After months of protest from UCSB employees, UC Care for has moved Sansum Clinic — a medical foundation with facilities throughout Santa Barbara — into the UC Select tier of university employee health care.
The announcement comes after months of negotiations with Sansum Clinic and Cottage Hospital, after UCSB employees protested the fact that the UC Select tier covered none of the major care providers in Santa Barbara, forcing those with that plan to travel to Lompoc, Santa Maria or Ventura for medical attention. UC officials and Cottage Hospital could not reach a deal, however, and its Goleta facility will remain a preferred provider for now.
Under the UC Care health plan, care organizations are categorized into three tiers, with higher tiers offering more benefits and lower premiums. The first two tiers — UC Select and Blue Shield Preferred — specify care providers in their network, while the third tier covers all out-of-network care providers. As a member of the UC Care team with Blue Shield of California, an employee named Courtney T. — who could not give her last name due to a corporate policy — said that despite the in-network limitations for higher tier plans, university employees have the option to keep their current care providers and stay within UC Care.
“Anyone offered coverage by the University of California can enroll in UC Care,” Courtney said. “Once they’re enrolled in this plan, which will go into effect on Jan. 1, 2014, anyone who is enrolled in it will have the freedom to move around the tiers and go to any doctor he or she wants to go to.”
Blue Shield of California, a nonprofit health care provider with the mission of offering affordable health care to all Californians, will be the UC Care Health Plan administrator beginning next year. According to its website, UC Care will provide “value and choice” to anyone covered by it, and the Sansum clinic will also provide convenience to UCSB employees covered by UC Care.
Under the UC Select tier, there is no annual deductible; there are set co-payments and the maximum annual out-of-pocket expense is $1,500 for individuals and $4,500 for families. Under the Blue Shield Preferred tier and the out-of-network tier, there are annual deductibles, higher maximum out-of-pocket expenses and larger, percentage-based co-pays. In addition, UC Care is a Preferred Provider Organization plan, allowing people covered to self-refer to any doctor since it does not allow anyone covered to have a Primary Care Physician.
In a letter addressing employees, Sansum CEO Kurt Ransohoff stated the Sansum Clinic staff decided to adjust their rates to come to a compromise with Anthem Blue Cross and Blue Shield, providing patients with rates comparable to coverage for other UC employees.
“UCSB employees will be able to use Sansum clinics at the same pay structure as the University of California hospitals,” Ransohoff said.
Currently, UCSB and UC Santa Cruz are the only two university campuses without medical centers.
A version of this article appeared on page 1 of November 26th’s print edition of the Daily Nexus.