Back in 2014, then-California Atty. Gen. Kamala Harris imposed a strict condition on the affiliation between Hoag Memorial Hospital and St. Joseph Health System, a Catholic hospital group: For the most part, Hoag was to be exempt from Catholic church restrictions on women’s healthcare services.
Doctors at Newport Beach-based Hoag say that condition has been flagrantly breached by Providence Health, the successor to St. Joseph — and the violations are proliferating.
Since 2015 and up to the present day, a managed health plan controlled by Providence has been refusing to pay for contraceptives prescribed by Hoag OB/GYNs for their patients.
We would like to be tops in women’s healthcare, but how can we be if there are certain things we will never be able to provide, based on our association with Providence?
Jeffrey Illeck, an OB/GYN at Hoag Memorial Hospital
The health maintenance organization, Heritage Healthcare, has cited the Ethical and Religious Directives for Catholic Health Care Services as grounds for refusing payment, even though the 2014 agreement under which Harris approved the affiliation explicitly states that Hoag would not be bound by the so-called ERDs then or “in the future.”
Frustration among Hoag OB/GYNs has been rising.
Several members of Hoag’s professional staff filed a confidential complaint with Atty. Gen. Xavier Becerra’s office on Oct. 9.
The complaint asserts that “Providence has increasingly disallowed women’s health services when they involve any form of contraceptive care,” even when IUDs are prescribed for reasons other than birth control, such as heavy menstrual bleeding.
Providence also has refused to cover deliveries when they’re combined with sterilization procedures such as salpingectomies (the removal of one or both fallopian tubes), even though combining those procedures is the standard of care to avoid requiring a patient to undergo two rounds of anesthesia and recovery rather than one.
The complaint says that physicians’ staffs are spending many hours a day pursuing reimbursement claims for Heritage enrollees.
“We have seen IUD reimbursements, for example, pending for as long as two years, requiring multiple appeals and grievances on behalf of patients,” the complaint states. Billing staff “have never spent so much time trying to get reimbursements for IUDs. … In many cases, payment is never received.”
The Hoag doctors say that Providence established “an anonymous hotline for people to complain if they believed Hoag was committing so-called immoral procedures involving women’s reproductive health.” The hotline was connected to the Orange County bishop’s office, they say, adding: “We were never told of its existence.”
In sum, “Providence has established a history of broken trust in its relationship with us, with absolutely no end in sight,” says the complaint, which is not a public document but which I’ve reviewed.
Providence has refused to comment on any of these assertions.
Becerra has not responded to the complaint, even