Retirees report coverage disruptions as SFHSS and Blue Shield review Medicare Advantage PPO transition

The San Francisco Health Service Board on Feb. 13 heard an update on the Jan. 1 switch of Medicare Advantage PPO benefits to Blue Shield of California, with officials saying the transition covered about 19,100 members but acknowledging continued member disruptions and high call volumes.

SFHSS Chief Operating Officer Ray Guillen said Blue Shield’s concierge call center handled most incoming calls after the changeover and that HSS staff handled 139 escalated calls in January. “Following a review of these reports, it appears that most instances relate to the way certain providers, such as UCSF, are billing Blue Shield rather than a difference in the benefits themselves,” Guillen said during the staff presentation.

The board heard details from both SFHSS and Blue Shield staff about where members were experiencing friction. Blue Shield senior manager Tiffany Gill told the board the two plans match on the core benefit structure and copay levels in roughly 98 percent of prescription tiers and copay assignments; the remaining 2 percent represents changes that could affect “close to 400 members” in the Medicare population, she said. Gill said Blue Shield paid more than 37,000…