Aetna is against what he called "unsupportable increases in reimbursement rates" that would raise costs for Yolo County members.
"We have a responsibility to our members and health plan sponsors to negotiate fair reimbursement rates," Kepnes emphasized. "We remain committed to negotiating in good faith for a fair contract."
If you are an Aetna or Partnership HealthPlan member who will be affected by this and wish to share your experience, please contact gzavala@dailydemocrat.com.
To read more about the negotiations, visit dailydemocrat.com/2024/03/26/thousands-of-yolo-county-residents-at-risk-of-losing-healthcare-coverage.
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