J&D Benefits Perspective

CalPERS Considers Plan To Eliminate Coverage at 45 Hospitals

CalPERS on Wednesday "jolted the health care industry" by announcing a plan to save about $72 million in premiums by eliminating coverage for its beneficiaries at 45 of California's most expensive hospitals, with about $53 million of the projected savings resulting from ending coverage at 15 Sacramento-area hospitals owned by Sutter Health, the Sacramento Bee reports. CalPERS, the nation's third largest purchaser of health care with 1.2 million beneficiaries, "singled out" not-for-profit, Sacramento-based Sutter Health because the pension fund's trustees said that prices at the health system's hospitals were 80% higher than the average costs at hospitals statewide.

Contra Costa County Physician Group May Face Bankruptcy After Cancellation of Health Net Contract

East County Medical Group, the "dominant" physician group in east Contra Costa County, may have to file for bankruptcy after Woodland Hills-based Health Net last month canceled a contract with the group, several East County board members said last week, the Contra Costa Times reports (Torres/Silber, Contra Costa Times, 12/31/03).

Physicians Group, Doctors Medical Center Staff Sue Blue Cross of California for Defamation

02/23/2004

Doctors from physician group Valley Heart Associates and the medical staff of Doctors Medical Center in Modesto have filed a defamation lawsuit in Stanislaus County Superior Court against Blue Cross of California, accusing the insurer of making "ghoulish and debasing" claims, the Modesto Bee reports (Carlson, Modesto Bee, 2/20). In October, Blue Cross released a review that said the hospital billed it for multiple medically unnecessary coronary bypass procedures. Blue Cross stopped authorizing payment for procedures at the hospital but later reinstated its authorization after Doctors tightened its internal oversight policies.