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SFHSS says Blue Shield transition on track for Jan. 1; staff report high call volumes and plan supports for members
Summary
San Francisco Health Service System staff and Blue Shield representatives told the Health Service Board that the transition of roughly 19,100 members to a Blue Shield MAPD PPO plan is largely complete, with ID cards expected the week of Dec. 16 and support options for members who experience provider or enrollment issues.
San Francisco’s Health Service System (SFHSS) told the Health Service Board on Dec. 12 that the conversion of about 19,100 members from UnitedHealthcare to a Blue Shield Medicare Advantage Prescription Drug (MAPD) PPO plan is on schedule for Jan. 1, 2025, and staff are prepared to support members through the change.
"Through the continuous close relationship between HSS and the Blue Shield implementation teams, we stand ready for January 1," said Olga Stavinskola Velasquez, operations manager for SFHSS, listing completed implementation milestones and ongoing PeopleSoft work that will carry into early 2025. She said the HSS call center resolved about 90% of transition calls on first contact and that the combined call centers handled nearly 10,000 calls during the open‑enrollment period.
Charles Lee, senior manager for Blue Shield (group retiree), said Blue Shield processed the enrollment file received from SFHSS on Dec. 4 and expected to change a small number of at‑risk items to green as processing continued. In November Blue Shield recorded roughly 900 calls related to the transition; Blue Shield reported an average speed to answer of about 35 seconds and an average handle time of approximately 13 minutes.
Staff said most members should receive ID cards the week of Dec. 16. "If a member does not receive their card or welcome kit by Jan. 1, they can call Blue Shield’s concierge service," Charles Lee said, and the insurer can walk members through the member portal or email PDFs of ID cards as a short‑term fix.
Board members raised concerns about provider acceptance of the new MA plan. Staff addressed questions about John Muir Health, noting that although some providers are contracted commercially and not yet on the Medicare Advantage side, Blue Shield can reimburse providers 100% on a fee‑for‑service schedule when no MA contract exists. "There is no balance billing," a Blue Shield representative said, citing CMS requirements for Medicare Advantage products.
During public comment, retiree Christopher Dimitropoulos asked how grievances and appeals would be handled during the transition and what additional resources members could use beyond town halls and the helpline; staff pointed callers to the concierge helpline, town halls and the microsite. Another caller, Herbert Weiner, urged members to ask providers in advance whether they accept Blue Shield and was told Blue Shield will outreach to providers when members report issues.
SFHSS staff also highlighted member‑facing work: six benefit fairs, targeted communications (including 89 custom templates), in‑person assistance for retirees during open enrollment and microsite materials such as the evidence of coverage and summary of benefits. Staff said a small batch of members already received cards and that the welcome kit will include information on Amazon Pharmacy home delivery for prescriptions.
The board did not take a formal vote on the transition itself. Staff said they will continue monitoring implementation, outreach to providers, and member feedback as Jan. 1 approaches.
