Blue Shield adds University of California hospitals to provider networks.
Blue Shield of California announced that they were adding University of California Medical Centers and Physician Groups as preferred providers for their individual and family, small group, and large employer health plan networks. Shortly after the initial announcement the UC hospitals and doctors were in-network; Blue Shield released another announcement to clarify that not all UC providers were in-network for all plans. Unfortunately, the second announcement also added potential confusion for many plan members.
Confusing provider networks
For consumers, health plan networks are necessarily confusing. Unless you work in the industry the distinction between the individual and family, small group, and large employer group provider networks becomes a blurred line. Then when you add PPO, HMO and EPO plan types on top of the product categories, it’s virtually impossible for the average person to determine if a doctor, pharmacy, hospital, or out-patient clinic will be considered in or out of the member’s respect health plan. But this is all by design to maximize the profits of the insurers and providers at the expense of the consumer.
Blue Shield adds UCs to their provider networks
Blue Shield’s first Producer announcement of the addition of UC providers on July 13th.
Blue Shield of California reaches new three-year agreement with University of California Health System (UC Health) effective July 1, 2015
Blue Shield of California has reached a new network agreement with the University of California providers, which includes the following hospitals and IPA/medical groups:
- UC Davis Medical Group
- UC Davis Medical Center
- UCLA Medical Group
- Ronald Reagan UCLA Medical Center and UCLA Medical Center Santa Monica
- UC Irvine Medical Center
- UCSD Medical Group
- UCSD La Jolla and UCSD Hillcrest
- UCSF Medical Center (Parnassus, Mt. Zion, Mission Bay) and Langley Porter Psychiatric Institute
Blue Shield and UC Health have agreed to three-year HMO/PPO contracts, effective July 1, 2015. In addition, effective July 1, 2015, the University of California Health System providers will participate in Blue Shield’s Individual and Family Plan (IFP) Exclusive PPO Network and IFP EPO Network with Covered California on-Exchange and off-Exchange directly through Blue Shield.
Blue Shield clarifies University of California providers
Blue Shield clarified the UC provider network with a second announcement on July 17th.
Blue Shield of California reaches new three-year agreement with University of California Health System (UC Health) effective July 1, 2015 – IMPORTANT UPDATE
On July 13, 2015 we sent you an announcement about the new three-year agreement with UC Health. Please note the important updated table below:
Blue Shield of California has reached a new network agreement with the University of California providers, which includes the following hospitals and IPA/medical groups:
UC Davis Med Group HMO and PPO
UC Davis Med Ctr HMO and PPO
UCLA Med Group HMO and PPO
UCLA Med Ctr HMO and PPO
UC Irvine Med Ctr HMO and PPO
UCI Med Group PPO only
UCSD Med Ctr HMO and PPO
UCSD Med Group PPO only
UCSF Med Ctr HMO and PPO
UCSF Med Group PPO only
Blue Shield and UC Health have agreed to three-year HMO and/or PPO contracts, effective July 1, 2015. In addition, effective July 1, 2015, the University of California Health System providers will participate in Blue Shield’s Individual and Family Plan (IFP) Exclusive PPO Network and IFP EPO Network with Covered California on-Exchange and off-Exchange directly through Blue Shield.
UC Health providers have long been a valued part of our network, providing high-quality care to our members in these markets. We are pleased that we have maintained and expanded our network relationship with UC Health.
Medical Groups bill separately from Hospitals
The Medical Centers are the hospitals or facilities that you would receive either in-patient or out-patient services. The Medical Groups are the actual doctors that you would either see for an office visit or who would provide perform the medical procedure at the UC Medical Center. (Remember, in California, hospitals can’t employ doctors so they have set up Medical or Physician groups to bill patients for services).
Not all UC Medical Groups accept Blue Shield HMO
Notice that most Medical Groups mirror their respective Medical Center in terms of being in-network for both PPO and HMO plans. However, the doctor Medical Groups in Irvine, San Diego, and San Francisco are only in-network for PPO plan members. In other words, none of the physicians in those Medical Groups could be assigned as a Primary Care Physician within a Blue Shield HMO plan. But a HMO member can choose to have a medical procedure performed at those hospitals and it will be invoiced as an in-network provider. See California Regions Map Page
What about EPO plans?
The other confusing element of this announcement is if the UCs are in-network for EPO plan members in Regions 1, 2, 6, and 9. (These regions encompass most of Northern California excluding San Francisco, Sacramento region, and Santa Clara Valley). With an EPO or Exclusive Provider Organization, there is no coverage for out-of-network providers similar to an HMO. But it has been our understanding that an EPO member in one region can visit and in-network provider in another region. See what’s the difference between an EPO, HMO, and PPO
Therefore, a Blue Shield EPO plan member in Yuba County should be able to travel to Sacramento and receive in-network services from UC Davis Medical Center or physician group. Unfortunately, the table of in-network plan types doesn’t include EPO, only the PPO and HMO. It could be that Blue Shield left the EPO off the table because there are no UC providers in the regions where only EPO plan are offered.
Regardless of whether you are an EPO, PPO or HMO Blue Shield plan member it is always best to check the provider search tool on the Blue Shield website with a follow-up phone to the doctor or provider to confirm you will receive in-network benefits when receiving health care services.