Sutter Health, Palo Alto Medical Foundation, Blue Shield and me

How do you make sense of a decision made by key players outside your coverage area that affects your community like a punch in the gut?

That is what happened when I got an email Monday afternoon containing the 4-page termination letter from Blue Shield for plan members who have doctors at Sutter Health. One of the largest doctor groups in our county, Palo Alto Medical Foundation, is affiliated with Sutter Health, which just finished a beautiful new medical office and is working on an expansion of its specialty maternity and surgery center, and I had been in touch with the PAMF spokesman before Christmas asking for an update of these negotiations with Blue Shield because Blue Shield was the sole plan offered by Covered California in our county with the PAMF doctors in network.

Of course, this would have an impact, but what exactly did it mean? It said termination, yet it mentioned a transition until June 30. Luckily, I had county market share figures for insurers (after having filed a Public Records Act).

Re-reading, I saw "higher out of pocket expense" and then began calling and emailing to people I thought could help interpret all the medical jargon.

Here's what I came up with, working on a 4 p.m. deadline and juggling a deadline story on another of my beats. 

It's an unfolding story where additional information is coming to light daily.

Photo by Robert Couse-Baker via Flickr.