[{"_1":2,"_99":-5,"_100":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75,87],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":68,"_72":73,"_74":73},"mediaId",6624788,"mediaKeyId","5168590-8cba3f972c48bf158df1a781553e3212","parentId",5168590,"title","Board approves $1.32 million dental stabilization buy-down; members urge action on shrinking Delta Dental network","audioSeconds",117,"startMs",3660000,"endMs",3777000,"viewUrl","/Search/View?dp=1&key=5168590-8cba3f972c48bf158df1a781553e3212&start=3660&end=3777","thumbnailUrl","https://assets.pipeline.soar.com/5168590-8cba3f972c48bf158df1a781553e3212/thumbnail_3660000.jpg","articleUrl","/articles/6624788/San-Francisco-City/San-Francisco-County/California/Board-approves-132-million-dental-stabilization-buy-down-members-urge-action-on-shrinking-Delta-Dental-network","mediaUrl","https://secure.pipeline.soar.com/6624788-0d562690272da212ccd9702ba3e4a866/orig.mp4?Expires=1775516879&Signature=Ncm2I6rUtjxlE5vypp8mZsCz~9LWzJ18OdUUaSQYgWdIpPVuN69MF61kSxFxbgF-WtNTQHQ0WZ8a9EZS9QUGvWj~x7P8bkiBpvc-95tszhbFJiorFuJTOAGBpcwAsWKcQe9~DM-D9BENbAocavH6QoVUrLPPjowvlTq7Yx-NcDmTjdn77VmeLqeZkuvwFf1GUCSyJUdPzJbTSoZkVRFjrmg0xuTsMRTgjXid9vTRj7L3xjrqU0ceXIGXCWAcrmZy7A1ki4ShtYcaDcE8FGN9ZVdRUIfAavbLN7GXOzAwRbH27L~CO3RiWzxUp0yyiQU-zh9S-sQr0Mg73iaqRpUA7Q__&Key-Pair-Id=KUT5TJCACFTXG","author","City of San Francisco","date","2025-03-13T00:00:00Z","article","The San Francisco Health Service Board unanimously approved a stabilization reserve action on March 13 that will apply $1,320,000 — one-third of the December 31, 2024 stabilization fund balance for the self-funded active dental PPO — as a buy-down to 2026 rates.

Aon lead actuary Mark Clark presented the recommendation under the SFHSS stabilization fund policy. Clark explained the calculation: the stabilization surplus balance as of Dec. 31, 2024 totaled $3,960,000; per policy the board may apply one-third of the stabilization balance to rate buy-downs, which equaled $1,320,000 for the active dental PPO. He noted the plan’s stabilization balance grew from prior favorable experience and that $2,640,000 would remain for future rating periods after the 2026 buy-down.

Commissioners discussed long-running concerns about Delta Dental network adequacy and provider reimbursement. Commissioner Sass and others said they have heard repeatedly from members and providers that dentists are leaving the Delta Dental network because reimbursement levels are too low, which reduces in‑network access. Aon and SFHSS staff acknowledged the concern and said Delta Dental representatives would be asked to present at the April rates-and-benefits meeting to explain renewal proposals and network strategies.

During public comment, Fred Sanchez of Protect Our Benefits and other callers urged the board to investigate the number of dentists who have left Delta Dental over recent years and to press the carrier on network access. Sanchez said retiree members sometimes find the plan’s capitation and reimbursement structure unattractive to providers and questioned the value proposition for certain retiree enrollees.

Board members noted the stabilization action applies only to the self‑funded active dental PPO, because the other dental plans (insured HMOs and retiree dental plans) are fully insured and thus not subject to the stabilization policy. The motion passed unanimously by roll call.

Ending: Staff promised a deeper review of dental network participation and county-level utilization in the next meeting’s rate materials; the $1.32 million stabilization buy-down will be applied across active PPO rating tiers for 2026.","mediaType","Video","parentTitle","City of San Francisco - Video Open Video Only in Windows Media Player - Jul 04, 2025","oneSentenceSummary","The Health Service Board approved using one-third ($1.32 million) of the active dental PPO stabilization reserve to buy down 2026 rates. Members and commenters told the board they are losing Delta Dental-participating dentists and urged the system and carrier to address reimbursement and network access.","taxTitle","San Francisco City, San Francisco County, California","taxId",5751,"location","headline","","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":68,"_72":73,"_74":73},6624793,"SFHSS finance report shows improved net position; board approves 10‑county survey for 2026 rates",4107,865000,4972000,"/Search/View?dp=1&key=5168590-8cba3f972c48bf158df1a781553e3212&start=865&end=4972","https://assets.pipeline.soar.com/5168590-8cba3f972c48bf158df1a781553e3212/thumbnail_865000.jpg","/articles/6624793/San-Francisco-City/San-Francisco-County/California/SFHSS-finance-report-shows-improved-net-position-board-approves-10county-survey-for-2026-rates","https://secure.pipeline.soar.com/6624793-e38c8dd3cb7f875673e15f57308bb985/orig.mp4?Expires=1775516879&Signature=cwuWGvQ7QyFFUPfHegZg3Ss-2w5hSkTIeIapxxkR-iwbTJay5VXQ9Cl0lvA2U3IjTps7ONWZv9RmQ3mefYT8xSE4caxILJ2tkGYiWMzTxkoMn5Ylov5mS--NSbfGVO-LUwuuzx3sjWsB1MoI0HHeLFmYq2ASCb7dpwPHJ3nrYCDvbiimhhnivpNuItwPCvbnsMq~DRrOgReoTit2saywFPmoFS3dII~icZOaoq~avM0qiC59FCuO3Oo~JzmoPYoXh3NDxyU1Y90NNMEmAECTKb8tQgYDXpCJsDgP68HLtwkGRUAXIcuhYvjHIf19XQfwml1fTlocJjPbPiJRhxp0mg__&Key-Pair-Id=KUT5TJCACFTXG","San Francisco Health Service System staff told the Health Service Board on March 13 that the system’s net position projection improved from a projected $37 million drop to a $25 million decline, driven in part by payroll timing and three pay periods in the reporting window, while medical and pharmacy claims remain elevated.

SFHSS Chief Financial Officer Iftikhar Hussain told the board the projection improved primarily because of pay-period timing: “We had a projection of a $37,000,000 drop last month, and it improved to $25,000,000 mainly on how the pay periods fall. So we had 3 pay periods.” He said pharmacy rebates and the timing of pay periods yielded favorable adjustments; interest income was expected to be “a good $6,000,000 due to the higher rates that we’re seeing.” The health sustainability fund projection remained unchanged with a projected ending balance of $5,100,000.

After the finance update, the board considered and unanimously approved the results of the annual 10‑county survey that SFHSS uses to set plan-year 2026 rates for non-represented employees. Iftikhar Hussain said the survey produced an average increase of 6.81% for the counties surveyed, moderated from the prior year’s peak of 9.46%. A roll-call vote recorded ayes from all present board members.

Actuarial staff from Aon then presented a series of reports on 2024 experience for SFHSS self‑funded and flex‑funded plans. Mike Clark, Aon lead actuary, summarized plan-level experience: Blue Shield HMO and the UHC EPO experience saw increases driven by facility-based medical claims and pharmacy; Health Net Canopy Care showed lower aggregate per-employee expense on some measures and continued enrollment growth; the non‑Medicare PPO plan’s financial position improved as active employee enrollment rose.

Aon reported large-claim activity: 38 members exceeded $500,000 in combined medical and pharmacy paid claims in 2024, accounting for $39 million of total spend; roughly $9.5 million of claims were reimbursed under the large-claim pooling arrangement for amounts exceeding $1 million. Prescription drug per‑covered‑life costs rose, with specialty medications and classes such as GLP-1s contributing materially to trends.

Board members discussed county-by-county variations in dental and medical network access and asked staff to include county-level utilization and network data in upcoming rate presentations. No new rate increases were adopted at the meeting beyond the procedural approval of the 10‑county survey results.

Ending: SFHSS staff and Aon actuaries will present more detailed rate recommendations and dental-specific network updates at subsequent meetings as part of the rates-and-benefits calendar.","SFHSS staff reported a smaller-than-expected decline in net position for the current year and forecasted interest and pharmacy rebate impacts. The board unanimously approved the annual 10‑county survey results, used to set plan-year 2026 rates; actuaries also presented 2024 plan experience across self-funded and flex-funded plans.",{"_33":88,"_35":36,"_37":38,"_39":89,"_41":90,"_43":91,"_45":92,"_47":93,"_49":94,"_51":95,"_53":96,"_55":56,"_57":58,"_59":97,"_61":62,"_63":64,"_65":98,"_67":68,"_69":70,"_71":68,"_72":73,"_74":73},6624797,"SFHSS and Blue Shield report fewer calls but retirees say problems persist after Medicare Advantage transition",1120,1088000,2208000,"/Search/View?dp=1&key=5168590-8cba3f972c48bf158df1a781553e3212&start=1088&end=2208","https://assets.pipeline.soar.com/5168590-8cba3f972c48bf158df1a781553e3212/thumbnail_1088000.jpg","/articles/6624797/San-Francisco-City/San-Francisco-County/California/SFHSS-and-Blue-Shield-report-fewer-calls-but-retirees-say-problems-persist-after-Medicare-Advantage-transition","https://secure.pipeline.soar.com/6624797-1bcc570bdd236a61f2f39cc5a928603a/orig.mp4?Expires=1775516879&Signature=QzLD4MWuSaf0Uq5YfUjlVEBvoZ9A3TGdca3cWjmP9U7AzLS0Cbut0qCXsg77hpmPtRguVWcraTZW~onhh8f5f56T3xETZvFPFCFO90vOxSzdwG15cZSrQ1PcjiS8MmW-cX6RVMpi3FuwqBVONpPke~SvU34TTo-mNGWdmyPS4oNf0Fi13bKJQCUfkxz99~Iq7J0XMee5h0cAm9dTgCnqrOjRj9jDvjdmPAAFXGCwXvz8p1XzxLXtd5fRYRl1EIHsZVVsvnie0nHjea5XgaVOf1gvdP7fa8Nkcz-rflu0lZZSXCKI3zSjp8n8Pp2zDnBHfBAjdb2USFyuaoK69AVHVw__&Key-Pair-Id=KUT5TJCACFTXG","San Francisco's Health Service System (SFHSS) and Blue Shield of California told the SFHSS Health Service Board on March 13 that transition-related call volume and service metrics for the Blue Shield Medicare Advantage PPO have fallen since January, but members and advocates said problems persist and need additional outreach and fixes.

SFHSS Chief Operating Officer Ray Guillen said the number of members walking in or calling for help related to the Blue Shield MAPD transition “has dropped by 50% compared to January,” and that the system’s average speed to answer, average handle time and first-call resolution improved in February. Guillen said HSS hosted a March 4 roundtable with Protect Our Benefits, Blue Shield leaders and SFHSS staff to discuss member-reported issues.

The session’s purpose was to assess remaining problems and Blue Shield’s plans to resolve them, Guillen said. “Once we move away from these monthly transition updates, we will continue to share with this board the HSS and Blue Shield call metrics in the monthly director’s report,” he added.

Charles Lee, senior manager for Blue Shield’s group Medicare business, presented the insurer’s metrics and said the Blue Shield concierge and HSS call center volumes “have dropped drastically” from January to February. Lee said Blue Shield’s abandonment rate dropped to 1% and average speed to answer returned to a roughly “30 second commercial timeframe.” He said average handle time remained in the 17–18 minute range and that some follow-up contacts account for a drop in first-contact resolution.

Lee described several resolved technical issues: a legacy membership file problem, an eligibility file issue with Blue Shield’s transportation partner, and a claim-side error that caused an incorrect $100 outpatient facility copayment for some retirees at UCSF. He said Blue Shield corrected the fee processing, will reprocess affected claims and will communicate to members about reimbursement.

Tiffany Gill, Blue Shield account executive, said the company and SFHSS agreed to send an additional member communication detailing frequently asked questions and to provide monthly and quarterly reports to SFHSS to continue joint monitoring. She also said Blue Shield will present at a RECCSF webinar to educate members and help them use Blue Shield engagement tools.

Retirees and advocates told the board the work is not complete. Fred Sanchez of Protect Our Benefits praised Blue Shield for fixing the UCSF facility fee but said the volume of emails the coalition is receiving has not fallen and that some serious access issues remain, including denials for routine services reported from out-of-area members.

Caller River Weiner told the board Blue Shield “did not replicate the services from UnitedHealth to the letter,” and urged Blue Shield to adopt a policy of replicating UnitedHealth services automatically rather than resolving problems on a case-by-case basis. Jan Miller, on the phone, said she and her husband have had “issues with the ASH network when it comes to acupuncture benefits,” saying the Blue Shield evidence-of-coverage and ASH processing differed and that she had been unable to resolve the claim after six weeks of back-and-forth.

Blue Shield staff acknowledged ongoing member questions about differences in benefit use and said education for members and providers is part of the response. Lee and Gill reiterated a member phone line for assistance: (800) 370-8852, 8 a.m.–8 p.m., seven days a week, and said notices about corrected claims will be mailed to members.

Board discussion focused on member communications, provider-side education (for example, notifying providers they can write a 100-day prescription), and whether outstanding problems should be escalated in parallel to continuing monitoring reports.

The board did not take a formal vote on this presentation; members thanked presenters and asked for the next monthly update.

Ending: SFHSS and Blue Shield said metrics improved in February, and both urged members with unresolved issues to use the insurer’s phone line while Blue Shield and SFHSS continue joint monitoring and targeted communications.","San Francisco Health Service System and Blue Shield of California said call volumes and call-center metrics improved following the Medicare Advantage PPO transition, but retirees and advocacy groups told the board ongoing issues remain, including benefit replication and acupuncture claims.","actionData","errors"]

Article not found

Board approves $1.32 million dental stabilization buy-down; members urge action on shrinking Delta Dental network

SFHSS finance report shows improved net position; board approves 10‑county survey for 2026 rates

SFHSS and Blue Shield report fewer calls but retirees say problems persist after Medicare Advantage transition