UEBT is alleging that Sutter uses unfair business practices to maintain its power over prices.
There’s competition all around.”Ĭastlight and the other self-insured companies believe they’re receiving this letter because of a lawsuit Sutter is facing from UFCW & Employers Benefit Trust (UEBT), which funds health coverage for 60,000 members of a grocery workers’ union. “Recent academic studies have been one-sided and misrepresent the competitive environment of Northern California,” said Bill Gleeson, vice president of communications for Sutter, adding that the studies “unjustly inflate the so-called market share of Sutter. Sutter rejects these claims and the research findings. Not signing the letter, she says, allows her company to “maintain our flexibility in fighting against what we consider to be difficult, anti-consumer provisions in provider networks.” “We want them, over the long term, to have choices in high-quality, low-cost providers.” “Having a very strong, dominant provider system will reduce choice for our employees,” Chaloemtiarana says. For comparison, Whaley says, the largest medical system in the Los Angeles area has 5 percent market share.Įconomists have long argued that Sutter uses this power to charge more for its services. Sutter’s hospital prices are about 25 percent higher than other hospitals around the state, according to a recent study from the University of Southern California. Sutter is the largest medical system in Northern California, with roughly 30 percent market share of hospitals, surgical centers and doctors’ groups, according to a data analysis by Christopher Whaley, a research economist at UC Berkeley. To Chaloemtiarana, waiving that right would only help strengthen the power of Sutter’s “already dominant” provider network. “This has just been handed to us as a one-sided, unilateral provision.”Īs an employer that pays its employees' medical claims, Castlight doesn’t like the idea that it will never be able to challenge Sutter over its prices in open court. “Arbitration provisions are pretty common among companies, but it usually occurs when you can sit down at a table and have a discussion and negotiation,” she says. As a lawyer, this makes Chaloemtiarana uncomfortable. And if it doesn’t sign, Castlight’s employees will lose their in-network medical rates. The letter is from Anthem, but it says if Castlight has any disputes with Sutter, Castlight has to agree to arbitrate with Sutter Health. “So the letter was unusual in that regard because it asked us to make certain legal agreements with Sutter.” "We don’t have a direct relationship with Sutter Health,” Chaloemtiarana said. Anthem basically functions like a middleman, including negotiating discounted prices with providers like Sutter.
But when an employee gets sick, Castlight, not Anthem, pays the bill. She thought it was strange.Ĭastlight is self-insured, meaning it hires an insurance company - in their case, it's Anthem Blue Cross - to manage the administrative details of its health coverage. “In both choices, Castlight and our employees lose,” says Jennifer Chaloemtiarana, general counsel for Castlight Health, a tech company in San Francisco that received one of these letters this spring. If they don’t, the letter says, the companies’ employees who get care at Sutter will no longer have access to discounted in-network prices. Bay Area companies say Sutter Health is strong-arming them into a contract that would help the medical system secure its power over prices and potentially raise the cost of medical care for their employees in the future.ĭozens of companies received a letter in recent months, via their insurance administrators, asking them to waive their rights to sue Sutter.
0 kommentar(er)
