Jul 03, 2018
Blue Shield of California will be moving members from the Blue Shield administered pod to alternate IPAs. In an effort to lower the cost of health care, Blue Shield will be closing the San Mateo Blue Shield Administered Direct Contract HMO (San Mateo DCHMO) and moving members to alternate IPAs. Blue Shield believes it is in the best interest of members to be managed by an IPA or medical group that offers the appropriate infrastructure, alignment of incentives, expertise, and experience to effectively manage their growing HMO membership in the San Mateo area.
The alternate IPAs are Brown and Toland Medical Group, Dignity Health Medical Network Sequoia, Hill Physicians San Francisco, Palo Alto Medical Foundation (PAMF), and PAMF Mills Peninsula Division. Members will be transitioned to an alternate IPA. Their last day in the HMO pod will be August 31, 2018. The closure of this HMO pod affects Small Business, Core, Premier, and CalPERS.
The Effect of This Closure on Blue Shield Members
Since the last day that the HMO pod is in their network is August 31, 2018, Blue Shield HMO/POS members who are currently assigned to San Mateo DCHMO will need to know the following: • On June 29, 2018, Blue Shield will send notifications to commercial HMO/POS members assigned to San Mateo DCHMO PCPs. The notifications advise members that they will be reassigned to alternate medical groups for a September 1, 2018, effective date. Members can call the Member Services number on their Blue Shield member ID card to self-select a PCP or IPA or they can go online to the Find a Doctor tool.
The alternate IPAs are as follows:
Brown and Toland Medical Group, Dignity Health Medical Network Sequoia, Hill Physicians San Francisco, Palo Alto Medical Foundation (PAMF), and PAMF Mills Peninsula Division.
Blue Shield members assigned to San Mateo DCHMO who are receiving care on September 1, 2018, or who have a procedure scheduled to be performed by San Mateo DCHMO within 180 days of September 1, 2018, can request continuation of covered services through Blue Shield for ongoing treatment with their provider. These members can call the Member Services telephone number on their Blue Shield ID card. They may also access Blue Shield’s continuity of care policy online.
Medicare members
Medicare members are not affected by this contract termination.
Communications
Letters to commercial HMO/POS members assigned to San Mateo DCHMO will be sent on June 29, 2018.
Please contact your LISI Regional Sales Representative for more information.
