How To Keep Your UC Davis Doctor After Western Health Advantage

Western Health Advantage member loosing their UC Davis doctors have other health insurance alternatives for 2018.

Members of Western Health Advantage (WHA) have been notified that beginning in 2018 they will no longer be able to have a UC Davis Medical Group doctor as their primary care physician. WHA has already started working with current members to transition to a new PCP with Mercy Medical Group, Hill Physicians, Woodland Clinic, or NorthBay Healthcare. However, if you don’t want to give up your UC Davis PCP and specialists, there are other health plans that UC Davis Medical Group will accept.

UC Davis Doctors Leave Western Health Advantage

UC Davis Medical Group of doctors and hospital accept a variety of individual and family plans, along with small and large employer group plans. Current Western Health Advantage HMO members can continue to see their UC Davis PCP and specialists through the end of 2017. But those providers will no longer be in-network with WHA in 2018. It’s interesting that UC Davis had already taken down WHA as a health plan they accept from their website as of early July 2017.

With the level of uncertainty in the health insurance market fostered by attempts to repeal and replace the Affordable Care Act, it is hard to predict if current health plans accepted by any provider in 2017 will be honored in 2018. The separation of UC Davis Health Systems from WHA highlights the fact that anything can happen within health insurance. After all, UC Davis was one of the founders that helped create Western Health Advantage in 1996.

Individual And Family Plans

Individual and family plans are offered through Covered California and off-exchange directly from the health insurance company. For 2017 UC Davis Medical Group was accepting:

• Anthem Blue Cross HMO
• Anthem Blue EPO
• Blue Shield PPO

There have been no indications that any of the above health plans will discontinue UC Davis doctors as in-network providers. But before you change plans during the open enrollment period in November 2017 for the 2018 plan year, it would be wise to conduct an online provider search to confirm your UC Davis doctor will still be in-network for 2018.

Small and Large Group Employer Plans

There are numerous small and large group employer plans from each health insurance company. The network of providers is not the same across all the different plans. For example, UC Davis doctors are in the Blue Shield small group PPO plans, but not the HMO plans for 2017. Your best bet is to perform an online provider search to determine if your current UC Davis doctor is in-network for another health plan other than WHA.

To do this you will need the specific name of the plan from the health insurance company. The online search tools combined with the numerous types of plans can often yield false positive results. In other words, the doctor may show as in-network, but because the wrong plan type was selected (PPO instead of EPO or HMO) the doctor really is not in-network. The best bet is to work with your health insurance agent to determine the network status of UC Davis Medical Group physicians for each health plan you are considering for your company or non-profit organization.

The UC Davis website gives some information about health plans they accept, but it is not detailed enough to make definitive determination because not all the different plans that the carriers offer are listed.

Accepted insurance plans http://ucdmc.ucdavis.edu/medicalcenter/accepted_health_plans.html

For employers, employees, and members who will be sticking with WHA and need to learn more about the transition from UC Davis doctors to another PCP you can read more information at this WHA page https://www.westernhealth.com/faqs/pcp-transition/

Covered California IFP health plans http://ucdmc.ucdavis.edu/medicalcenter/cliniclocations/primarycare/Covered-California.html

In most cases, the networks for the individual and family plans offered through Covered California are mirrored in the off-exchange plans.

Western Health Advantage UC Davis PCP Member Letter

Dear Member:

Thank you for trusting Western Health Advantage with your health coverage. With that trust comes our promise to keep you informed of important news. You are receiving this letter because you, or someone in your household, have a primary care physician (PCP) with UC Davis Health.

Last week, WHA received notification that UC Davis Health is modifying its agreement with WHA effective January 1, 2018. As a result, WHA members with a UC Davis PCP will need to select a new PCP before December 15, 2017. But you don’t have to wait. You may make this change to be effective as early as August 1, 2017.

Many WHA employees, myself included, have a UC Davis PCP. We personally understand the distress and inconvenience this change may cause you and will do whatever we can to support you throughout this transition period. UC Davis Health made this decision because, in today’s health care climate, they determined that the high-cost structure of their academic medical center is no longer compatible with a regional HMO like WHA, which strives to be a market leader in affordability.

While we are disappointed in this decision, I assure you that everyone at WHA remains committed to our mission — ensuring you and your family have access to affordable and high-quality health care. Our extensive regional physician network remains strong, and you have over 250 PCPs to choose from in the Hill Physician Medical Group, Mercy Medical Group, Woodland Clinic Medical Group and NorthBay Center for Primary Care.

In addition, if you are actively receiving treatment through UC Davis Health as of December 31, 2017, you can request to temporarily remain with your doctor under certain conditions to ensure continuity of care. WHA is also working with UC Davis Health to allow access to UC Davis Medical Group specialists and the UC Davis Medical Center with an approved referral from your PCP.

Over the next couple of months, expect to receive additional information that will help guide your PCP transition. We are also setting up a new hotline staffed by a dedicated Coverage Transition Team specially trained to assist you with selecting a new doctor and to answer your questions about this network change. The Coverage Transition Team will be available at 916.246.7494 or mywha.org/PCPtransition starting on July 17.

Thank you for choosing Western Health Advantage. We appreciate your support and, as always, remain committed to the health of you and your family.