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Your Health Insurance Plan May Be No Good At Alameda Hospital

Your health insurance plan may not cover you at Alameda Hospital. (Google Street View)

Your health insurance plan may not cover you at Alameda Hospital. (Google Street View)

Alameda residents are complaining that Alameda Hospital no longer accepts common insurance plans, with no immediate resolution in sight. And local health officials don’t seem to want to talk about it.

The issue began surfacing in local papers last month, with residents in-the-know alerting the public.

Ann and Joe Wlad, of Alameda, wrote, “The homeowners in the city of Alameda are likely not aware that effective Jan. 1 Alameda Hospital no longer accepts Anthem Blue Cross, Blue Shield, Aetna and United Healthcare insurance. This affects nearly 90 percent of Alamedans.”

(Ann Wlad did not respond to a request to comment for this story.)

The Wlads, and others, have called for a repeal of the annual $298 parcel tax levied on Alameda property owners since 2002. What value do they receive, they ask, in return for the tax?

That money goes to Alameda Health System, to fund operations of Alameda Hospital, and that agency has its own financial troubles.

An Alameda County Civil Grand Jury report last year slammed Alameda Health System (AHS) for the ongoing financial disaster, writing, “AHS has a nearly $200 million debt owed to the County of Alameda Consolidated Treasury and is suffering from significant issues regarding its financial structure. The recent acquisitions of Alameda Hospital and San Leandro Hospital have exacerbated these financial challenges.

“…the Grand Jury is concerned that the lack of leadership and scrutiny on the part of the AHS board of trustees and lack of oversight by the county board of supervisors contributed to the financial problems at AHS. [Resulting in] a roadblock to crafting a comprehensive solution to the $59.1 million gap between AHS’s obligation to the county and its actual performance as of June 30, 2014.”

Alameda County District 3 Supervisor Wilma Chan, whose district includes the city of Alameda championed the health system’s acquisition of struggling San Leandro Hospital in 2013.

Chan is also the chair of the county board of supervisors’ health committee.

Her office declined to respond to multiple requests for her to comment on the situation at Alameda Hospital with regards to insurance participation.

A staffer in Chan’s office deflected the inquiries to Terry Lightfoot, director of government and community relations for Alameda Health System.

An AHS spokesperson responded to an inquiry addressed to Lightfoot’s e-mail address, asking for specific questions. She had not followed-up with any responses to specific questions by press time.

Tracy Jensen, a member of the board of trustees for AHS, blamed the insurance carriers for failing to include Alameda in their service networks.

She wrote to Action Alameda News, “before Alameda Hospital joined Alameda Health System (AHS), commercial insurance carriers were paying significantly less for services provided at Alameda Hospital in comparison to the rates paid to Alta Bates, Summit and Stanford hospitals. Entering into the operating agreement with AHS gave Alameda Hospital a more comprehensive service network, and increased market leverage to negotiate with the commercial insurance providers.

“The organizational change emphasized the discrepancy between the rates insurers paid to Alameda Hospital compared to other hospitals. When AHS requested that private insurance companies re-negotiate the rates, most carriers were responsive and agreements were reached quickly. Unfortunately, some plans have not responded to the AHS request for contract review, and in order to get those plans to the table AHS was forced to terminate the contracts.”

It’s these contract terminations that are impacting what Alameda residents experience when they settle their bill with the hospital.

Jensen notes that although Alameda Hospital is considered “out of network” by some private insurance plans, people covered by those plans can use Alameda Hospital and receive a discount that applies towards the annual deductible.

“The ‘prompt pay discount’ for out-of-network services applies to outpatient procedures such as labs, imaging, infusion therapy or outpatient surgery,” Jensen continued.

Jensen also said that Medicare beneficiaries are not impacted.

So long as the impasse drags on, calls to repeal the parcel tax are likely to amplify.

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