google-site-verification: googlea33552291e834fff.html Education: Further Troubles with UC Care

Thursday, April 10, 2014

Further Troubles with UC Care

by Judith Paltin, UC Santa Barbara

On this blog last October, Berkeley Anonymous pointed outthat the UC�s employee compensation/benefits website, At Your Service, was promising:,"If you do nothing, you will be enrolled in the new UC Care plan, with the same dependent coverage you have now. UC Care has the same in-network and out-of-network coverage you have now, with much more.�

However, the stories brought to the UCSB Faculty Association meeting on April 9 demonstrate that faculty coverage and, consequently, their medical decision-making, are in fact very different under UC Care. One faculty member, unable to find any labs contracted to provide Tier 1 benefits, was advised to travel 80 miles to Santa Monica to receive covered lab services, a trip she would have had to make repeatedly. Upon her objections, she was told (incorrectly, according to the insurance company) to �use whatever lab [local Tier 1 medical clinic] Sansum uses� � she is now attempting to appeal the insurance company�s subsequent denial of her lab charges. A UCSB Health Care Facilitator told her that the UCOP �forgot to negotiate� with any nearby labs. 

One pregnant faculty member said she signed up for UC Care under the understanding that she would be covered for a Sansum obstetrician and a Santa Barbara delivery. Now her UC Care choices are to bear the Cottage Hospital Tier 2 charges for herself and the baby (up to $6,000), or to risk having her baby on the open road on the way to UCLA. Another reported: �My wife needs surgery�  so the Sansum doc will do it outpatient rather than have us go to UCLA, or face the Cottage costs.�

Finding UC select providers (i.e., those who count as �in-network�) has proven to be a challenging exercise in Deep Web research. Members reported yesterday that after due diligence, they have not been able to compile a complete list of UC providers, and that insurance specialist personnel at UC medical centers have been unable to tell them which doctors, labs, anesthesiologists and other specializations with privileges at their facilities count as UC providers. (According to a licensed health benefits specialist at BalanceCare, a national health advocacy service provider, most private insurance companies do not provide lists of anesthesiologists, since patients have no control over that selection, but the companies nevertheless routinely rule these to be out-of-network charges, leaving a majority of patients in multi-payer systems with the additional post-surgery task of appealing anesthesiology charges.)

An assistant professor reported: 
I live in Ventura and there is no physician coverage here. The only coverage here are clinics structured to cater to farm workers and the uninsured. Kaiser is not an option for my family, since it too is in another city [Woodland Hills, about 40 miles away]. Seaview Medical Group, a physician group that used to participate with UC, dropped participation with Healthnet Blue & Gold where it formerly participated. To get my family to primary care providers and specialists we have to drive 30 or more miles to Santa Barbara. The doctors in the medical groups in Santa Barbara are oversubscribed and it takes months to get appointments. Given the increased cost, the university effectively dictates which medical practices get UC workers as patients. Mostly this seems to be Sansum Clinic.
This faculty member  has tracked a massive flight of Ventura-area doctors from UC health networks since she first signed on. She reported being told, improbably, that the Ventura conditions are �only a problem for five people.�

Many attendees agreed that doctors in Santa Barbara are heavily over-subscribed and one may wait months for an appointment. Sansum Clinic offered one attendee who requested an ophthalmological consult an appointment in February 2015.

Another faculty member said, 
I signed up for UC Care originally and recently switched to HealthNet. The reason I switched is that I didn't realize that lab work wouldn't be covered as Tier 1 in UC Care, even though the work was done right inside Sansum Clinic.  This can end up costing a lot, as the deductible is quite high. It is frustrating that UC Care costs a lot per month for a family and yet out-of-pocket is also high.
Another was surprised to discover that a leg cast counts as an (out-of-network) lab charge.A third person observed: �In my 14 years as a UC faculty member, I have witnessed higher costs and lower benefits� Did you know our co-pay for mental health has increased about 40% since January?�

Another faculty member�s doctor recommended immediate surgery for a suspicious mass. In order to have that work done at UCLA, the nearest UC Care provider, the faculty member would have had to locate a new doctor, schedule a consultation, a pre-operative appointment and surgery. Fearing the length of time that would take, the UC Care subscriber decided to accept Cottage hospital�s offer to schedule the surgery within five days. This faculty member is still waiting to see what all the bills will add up to.

In a dramatic set of meetings held in front of overflowing crowds last fall, outgoing UCOP CFO Peter Taylor, whose resignation was announced abruptly at the end of March, alleged that Cottage Hospital wants �too much money� from UC. At Wednesday�s meeting, Faculty Association President and labor historian Nelson Lichtenstein called that �egregious,� even if true: �Just leaving us out of the pool defeats the whole point of insurance.� Since it is the nature of insurance that some places and providers are more expensive and some less, the insurance pool is created precisely to even out those differences.

The promise of UC Care was that it would effectively provide the best of both worlds by combining the negotiating power of a single, large-scale payer with the range of choice offered by a menu of multiple plans. In fact it seems to have picked up the worst qualities of each type of system:  It has refused the advantages of single-payer or large-scale systems by denying parity to its campuses and faculty, treating each campus as a separate negotiating entity, and has also refused to allow individual campuses to negotiate for themselves with the local folks they know. So far, this UCOP strategy has not been conspicuously successful. Although Santa Barbara does not have the same quantity of medical facilities some other campuses have nearby, it is not a medical desert; the city does have lab services and a well-regarded hospital and emergency room, which just happen to be unavailable because UCOP failed to reach an agreement with Cottage, and only achieved a one-year agreement with Sansum. Moreover, the changes in faculty benefits also affect the collectives which have a �me too� clause, such as UCSB�s pool of lecturers.

Concerned faculty are calling for an open forum online where they can share information, broken promises, provider experiences and interactions with university administration, and want the Faculty Association to seek legal advice. (The blog has started a page called "Share Your Healthcare Story.")  

The Faculty Association has scheduled a general meeting open to all on May 7, featuring representatives from United Academics, the new collective bargaining group representing tenured, tenure-track and non-tenure track and adjunct faculty, in addition to librarians, research assistants, post-docs, and other academic employees at the University of Oregon. They will talk about similar experiences at the University of Oregon, and how collective bargaining is working out for them. 

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