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Blue Shield warns Sutter negotiation breakdown could force thousands of San Francisco members to change doctors
Summary
Blue Shield of California officials told the Health Service Board that termination of their Sutter Health contract, driven in part by a proposed arbitration clause, could require about 5,700 members to change primary care doctors and prompt April 1 transitions if no agreement is reached.
Blue Shield of California officials said a breakdown in contract talks with Sutter Health has put thousands of Health Service System members at risk of losing in-network access to Sutter hospitals and some specialists.
Tom Epstein, Blue Shield's vice president for public affairs, told the Health Service Board on Jan. 8 that negotiations faltered after Sutter sought new contract language that would require arbitration and bar customers from suing Sutter in open court. Epstein said Blue Shield rejected that clause and continued to negotiate "in hopes that we can resolve this before any members are ultimately impacted."
Paul Brown, Blue Shield's area vice president for premier accounts, estimated the termination would directly affect "about 5,700, or about 10 to 12 percent," of the board's membership by requiring a change of primary care physician. Brown said members would be notified around Jan. 15 and that Blue Shield has arranged a transitional period that would allow members to keep their Sutter primary care physician until April 1 if no settlement is reached.
Board members pressed Blue Shield for county-level counts and continuity-of-care details. Director Catherine Dodd and commissioners noted that some affected members can keep their Brown & Toland or other non-Sutter primary care physicians but may be redirected to non-Sutter hospitals for inpatient or specialist services. Commissioners and public commenters, including retirees'group representatives, urged Blue Shield to minimize disruptions for older members and those in active treatment.
Blue Shield said it has contingency plans for outreach and assistance, including auto-assignment of a new primary care physician for members who do not choose one, and that the State Department of Managed Health Care approved the insurer's network transition plan. Blue Shield also offered to meet with retiree groups and unions to explain options.
The board asked staff to obtain detailed member counts by county and medical group so it can track impacts and follow up at future meetings. No formal board action was taken on the network dispute during the meeting; Blue Shield representatives said they would keep Director Dodd updated on negotiations.
The board's discussion emphasized continuity of care for members in active treatment and the geographic limits of alternative provider capacity in areas such as the East Bay and North Bay.
