Op-ed: The implosion of health insurance at UC

If you have worked for UC Berkeley at any time over the past 30 years, you might warmly remember that the university was well known for offering largely functional health insurance plans that made healthcare affordable for employees at every income level. The changes in these plans over recent years have recently accelerated, to the point where the newest PPO plan is disintegrating in our hands. Message boards have been lighting up in heated discussion.  hose UC employees who elected to participate in UC’s PPO, known as “UC Care,” have seen their coverage fail, especially in Berkeley, in spectacular fashion.

In 2014, the University of California rolled out new options for employee and retiree health plans.  Simultaneously, UC discontinued the old PPO plans that they offered, because “they continue(d) to show double-digit price increases.”

UC Care was billed as “a new medical plan structured as a comprehensive preferred provider organization, or PPO, designed to fit the needs of University of California employees.” It was especially attractive to those who have dependent children studying in colleges outside California.

UC Care promised “a broad network of providers that included doctors and facilities conveniently located near all UC campuses and medical centers. We were promised we could choose from a wide network of providers, just like those in UC’s previously offered PPO plans.”

UC promised that “UC Care’s network of providers overlapped by 97% with the Anthem networks.” It offered, they said, the same flexibility for patients and included UC’s world-class medical centers.

UC Care’s monthly premiums were promised to be lower than the pre-2014 premiums for Anthem’s PPO, and we were told that, in some cases, patients would pay less to visit a provider. In addition, when visiting a select group of health providers, including all UC Medical Centers as well as “some other doctors and providers near ALL UC campuses,” patients would be subject only to copays for visits.

Midway into 2014, the first year of UC Care’s existence, subscribers began to notice unexplained charges coming in the mail to them after routine office visits, as well as after more complex medical procedures. No explanation was ever offered. Every unexpected bill necessitated a phone call, or several, to the health insurance administrators at UC. Resolution took months. Sometimes, resolution disintegrated, and bills began coming again, from collection agencies.

Blue Shield of California, who administers UC Care, is now embroiled in (thus far, failed) contract negotiations with Sutter Health of Northern California, which owns and operates all the hospital facilities in Berkeley. This means that UC’s employees who opted for UC Care are now paying much more for medical care than we were promised, and access at contractual rates to Sutter’s medical centers will end on June 30 of this year. Nothing was said during open enrollment for 2015 about Blue Shield-Sutter negotiations, or the possibility that these might lead to contract termination.

Sutter Health volleyed into the fray, blaming Blue Shield for the disintegration of our coverage, stating “Blue Shield sold health plan products during open-enrollment that featured the doctors and hospitals of Sutter Health; and then just days into the New Year abruptly announced plans to reassign members to non-Sutter doctors” and adding that “Blue Shield continues to collect rate increases from its members and employers this year of up to 23 percent.”

Clearly, everything about this model of health insurance administration and provision of medical care is broken. We have a not-for-profit hospital, which in Berkeley, anyway, has a monopoly, raising its demands for increased payments, and an insurance company rapidly accelerating its costs to employees. Holding the short end of the stick, we have UC employees being made to patch the gap with their hard-earned dollars. The experience, I can tell you, is like going for services with no knowable price affixed. The providers and insurers send you a bill AFTER you have received services, and that amount of money bears no semblance to what you originally expected to pay.  Would we accept this model of payment from a mortgage provider? An optometrist? An auto mechanic? A grocery store?  No. And we should not agree to this method of payment to our health care providers.

The UC Santa Cruz Faculty Association has drafted and is circulating a petition to President Janet Napolitano. I invite you to read it, and if this matter affects you, please sign it and circulate it.

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Melissa Quilter has lived and worked in Berkeley for 31 years and has received her family's health insurance via the UC Berkeley. Her husband teaches and conducts research at UC Berkeley.