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Sansum Clinic Still Not Accepting Blue Shield Plans Under State Health-Insurance Exchange

(This article originally appeared on

By Giana Magnoli, Noozhawk Staff Writer | @magnoli

Sansum Clinic may not reach an agreement with Blue Shield in time for local patients to get Covered California exchange health insurance plans for Jan. 1.

The 23-clinic organization reached an agreement with Anthem Blue Cross at the end of November, but still hasn’t with Blue Shield, according to marketing director Jill Fonte.

That means local patients with Covered California state exchange plans through Anthem can use their insurance with Sansum doctors, but Blue Shield patients can’t — as of now.

Those are the only two insurance companies with health insurance exchange plans for Santa Barbara County.

California residents who want health insurance coverage starting Jan. 1 must sign up by Dec. 23, which was pushed back from the previous Dec. 15 deadline.

Sansum isn’t sure it will make a deal with Blue Shield in time, Fonte said. 

“Our highest level executives continue talking with Blue Shield, and we remain hopeful, but we haven’t made a lot of progress,” she said.

Negotiations are centered on reimbursement rates that the clinics receive from insurance companies. Sansum Clinic did agree to a decrease with Anthem, but it found common ground, CEO Kurt Ransohoff told Noozhawk in November.

There are many independent doctors in the community who are accepting exchange plans as well, he noted, but Sansum represents 23 primary-care and specialty clinics on the South Coast that serve 61,000 patients per month.

Sansum discovered it was not included as a provider on the state insurance exchange in early October, when public enrollment began, and has been negotiating with insurance companies ever since.

The Patient Protection and Affordable Care Act, also known as Obamacare, provides for an expansion of Medi-Cal benefits and a statewide insurance exchange with subsidies available based on income, gender and age.

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