06 DEC 2016

Contract Expires, Blue Shield Members Scramble

More than 1,800 local residents may have lost access to their NorthBay Healthcare physicians, specialists and hospitals because Blue Shield of California unilaterally terminated its contract on December 1.

CalPERS Blue Shield members who did not choose an alternative health plan by the October deadline will not be able to keep their current NorthBay Healthcare primary care physician and will have to travel elsewhere for specialty care, and if needed, hospitalization. Emergency care will still be available to all.

Some patients already under the care of NorthBay Healthcare for acute medical conditions may be able to continue with their current treatment, including those with chronic conditions, pregnancy, terminal illness, care of a child under 3 years of age or a scheduled surgical procedure.

Anyone with questions can call a hotline at NorthBay Healthcare: (707) 646-3280.

“Sadly, the last-minute notice given to its members by Blue Shield prevented many from making an informed decision on their final health insurance plan for next year,” explained Elnora Cameron, the vice president at NorthBay Healthcare whose division oversees contracts with health plans.

Blue Shield informed NorthBay Healthcare in October that it would terminate its current contract. That would spur an interruption of care for 1,300 Blue shield HMO and PPO members, as well as 500 CalPERS members.

NorthBay Healthcare has had PPO and HMO contracts with Blue Shield since 2008. “Our Blue Shield contract was ongoing with no specific expiration date. But now, Blue Shield decided it would terminate its relationship with our physicians and hospitals,” said Cameron.

“Not only has Blue Shield unilaterally decided to terminate our agreement, it also has refused to negotiate terms for new contracts,” she added. “Their termination notice demanded a 35 percent cut in their payment rate to our health system, which is insufficient for us to continue providing quality care. We countered with a rate reduction that would have saved Blue Shield several million dollars, but they drew a line in the sand and they have not talked with us since.”

This has forced anyone enrolled in a Blue Shield health insurance plan who wants to maintain their NorthBay Healthcare physician to select a physician outside NorthBay Medical Group. Unless they are willing to pay more out of pocket, most Blue Shield members will not be able to use NorthBay Medical Center or NorthBay VacaValley Hospital, except in emergencies.

“Our advice to those who want to continue their relationship with their NorthBay primary care doctor is that they contact their human resources manager immediately and learn about their options,” Cameron said. “We believe our patients are loyal and satisfied with their primary care physicians, their specialist and they want to maintain the continuity of their care.”

Cameron continued, “Our main concern is the disruption and anguish this creates for patients whose relationship with their physicians is very important to them.”

You Might Also Like:

NorthBay Takes Reins of Urgent Care Top-notch care, better access is our promise to you. Posted: March 4, 2024
What’s the Right Choice? When is Urgent Care, Emergency Care or Primary Care the answer? Posted: March 4, 2024
NorthBay’s Medical Mission to the Philippines Surgeons, nurses join Bay Area team caring for rural patients. Posted: March 4, 2024

Get the best of NorthBay Healthcare News sent to you.

Never miss our latest health tips, or our best stories, by signing up for NorthBay Pulse today.

Are you a news professional looking to access our facilities, health care experts, or news team?