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Blue Shield warns UC contract could go out-of-network July 10; HSS, Blue Shield outline member options
Summary
Blue Shield of California told the San Francisco Health Service Board that the University of California health system may end its contract on July 10 unless a new agreement is reached. Blue Shield said in-network access to UC facilities continues through July 9; impacts vary by HSS plan and members should check referrals and continuity-of-care.
Blue Shield of California told the Health Service Board on June 12 that the University of California health system has given notice it will end its contract on July 10 if the parties do not reach a new agreement, potentially putting UC hospitals and specialists out of network for some SFHSS members.
The head of Blue Shield's regional operations told commissioners the insurer is negotiating in good faith and that, under the current agreement, SFHSS members will retain in-network access to UC providers through July 9. The company urged members to call the customer service number on their ID cards and said Blue Shield will assist members with continuity-of-care applications or with locating alternative in-network providers.
Why it matters: UC health facilities, including UCSF Medical Center and UCSF Benioff Children's Hospitals in San Francisco and Oakland, are major providers for city employees and retirees. A contract lapse could change cost-sharing or access for specialty care for some plans and cause disruption for scheduled care.
What Blue Shield and SFHSS said at the meeting - Amy DeHart, area vice president for Blue Shield of California, told the board negotiations have not produced a new contract and UC could end the agreement effective July 10 unless reimbursement terms change. She said the insurer hopes to reach a deal that preserves access at sustainable cost. - DeHart said all Blue Shield members remain in-network with UC under the current contract through July 9. For HMO members whose primary care is arranged through Hill Physicians Medical Group (the Access Plus and Trio HMOs), PCP visits should remain unaffected, she said, but referrals to UCSF specialists and inpatient services could become out-of-network after July 9. - DeHart said UCSF Medical Center and UCSF Benioff Children's Hospitals would be out-of-network for hospital services after July 9 if no agreement is reached, but St. Francis and St. Mary's hospitals would remain in-network. - DeHart said the Medicare Advantage PPO (the MAPD plan) offered through Blue Shield is expected to be unaffected because that plan charges the same cost-share for in- and out-of-network providers; Blue Shield's statement said that in general Medicare providers that continue to bill Blue Shield would maintain access under Medicare rules. - Ray Guillen, SFHSS executive director, said his staff is preparing a member FAQ and communications; staff committed to an FAQ posted on the SFHSS website and to close coordination with Blue Shield.
What members should check and do - Confirm plan type: impacts differ by plan (Access Plus/Trio HMOs, non-Medicare PPO, Medicare Advantage PPO). HMO members with Hill Physicians PCPs were told their PCP access should be maintained, but specialist referrals may be affected. - Check referrals: members who need UCSF specialty or hospital services after July 9 should contact their primary care provider and Blue Shield to verify referral status. - Consider continuity of care: Blue Shield described a continuity-of-care process for ongoing courses of treatment (examples include ongoing pregnancy care, inpatient stays, or chronic serious conditions). Members who believe they qualify should submit a continuity-of-care request to Blue Shield customer service. - Use the ID-card phone number: Blue Shield said the concierge/customer-service line on members' ID cards can help resolve provider or billing issues.
Board and public reaction - Commissioners and public commenters urged timely, clear member communications and earlier FAQs to reduce confusion. SFHSS communications staff said they aimed to publish vetted FAQ materials by the end of the week following the meeting.
Limits and uncertainties - Blue Shield's presentation described the parties' positions and the insurer's offer to continue negotiating; it did not announce a new agreement. The board did not take formal action on the contract at the meeting.
Ending note SFHSS members should monitor official SFHSS notices and Blue Shield communications and call the number on their ID card for case-specific guidance. SFHSS staff said it will post a member FAQ and provide dedicated phone-line support for affected members.
