Blue Shield of California and Providence Health & Services are set to bring about a transformation in California healthcare this summer. As a result of crucial negotiations and financial decisions, their update will directly impact numerous patients in Orange and San Bernardino Counties. If you’re currently enrolled in the Blue Shield Trio Individual and Family HMO plan, it’s essential to stay informed about these changes to ensure uninterrupted access to quality care. Here’s what you need to know to navigate this transition smoothly and effectively.

What is Happening with the Blue Shield and Providence Contract?

On April 30, Blue Shield announced a tentative new contract agreement with Providence Health & Services. However, this agreement does not include Providence physicians and hospitals in Orange and San Bernardino Counties as participating providers in the Blue Shield Trio Individual and Family HMO plan. This change will be effective August 1, 2024.

Why Were Providence Providers Excluded?

The decision came after negotiations between Providence and the healthcare company fell through due to disagreements over costs. Both parties tried to find a middle ground, but the gap between what the healthcare company could afford and what Providence needed was just too wide. The goal was to keep healthcare costs down for everyone, but they couldn’t make it work this time.

Who Will Be Affected by This Change?

Patients using the Blue Shield Trio Individual and Family HMO plan in Orange and San Bernardino Counties will be most affected. They will need to seek alternative in-network providers after August 1, 2024. Members with Blue Shield IFP PPO plans will still have access to Providence providers.

What Should Affected Members Do?

  1. Identify New Providers: Blue Shield will assist members in finding new in-network providers. It’s important to start this process early to ensure a smooth transition.
  2. Check Coverage Options: For those wanting to remain with Providence, options include transitioning to Blue Shield IFP PPO plans or other special enrollment periods facilitated through Covered California or directly with Blue Shield.
  3. Continuity of Care: Pregnant members or those receiving treatment for chronic conditions may qualify for extended in-network access under “Continuity of Care” provisions. Contact Blue Shield member services to explore this option.

What Steps Should Members Take Now?

How Skyline Benefit Can Help

Navigating the changes in your healthcare network can be overwhelming, but Skyline Benefit is here to help ease the transition. As California’s premier health insurance broker, we offer personalized, one-on-one consultations to guide you through the process. Here’s how we can assist:

  • Understanding Your Options: We will help you understand the implications of the Blue Shield and Providence contract changes and how they affect your specific situation.
  • Finding New Providers: Our team will assist you in identifying new in-network providers, ensuring you continue to receive quality care without interruptions.
  • Exploring Plan Alternatives: We work with various insurance companies and carriers to suggest and select the best plans for you, whether it’s transitioning to a Blue Shield IFP PPO plan or another suitable option.
  • Continuity of Care: For pregnant women or undergoing treatment for chronic conditions, we will help you navigate the “Continuity of Care” provisions to ensure you continue receiving necessary treatments without disruption.
  • Emergency Services Guidance: We provide information on accessing emergency care and understanding your out-of-network benefits to minimize any potential issues.
  • Medicare Advantage Guidance: Assisting Medicare Advantage members with understanding their coverage and transitioning if necessary.
  • Emergency Services and Out-of-Network Options: Providing information on accessing emergency care and understanding out-of-network benefits.

Impacted Medical Groups and Hospitals

  • Medical Groups:
    • St. Joseph Heritage Medical Group
    • Providence Affiliated Physicians, St. Joseph
    • St. Jude Heritage Medical Group
    • Providence Affiliated Physicians, St. Jude
    • Mission Heritage Medical Group
    • Providence Affiliated Physicians, Mission
    • St. Mary High Desert Medical Group
    • Providence Affiliated Physicians, St. Mary
  • Hospitals:
    • Providence St. Joseph Hospital, Orange
    • Providence St. Jude Medical Center, Fullerton
    • Providence Mission Hospital, Mission Viejo
    • Providence St. Mary Medical Center, Apple Valley

This notice does not affect Blue Shield IFP PPO, Medicare, or employer group commercial plans. Stay informed through communications from Blue Shield and Providence, and reach out to Skyline Benefit for personalized assistance during this period of change.

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.

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