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Healthcare shakeup: Medicare patients have to shop at home

Op-Ed

Last week, a Sonoma resident wrote a letter to the editor of the Index-Tribune asking why, under the new MedicareComplete United Healthcare policy, she will be unable to use her local doctors and Sonoma Valley Hospital, since the new plan is accepted only by doctors and hospitals in the Sutter network.

  The writer wondered if this change was a result of the new health reform bill, and what had happened to the promise that patients could remain with their own health plan and choose their own doctors.

  These are serious questions for Sonoma Valley Hospital, for our local doctors, and for the 300 local residents who have enjoyed United Healthcare coverage. For them, and the many patients who have called our hospital and doctors’ offices, upset and confused, we want to respond.

  This action by UnitedHealthcare has taken us all by surprise. Dr. Brian Sebastian, former president of the medical staff of Sonoma Valley Hospital, said, “We had no idea we were being left out. It sounds as though Sutter is trying very hard to push into our bubble here, which certainly does not serve our community in any way.”

  Sonoma Valley Hospital administration was equally surprised and, indeed, found out only after patients and doctors did that we were being excluded from the UnitedHealthcare contract.

  That is poor communication on the part of UnitedHealthcare, but more serious is their failure to inform patients about the fact that, along with the benefits of the new program, it excludes both local physicians and Sonoma Valley Hospital.

  We want people to understand that if they sign up for the new UnitedHealthcare plan, they will only be able to use doctors in the Sutter system and Sutter hospitals. They will not be able to use Sonoma Valley Hospital or non-Sutter doctors.

  We want to make it absolutely clear that Sonoma Valley Hospital has no influence over what UnitedHealthcare or any other insurance company does, nor does this decision of theirs relate in any way to the new Affordable Care Act, which some call “Obamacare.”

  The decision to exclude Sonoma doctors and Sonoma Valley Hospital from the UnitedHealthcare plan relates only to a deal between UnitedHealthcare and Sutter Health, acting as independent businesses in a highly competitive marketplace. As such, United Healthcare, like any other insurance company, contracts with doctors, groups of doctors, and hospitals, and has, for its own reasons, decided not to contract with our community’s doctors or our hospital, but rather has made an exclusive deal with Sutter Health.

  This affects some 300 people in Sonoma Valley. As Dr. Clinton Lane, said, “It’s a good size number that we don’t want to see go out of the Valley and who don’t want to go to Santa Rosa themselves!”

  We’ve been asked by some patients to recommend options. Lisa Duarte, patient financial counselor at Sonoma Valley Hospital, explained that, in a general sense, “The best thing I can advise for someone looking into purchasing medical insurance is not just to find a monthly premium that fits the budget, but a whole plan, with deductible and out of pocket that works for them in the broad picture, in the event they are hospitalized.”

  In other words, a $50 monthly premium may sound good, but an $8,000 deductible could be devastating if you get hospitalized. Sonoma Valley Hospital can’t recommend specific plans, but if a patient comes in with several options, Lisa can help them understand the plans and review the options so the patient can make the best choice.

  We want to remind patients that there are other insurance carriers who have a Medicare HMO product. Marin-Sonoma IPA is finalizing an agreement for Health Net to offer Health Net’s Medicare plan, which is available throughout Sonoma County, in Sonoma Valley effective Jan. 1. Marin-Sonoma IPA physicians and Sonoma Valley Hospital will be participating. We will make sure this newspaper and our local primary care physicians are all notified when this plan is announced, so that patients will have an opportunity to review and consider this plan well before the end of the open enrollment. We all want our patients to remember that they have the right to choose.

  Finally, as your doctors and your hospital, we don’t want any of our patients to have to change their doctors, or go out of the community for your healthcare. We want you to know about your alternatives. We are eager to continue our relationships with all our patients and we are working to help you find better alternatives for your family.

  If patients have further questions, we encourage them to call their primary care physicians or, if they have several options they’d like help interpreting, they can call Lisa Duarte at Sonoma Valley Hospital at 935-5000.

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  Kelly Mather is president and CEO of Sonoma Valley Hospital and Dr. Jerome Smith is president of the medical staff of Sonoma Valley Hospital.