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SFHSS and Blue Shield apologize for rocky Medicare Advantage rollout; audits find programming and operational gaps
Summary
The San Francisco Health Service System (SFHSS) and Blue Shield of California apologized Thursday for a troubled transition of nearly 19,000 retirees into a Blue Shield Medicare Advantage PPO plan that took effect Jan. 1.
The San Francisco Health Service System (SFHSS) and Blue Shield of California apologized Thursday for a troubled transition of nearly 19,000 retirees into a Blue Shield Medicare Advantage PPO plan that took effect Jan. 1. Ray Guillen, interim executive director for SFHSS, told the board the implementation "was unacceptable and nowhere near the experience that we had planned for or what they deserve."
Why it matters: retirees reported interrupted care, lengthy holds and repeated phone calls. Guillen and Blue Shield representatives said many issues have been fixed and that call volumes and most service metrics have improved since January, but acknowledged the transition eroded trust with retirees.
What SFHSS presented: SFHSS engaged Aon to perform two post‑implementation audits — a programming and claims analysis and an operational readiness assessment — and shared those findings with the…
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