Nearly two weeks after Anthem Blue Cross regained access to Scripps doctors following a contract lapse, it appears that the process of returning to previous caregivers has been rocky for those enrolled in health management organization plans.
The contract between Scripps and Anthem ended on Jan. 1, 2025, after the two parties could not agree on a range of issues from proper compensation to the pre-approval process for medical claims, causing an estimated 125,000 Scripps patients to either switch doctors or pay out-of-network rates. Those enrolled in HMO plans, which require each member to have a primary care doctor, were reassigned to physicians at other local health systems such as Sharp HealthCare.
However, the split was short-lived. On May 6, Scripps notified its patients that the previous contract had been extended through Sept. 30, 2026, restoring the status quo while the two parties continue to work on a long-term deal that both find acceptable.
An email message that Scripps sent to Anthem beneficiaries on May 6 indicated that HMO would have to call the health insurance company and request to be assigned back to their original Scripps doctors. It was thought that those with preferred provider (PPO) or exclusive provider (EPO) plans would be able to immediately start scheduling appointments with Scripps doctors, as those plans do not require assignment of a primary care doctor as HMO plans do.
An HMO Anthem member seeking to return to Scripps told The San Diego Union-Tribune in a recent email that she has been unable to get Anthem representatives to follow through with her request to go back to Scripps.
The medical provider said in a statement that it believes that it has done what was required to make such transfers possible.
“Scripps has provided Anthem all requested information for them to complete their istrative workflows to enable patients to access Scripps doctors and facilities,” Scripps said. “Anthem has not been able to provide a timeline for completion of that work.
“To our knowledge, the issue is related to HMO patients being reassigned to a Scripps provider and is not affecting individuals with PPO or EPO insurance.”
In its own short statement on Monday, Anthem said that it “has a dedicated team working diligently to get Scripps reloaded into our network system.”
“Getting a health system reloaded into the system can take some time,” said Anthem spokesman Michael Bowman in an email Monday.
To re-enroll at Scripps, Anthem with HMO coverage are directed to call the toll-free number on their health insurance cards.
Anthem did not provide the total number of HMO potentially affected by the Scripps repatriation effort.
