A Health Plan Update

We have received questions about why Kaweah Health is no longer contracted with La Salle, a Medi-Cal independent practice association (IPA), which sub-contracts with both Anthem and HealthNet to administer Medi-Cal benefits in Tulare County. We assure you that this was not Kaweah Health’s decision. La Salle chose not to contract with Kaweah Health for elective, ancillary services such as urgent care visits, physical therapy, infusion and specialty care such as cardiology at our clinics; their patients can still come to Kaweah Health for all other services including emergency and in-hospital care.

Unfortunately though, effective Jan. 4, 2023, La Salle’s decision left approximately 55,000 people in Tulare County who have Anthem or HealthNet as their Medi-Cal health plan and La Salle as their as IPA administrator, facing out-of-network charges for these elective, ancillary services. Patients covered by Anthem and HealthNet that do not have La Salle as their IPA, were not impacted by this change. Whether Anthem or HealthNet members come under LaSalle is determined by their primary care physician assignment by the health plan or selection by the patient.

With the looming expiration of our contract, Kaweah Health reached out directly to La Salle multiple times beginning early in the fall of 2022 to negotiate and renew our contract. La Salle remained silent and ultimately chose not to renew and let the contract expire. Kaweah Health continues to contract with all other Medi-Cal managed care plans and remains committed to discussions with La Salle about future contracting opportunities. In fact, Kaweah Health just finalized an agreement with Dignity Health IPA for their managed Medi-Cal members in Tulare County for elective and ancillary services beginning March 1.

Kaweah Health exists to care for all patients regardless of their health plan - we are one of the largest providers of Medi-Cal patients in the State. We have also been recognized by a number of health plans, most recently by HealthNet, for providing outstanding quality care to patients, which we expect to continue for years to come.

If you are a patient of La Salle (Anthem or Health Net) and have any questions about your coverage, you may contact them directly or express your concerns directly to the State agency who oversees them (i.e. the Department of Managed Health Care):

Health Net or Anthem

Refer to contact info on back of your card

La Salle Medical Associates

Authorization or Referral-Related Inquiries

C/O Network Medical Management

(888) 554-4562 Option #3

Department of Managed Health Care

1 (888) 466-2219 or www.dmhc.ca.gov