Apr 01, 2024
Upon receiving a termination notice from Providence St. Joseph Health System in October 2023, Blue Shield began negotiating in good faith with Providence to establish a new contract.
Blue Shield’s goal is to reach an agreement that sufficiently covers the cost of providing access to quality health care and that enables Blue Shield to offer competitively priced coverage to customers and members.
Blue Shield is disappointed that Providence has been unable to come to an agreement with Blue Shield to continue their long-standing network relationship. Without reaching a renewal agreement, the current contract will end May 31, 2024.
Blue Shield is alerting you of this potential network change at this time so that you can be prepared to answer questions once they begin sending required member communications regarding Providence’s participation in the Blue Shield provider network (listed below).
Members can continue their care with Providence providers with in-network coverage through the end of the current contract period. In the event they are unable to reach an agreement, Blue Shield will ensure members have continued, uninterrupted access to care with an in-network provider.
As required by regulators, Blue Shield will provide timely notifications to members regarding Providence’s participation in the Blue Shield provider network:
April 1, 2024
60-day advance notification to impacted HMO members Sample HMO member letter
May 1, 2024
Medicare members with Saint John’s Physicians Partners are being provided a 30-day advance notification, which includes reassignment to another provider within 15 miles. All other Medicare membership affiliated with Providence is NOT impacted. Sample Medicare member letter
June 5, 2024
Five days post-contract termination to HMO and PPO Individual and Family Plan, Small Business, and Large Group members who have received care in the last 12 months and/or PPO members within a 15-mile radius of a Providence St. Joseph Health facility Sample Commercial member letter
Blue Shield's Fina a Doctor tool will continue to include Providence St. Joseph Health System up through the contract termination date, however, panels will be closed to prevent members from newly selecting a Providence St. Joseph Health System PCP. Members can use the Find a Doctor tool to select a new PCP or call the Customer Service number on the back of their Blue Shield member ID card for assistance.
Blue Shield of California members who need emergency services should call 911 or seek care at the nearest emergency room, including Providence St. Joseph Health system facilities. Blue Shield will provide the full emergency care level of benefits for these services.
Amwins Connect is here to help answer questions and provide updates as they become available. Contact your Amwins Connect team today.
