Blue Shield of California and Providence Health & Services have recently announced that they will terminate their contract, which has been making headlines. The contract will be terminated on June 1, 2024. This decision has left many patients across California concerned about its impact on their healthcare and access to quality providers.

At Skyline Benefit, we aim to provide a comprehensive understanding of the reasons behind the Blue Shield and Providence contract termination, how it will affect patients, and what steps can be taken to maintain continuity of care. We understand that this can be a difficult time for patients. As California’s best health insurance broker, Skyline Benefit is here to help clients navigate these changes and ensure a smooth transition in their healthcare coverage.

What Happened Between Blue Shield and Providence?

Providence Health & Services, a not-for-profit healthcare system with 17 hospitals across California, decided to terminate its contract with Blue Shield after several months of negotiations. Despite Blue Shield’s efforts to reach an agreement with sustainable rates, the gap between the two parties remained too wide. This led to the current network agreement’s termination, set to take effect on June 1, 2024.

Why Did the Contract End?

The termination of the contract between Blue Shield and Providence was primarily due to a disagreement over reimbursement rates and other financial considerations. Despite Blue Shield’s goal to offer competitively priced coverage to its members while ensuring quality healthcare access, Providence’s demands for higher rates, driven by rising costs of care, created an insurmountable gap.

As Tracy Barnes, Blue Shield’s vice president of provider partnerships and network management, stated, “The gap between what Providence is requesting and what Blue Shield can afford is too large to overcome.” This ongoing struggle highlights the challenge of balancing affordable health coverage with the costs of delivering quality care.

How Will This Affect Patients?

Patients currently receiving care from Providence providers may experience disruptions once the contract ends. This impact varies depending on the type of health plan:

HMO Members: If your health plan is a Health Maintenance Organization (HMO), It is important to note that you may need to find an alternative in-network provider after May 31. However, you need not worry as Blue Shield plans to assist you in identifying new Primary Care Providers (PCPs) and will ensure compliance with regulations regarding network changes.

PPO Members: If you have a Preferred Provider Organization (PPO) plan, you can continue to see Providence providers using out-of-network benefits, However this may involve additional out-of-pocket costs. Be sure to check with Blue Shield to understand your coverage and associated expenses.

Medicare Advantage Members: Certain Medicare Advantage plans will not be impacted, while others may require a switch to a new provider. Blue Shield guides members who need to transition to new providers.

What Can Patients Do to Maintain Continuity of Care?

If you have appointments or procedures scheduled at Providence after the contract termination date, it’s crucial to contact Blue Shield to understand your options.

Firstly, to ensure that you are fully aware of your insurance coverage, we recommend proactively contacting Blue Shield or our Broker at Skyline Benefit. This will help you understand how your insurance plan may be impacted. Additionally, don’t hesitate to inquire about out-of-network benefits or continuity of care provisions if necessary, as it’s important to be informed and prepared.

Secondly, regardless of contract status, emergency services remain available. In case of an emergency, seek care at the nearest emergency room, including Providence facilities.

What Happens Next?

Although the contract termination is imminent, Blue Shield remains open to discussions with Providence to resolve the dispute and avoid disrupting patient care. Despite the dispute, the health plan is trying to notify members of any changes and providing resources to ensure continued access to quality healthcare.

Additionally, for ongoing updates, Blue Shield recommends that members stay informed through communications sent by the health plan and consult their customer service for any questions regarding their coverage and access to care.

How Skyline Benefit Can Help Clients Maintain Continuity of Care During Healthcare Network Changes

At Skyline Benefit, we understand that changes in healthcare networks can be stressful and confusing. However, our brokers are always willing to assist clients with their healthcare insurance requirements, especially during times of disruption due to contract terminations. With our extensive expertise and partnerships with major insurance providers, we can help you find the best health insurance plans available and guarantee continuity of care.

Our brokers work closely with you to 

  • Find new in-network providers for HMO and PPO plans
  • Assist Medicare Advantage members in transitioning to new providers or understanding their coverage
  • Provide guidance on emergency services and out-of-network options to minimize disruptions. 

Need Help with a Health Insurance Broker in California?

Skyline Benefit is an independent health insurance broker in Fullerton, CA that offers affordable and flexible health insurance options. Selecting the best health insurance plans can be overwhelming; our mission is to simplify the process and help our clients every step of the way.

Schedule a consultation today. Call us now at (714) 888-5112

Get an Online Quote