healthcare

UC San Diego Health Drops Molina Insurance, Affecting Thousands of San Diegans

NBC 7 Responds looked at the options for people who no longer have access to UC San Diego Health through Molina Healthcare

NBCUniversal, Inc.

Losing your insurance is a scary thing, but losing a doctor while keeping your insurance can be downright confusing. Thousands of San Diegans who use Molina Healthcare as an insurance provider found they can no longer go to UC San Diego Health for treatment.

"In the middle of a year like this it's very surprising," said Craig Gussin, an insurance agent at Aurbach & Gussin. "I was shocked when I heard it because it just doesn't happen that often."

UCSD Health's decision took effect on June 30th. Molina Healthcare says it covers 225,000 San Diegans, many of whom enrolled through Medi-Cal, and 9,000 of them were directly affected. So what happens for the thousands of people who lost their doctor?

Gussin says there are a few options. People can sign up for a new plan, or work within the healthcare system to continue any treatment they were already receiving at UCSD Health.

"There's something called a qualifying event," Gussin said. "That kicks in during the year if you lose your job, lose your benefits, get married, or have a baby, so that would kick in."

That means people can go to places such as Medi-Cal and Covered California and pick a new plan. It is especially easy for people to do that now because the state has extended its open enrollment period through the end of July due to the coronavirus pandemic.

Gussin says if someone is already being treated at UCSD Health, they can likely continue that treatment if they fill out the proper paperwork.

"The decision to terminate was difficult and made reluctantly," read the statement from UC San Diego Health. "We realize this action impacts our patients, many of whom have developed long-term, close and meaningful relationships with UC San Diego Health."

UCSD Health has created a hotline for people who were affected by the decision. It can be reached at 619-543-7780. It also has a webpage with more information for patients.

Molina is also trying to help those affected and is adding new healthcare providers to its network.

"We have partnered with the Family Health Centers of San Diego to facilitate a smooth transition," read a statement from Molina Healthcare. "Molina maintains an expansive provider network ... including the recent addition of Paradise Valley Hospital ... and Alvarado Hospital Medical Center effective August 1."

UCSD Health told NBC 7 Responds in a statement that it made the decision because of a number of issues with Molina:

The contract termination is the consequence of a history of issues that have resulted in a profoundly poor experience for both our patients and employees, such as unreasonable delays in care authorizations, continuous denials of care, and unfulfilled payment obligations on behalf of Molina Healthcare. Repeated efforts over many years by UC San Diego Health to remedy the situation have been unsuccessful. 

However, in the statement Molina Healthcare sent to NBC 7 Responds, it said the decision was without cause.

The University of California San Diego (UCSD) recently made the decision to terminate without cause its contract with Molina Healthcare of California. We are deeply disappointed by this action and believe that Molina had demonstrated the value that it offers members and providers through the care coordination and cost savings that it offers.

If someone has questions about their insurance or are looking to change a plan, Gussin recommends reaching out to an insurance agent.

"It costs nothing to use an insurance agent," said Gussin. "When in doubt, reach out. We may end up telling you we can't help, but then at least you'll know."

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