Blue Shield of California is sending letters to their plan members notifying them that Stanford Health Care hospital and facilities are out-of-network as of June 28, 2024. For individuals and families Covered California plan members, only the Blue Shield HMO plan included the hospital and some specialists. This will be a bigger challenge for group plans whose members wanted to use Stanford hospital. As noted in the letter, there are continuity of care provisions for individuals undergoing treatment with Stanford Health Care.
Stanford facilities affected:
- Stanford Health Care Medical Center
- Lucile Packard Children’s Hospital
- Stanford Health Care Tri-Valley
Below is the Broker Alert sent to insurance agents regarding Stanford Health Care from Blue Shield of California.
The Stanford Health Care hospitals and facilities contract with Blue Shield ended on June 28, 2024. Despite many months of good faith negotiations with Stanford Health, we have not been able to reach a reasonable agreement on reimbursement rates and contractual terms that are beneficial for both parties and keep care sustainably affordable for our members.
We are notifying impacted members, as is required, regarding this network change:
Impacted HMO and PPO Individual and Family Plan, Small Business, and Large Group members – those who have received care in the last 12 months and/or PPO members within a 15-mile radius of a Stanford Health facility – will be notified five days post contract termination (July 3, 2024).
Please see list of the nearest alternate facilities (These all have pediatric and/or NICU services, unless otherwise noted):
- El Camino Health
- Good Samaritan Hospital
- Mills-Pen Medical Center
- O’Connor Hospital
- Regional Medical Center of San Jose (NO pediatric and/or NICU services)
- Santa Clara Valley Medical Center
- UCSF Medical Center and UCSF Benioff Children’s Hospital – Oakland (37 miles from Lucille Packard Children’s Hospital)
Blue Shield has taken steps to ensure members will continue to have uninterrupted access to quality medical care in their area. Blue Shield has an extensive hospital network that is available to serve members who previously received care through the Stanford Health Care hospitals and facilities. We will work with our providers and members to ensure a smooth transition.
Blue Shield will continue to act consistently with our not-for-profit mission of providing access to quality health care that is sustainably affordable. Blue Shield seeks financial arrangements with providers that are sufficient to cover their cost of providing health care, provide them with a fair margin and enable us to offer competitively priced coverage to employers and members.
Members can use the Find a Doctor tool to search other facilities and hospitals or call the Member Services number on their Blue Shield member ID card for assistance.
Continuity of Care Provisions
Right to Continued Care
We realize that when you are in a course of treatment, it is important not to interrupt your care. Federal law guarantees you the option to continue receiving treatment from a terminated provider for 90 days after the receipt of this letter or until your treatment concludes, whichever is sooner. Your treatment will be provided under the same terms and conditions that applied before the contract termination date. Federal law qualifies you for continuing care if you are receiving treatment for a serious and complex condition, pregnant, undergoing inpatient care, scheduled for non-elective surgery, or terminally ill.
Under California law, you can request continuation of covered services for the following conditions:
- An active course of treatment for an acute medical or behavioral health condition, including a
maternal mental health condition - An active course of treatment for a serious chronic condition
- A pregnancy, regardless of trimester, and including postpartum care
- A terminal illness
- Care of a newborn (0 to 36 months)
- Performance of a surgery/procedure that has been authorized by Blue Shield as part of a
documented course of treatment and has been recommended to occur within 180 days of the
above-mentioned cancelation date
To request continuation of covered services at Stanford Health Care, please call (800) 393-6130 (TTY: 711) or the Customer Service number on your Blue Shield member ID card. To learn more about our Continuity of Care Program, please visit blueshieldca.com/find-a-doctor/help/continuity-of-care.