REGION — Since finding out on New Year’s Day that Anthem would no longer cover her care at Scripps Health, Escondido resident Kirsten Lozano has spent hours every day on the phone trying to get help.
Lozano, who lives with ulcerative colitis, had scheduled medical leave from her job for January and February to receive iron transfusion treatment for her low ferritin levels, which had left her feeling exhausted much of the day.
Instead, she was left in a state of panicked limbo after Anthem Blue Cross and Scripps Health failed to agree upon contract terms and terminated their contract on Jan. 1, leaving Scripps out of network for Anthem policyholders.
The change has affected around 125,000 people, who can no longer get their care covered at one of the largest medical systems in San Diego County.
“I was in tears on Jan. 2 because I could not get a hold of my primary physician, and I was getting messages from the Scripps care team that I was no longer a patient at Scripps. It was a terrifying moment for me, because I had no income,” said Lozano, 51.
Lozano said she switched to Scripps from UCSD Health in November, tired of driving from Escondido to La Jolla for appointments. She was never informed that in a matter of weeks, Scripps may no longer be in-network for Anthem.
She learned negotiations had fallen through while watching New Year’s Eve news. Lozano said she never would have switched from UCSD had she known this was possible.
“I’d be nuts to take that chance. I would have stayed with UCSD, 100%, because now I’m going to go back to them anyway. When my continuation of care runs out, I’m going back to UCSD,” Lozano said.
Anthem and Scripps had been in contract renewal discussions since early 2024 and warned customers in October that Scripps may no longer be in-network if the two parties couldn’t agree. After failing to reach an agreement by the end of the year, they announced the end of their contract effective Jan. 1.
Both parties have pointed the finger at each other. Scripps officials said Anthem would not agree to remove bureaucratic “red tape” that required significant time for medical staff to navigate. Anthem said Scripps was demanding excessive pay increases to reimburse providers.
Scripps patients being treated for ongoing conditions as of Jan. 1 have been advised to request continuity of care from Anthem to retain coverage for treatment. In Lozano’s case, this took weeks to get, and she has been unable to get care due to her authorizations from Anthem being repeatedly canceled.
She spends hours on the phone daily with either her insurance or Scripps.
“It’s been unbelievable. I’m pretty sick; I’m not doing well. I would hope that people who have worse situations than myself aren’t having to go through this,” Lozano said.
Others have also faced confusion over which plans are affected. Scripps’s website says they are out-of-network for Anthem, Anthem Blue Cross and Elevance plans, but Blue Shield of California and Anthem Blue Cross Medicare plans are unaffected.
Erin Schrenk, 63, of Vista, has Blue Cross Blue Shield for federal employees and was initially told her care would no longer be covered at Scripps. After canceling appointments with doctors, her insurance said they would continue to cover Scripps care for another 90 days.
Regardless, Schrenk and her husband plan to switch to Medicare in May when her husband turns 65. Once she switches, she hopes to continue seeing her Scripps primary care doctor, whom she’s had for around 20 years.
“I just have to look forward to May, and maybe that will work out for me,” she said.
Those in the health insurance industry are trying to help patients navigate the chaos. Jessica Schulte Walker, principal at Schulte Insurance Agency in Encinitas, said half her work is currently dedicated to helping impacted Scripps patients.
“You want to give your clients the right answers, and when you’re getting wrong answers on five calls and then right answers on the next ones, it’s very difficult,” Walker said. “A lot of employers are going to want to switch their plans. There’s a lot of huge employers in San Diego that use Anthem.”
Those who did manage to get procedures done before the new year still face challenges. After finding out in October that negotiations between Scripps and Anthem might fail, Carlsbad resident Susan Beeson scrambled to get a necessary surgery at Scripps rescheduled from Jan. 2 to early November.
In addition, Beeson is one of thousands of people now trying to find new doctors, including pediatricians, for her family. After spending hours on the phone trying to establish care, she said many doctors aren’t taking new patients or don’t have openings for several more months.
“All of our family of four’s doctors and specialists are with Scripps. It is literally a nightmare,” Beeson said.
Ongoing negotiations
As care costs rise, contract disputes between providers and insurance companies are becoming more common. Medical providers have decried that insurance reimbursements aren’t keeping pace with the skyrocketing cost of health care.
Walker said it’s a lousy situation for patients. All the same, she is hopeful the two parties will reach an agreement.
“With the cost of care rising and inflation, where in the past contracts would just renew, in the past three to four years we’re hearing so much about contracts being negotiated and then waiting until the last minute,” Walker said. “It scares people, of course it does, because people don’t want to lose that care that they need.”
At this time, Scripps and Anthem remain in contract negotiations. Scripps said it continues to work with Anthem but did not comment on the status of the talks.
“While Scripps continues to pursue a reasonable resolution, Scripps patients should contact their employer’s human resource departments to understand their health insurance options,” said Scripps spokesperson Janice Collins.
Anthem said they would like to see Scripps doctors back in-network.
“We continue to work in good faith to negotiate a new agreement for Scripps to remain in our network that includes reasonable payment increases that fairly compensate Scripps for the care they provide while also keeping care accessible and affordable for those we serve in San Diego County,” Anthem said on its website.
This is not the first time Scripps patients have lost coverage. On New Year’s Day of 2024, around 32,000 San Diego County seniors were affected when two major Scripps medical groups ceased accepting Medicare Advantage plans from carriers, including Anthem Blue Cross, Blue Shield of California and others.
