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SFHSS, Blue Shield report fewer calls but members and advocates press unresolved MAPD issues
Summary
SFHSS staff and Blue Shield of California reported a sharp drop in MAPD-related call volume in February and said many transition problems have been fixed, but member advocates and retirees told the board that unresolved issues — including claims for facility fees and acupuncture coverage — persist.
San Francisco Health Service System (SFHSS) staff and representatives from Blue Shield of California told the Health Service Board on March 13 that call volume and service metrics tied to the Blue Shield Medicare Advantage PPO (MAPD) transition fell substantially in February, and that many reported issues have been resolved.
The update came as the board heard repeated public comments from retirees and the advocacy group Protect Our Benefits asking the system and the insurer to resolve remaining claims and to “replicate” services members said they had under the prior carrier.
Ray Guillen, SFHSS chief operating officer, said the system and Blue Shield held a March 4 roundtable with Protect Our Benefits and that both organizations saw call volumes drop by roughly half from January to February. “We have experienced significant improvement in our average speed of answer, our average handle time, and our first call resolution compared to January,” Guillen said.
Charles Lee, senior manager for Blue Shield’s group Medicare business, told the board Blue Shield’s own call metrics also improved: abandonment rates fell to about 1…
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