Blue Shield of California, a major health insurance provider, was unable to reach an agreement with UCLA Medical Group over compensation rates, and suspended coverage for some patients and services on May 1.
While patients holding Blue Shield’s Preferred Provider Organization plan will still be admitted for treatment at UCLA, out-of-pocket expenses could be considerably higher, UCLA spokeswoman Roxanne Moster said in a statement.
University-provided health insurance plans including SHIP are not affected, and co-pays will remain the same, according to the Ashe Center’s Web site.
In the patient billing process, medical officials bill health-care providers for a cost they determine. But when agreements are not made, health insurance companies may not cover the total cost of procedures, leaving it up to the patient to pay for the remainder.
In a letter sent by Blue Shield to its members, the organization claims that UCLA’s rates are higher than other health-care providers’ in the area and therefore refused to reimburse certain patients at UCLA Medical Center.
But the university maintains that the costs are justified to maintain its level of care.
“UCLA remains committed to providing exemplary health care to our Blue Shield patients, but cannot do so without adequate reimbursement that reflects the value of our services,” said Dr. Thomas E. Sibert, associate vice chancellor and president, UCLA Faculty Practice Group, in a statement.
UCLA Medical Group officials said they hope additional negotiations can help restore service, and are taking steps to ensure patients can afford treatment.
“UCLA will work with affected patients to explore discounting these physician expenses,” Moster said.
The loss of coverage will not affect Blue Shield HMO plan holders or In Network Point of Service members, according to a medical center press release.
Negotiations between Blue Shield and the UCLA Medical Group previously stalled in July 2006, resulting in a termination of agreements. A new contract was reached three months later in October.
During that period, UCLA students and faculty with Blue Shield found their coverage compromised.
Third-year political science student Jenna Murphy, who is covered along with her family by Blue Shield, became ill in the summer 2006. After being denied coverage of certain services in the medical center, she decided to buy a SHIP plan.
“I still have the (SHIP) plan just to make sure I’m covered,” Murphy said.