What is happening with Blue Shield-Sutter Health?
Blue Shield of California and Sutter Health have been engaged in discussions on rates and terms for several months. Unfortunately, they were unable to reach an agreement on new contract terms and, as a result, the network relationship between Blue Shield and Sutter Health was terminated on Jan. 1, 2015.
However, in order to ensure an orderly transition of care for members, Blue Shield and Sutter Health have agreed to a six-month transition period through June 30, 2015, while they continue contract negotiations. There will be no disruption of care during this transition period.
This affects all Blue Shield of California plans, including UC plans that use the Blue Shield preferred network: UC Care, Blue Shield Health Savings Plan and Core.
What is UC’s role? What can UC via the HR/Benefits Department do to settle the dispute in these contract negotiations?
UC cannot settle the dispute. This is a matter between Blue Shield and Sutter Health. UC hopes that Sutter Health and Blue Shield of California will come to agreement before the transition period ends on June 30, 2015. UC Care management, Risk Services and UC Benefits Programs & Strategy department are taking steps to minimize program disruptions.
What is UC Human Resources doing about this issue?
Along with UC Care management, we are expressing our great disappointment that the issue could impact our employees, closely monitoring the situation, and evaluating options for our employees if a settlement is not reached. We will provide additional information when it is available, but no later than the end of April 2015.
There will be no disruption of care during the six-month transition period through June 30, 2015; therefore the University is not deploying a special enrollment period for employees and retirees to change medical plans before April if it is needed. UC is making contingency plans in the event Blue Shield and Sutter do not agree to a contract during the transition period and will share that information should the negotiations fail. Contract negotiations are ongoing, and UC hopes that Sutter Health and Blue Shield will come to an agreement before the transition period ends.
Why wasn’t I told about the termination during Open Enrollment?
During Open Enrollment, no one at UC was aware that negotiations had become so contentious. This was a surprise for everyone affected. Contracts between plans and providers expire and renew frequently – usually with little or no impact to employer or employees and retirees. This situation is clearly difficult.
UC hopes Blue Shield and Sutter can resolve their differences before June 30. Over the next several months, UC will consider contingencies in the event Sutter becomes a non-network provider on July 1.
When I called to make an appointment, my doctor says I’m no longer covered. What should I do?
Call Blue Shield (855-201-2087 for UC Care or 855-201-8375 for Blue Shield Health Savings Plan or Core) and ask them to contact your doctor. Your doctor may not understand there is an extension. Coverage has not changed and you can receive care at the coverage level you had previously, until June 30th.
How does this affect what I pay for health care?
During the transition period – through June 30, 2015 – nothing has changed.
UC Care plan members will continue to receive services at the same level as they had previously:
- If the Sutter provider is in UC Select, the member is responsible for the applicable copayment.
- If the Sutter provider is in Blue Shield Preferred, services will be covered at the in-network level (80%), but out-of-pocket costs may be higher because Sutter’s costs may be higher.
- If the Sutter provider was out-of-network in 2014, it will remain out-of-network during the transition period.
Blue Shield Health Saving Plan and Core Plan members will continue to be covered at the in-network level (80%). However, Sutter’s charges may be higher, which may result in higher out-of-pocket costs for Sutter’s services.
The underlying cost Sutter providers charge Blue Shield for various services has changed. Therefore, members who use services from in-network (preferred) Sutter providers may have higher out of pocket costs in some cases. While the plans will continue to cover 80 percent of the preferred rate, the underlying cost of members’ 20 percent co-insurance will be higher.
For example, if a medical service previously cost $150, you paid $30 and Blue Shield paid $120. Now, if the medical service costs $200, you pay $40 and Blue Shield pays $160. (Note: this example is for illustration purposes only and does not represent an actual charge or percentage of increase in charges. The actual increase in charges is considered proprietary information of Sutter Health/Blue Shield and has not been shared with UC.)
Will there be a Period of Initial Enrollment (PIE) to change medical plans?
The need for a PIE will be assessed and announced if an agreement has not been reached. We expect to make this announcement by the end of April to allow for plenty of notice.
What can or should I do?
To ensure an orderly transition of care for members, Blue Shield and Sutter Health have agreed to a six-month transition period through June 30, 2015, while they continue contract negotiations. There will be no disruption of care during the transition period; so there is no need to make changes at this time.
If you are currently under care that is likely to continue past July 1 or if you are planning to have surgery or other procedures in the spring, you may want to talk with Blue Shield about applying for continuity of care.
If you have any questions, call Blue Shield first.
How can
I learn about other provider groups available through Blue Shield?
To
find other Blue Shield network providers, see the appropriate chart for your
location:
UC Berkeley, Berkeley Lab, UCOP
What if my current treatment by a Sutter provider or at a Sutter facility is expected to continue past July 1?
Call Blue Shield at (855) 201-2087 (for UC Care) or (855) 201-8375 (for Blue Shield Health Savings Plan or Core) to request a continuity of care arrangement. Continuity of care arrangements allow a period of time for you to continue to see your current provider during the course of your treatment while still receiving the in-network level of benefits from your plan. More information is available here.
Your request may or may not be approved. If it is not approved, Blue Shield will help you identify network providers who can offer you necessary care once the transition period ends.