Blue Shield of California and Health Net are two of the health plans that are currently in negotiations with Sutter Health regarding contracted in-network doctors and hospitals for 2017. Both health insurance companies are alerting agents to the potential that Sutter hospitals and doctors may not be covered in many of their health plans in 2017 if they don’t come to an agreement soon.
Blue Shield of California
Blue Shield of California
Sutter Health Negotiation Update
Background
Last month, we told you that Blue Shield of California and Sutter Health have been engaged in discussions on rates and terms for a new network contract (HMO/PPO and in some cases, Group Medicare Advantage). The current contract is set to expire at the end of this year and without a new deal, Sutter Health would no longer be a Blue Shield in-network provider starting January 1, 2017.
We continue to work diligently in good faith to complete a new contract that is fair and sustainably affordable for our customers. If the network relationship terminates, Blue Shield will ensure that members have continued access to care in their area, including continuity of care for those who qualify to continue in their current course of treatment with a Sutter Health provider.
Key updates
While our contract negotiations continue, we are taking steps to ensure members have access to care, and can make informed decisions about any doctor selection they are making now or in the coming months.
Website message to all members and potential members
A message has been posted on the member portal Home page and Find a Doctor page stating that Sutter Health could potentially go out of network if a new agreement is not reached by the end of the year. The message alerts customers to the possibility of being reassigned to an alternate Primary Care Provider (PCP) if they select a Sutter doctor and Sutter’s contract with Blue Shield expires on December 31, 2016.
New HMO members who have selected a Sutter PCP during enrollment
All new Blue Shield HMO members who enroll with a Sutter-affiliated PCP with an effective date of January 1, 2017 or later, will manually be reassigned an alternate, in-network PCP and will receive their member ID cards reflecting the alternate doctor and not the Sutter Health provider they originally selected. A buck slip will be inserted into the ID card mailing to explain the reason for this change.
Current HMO members who enrolled with a Sutter PCP
In most cases, all current members who have a Sutter Health PCP, or who have recently selected a Sutter PCP, would be notified of a PCP reassignment 60 days in advance of a contract termination per DMHC regulations. At this time, no letters have been mailed to our members, but this is subject to change based on the progress of the negotiations. If/when we mail letters to members and subsequently reach a deal with Sutter, then we will notify our members who were affected by the contract termination and ask them to call the Customer
Service number on their member ID card if they would like to switch back to a Sutter-affiliated PCP.
Our commitment to affordably priced health coverage
Blue Shield continues its provider contract discussions with Sutter Health in hopes that a new agreement will soon be reached. We appreciate your patience while we work to secure the best possible outcome for our customers and members. Our goal is to provide our members with access to quality health care at an affordable price.
Emergency services
Blue Shield members who need emergency services should call 911 or seek care at the nearest emergency room. Blue Shield will provide the full emergency care level of benefits for these services. Blue Shield encourages members to make informed decisions about when to use urgent care as opposed to emergency room care. Urgent care is appropriate when a member needs a physician’s attention for a condition that is non-life threatening. Any member needing urgent care, but whose physician or network provider is unavailable, should go to the nearest immediate or urgent care facility. Members can access a list of nearby urgent care facilities using the Find a Doctor tool at www.blueshieldca.com.
Health Net
Health Net
Important Update – Current Contract Negotiations with Sutter Health
Health Net of California, Inc. and Health Net Life Insurance Company (Health Net), and Sutter Health are currently negotiating our contract, set to expire on December 31, 2016. While we are working in good faith to reach a fair agreement that offers sustained affordability to our members, if Health Net and Sutter Health are unable to complete a new contract, Sutter Health physicians, medical groups and hospitals will no longer participate in currently contracted Health Net networks.
In compliance with regulatory requirements, in the event the parties are not able to reach agreement for a renewal, affected members will receive a letter informing them of Sutter’s termination. As part of our contract with Sutter Health, impacted members will continue to have access to their Sutter provider during a transition period, prior to being assigned to their new provider. The letter will provide members the following details in the event of a termination:
- HMO and Medicare Advantage members will receive written notice from Health Net at least 60 days prior to the change taking effect.
- Their new primary care physician (PCP) and medical group.
- The option and steps to select a new PCP or medical group, other than the one assigned, if desired.
- PPO members who have accessed a Sutter provider for services in recent months will receive written notice of the provider termination.
- Information about continuation of care assistance, if members or covered dependents are currently receiving ongoing medical treatment with a Sutter Health provider.
Health Net Lines of Business Affected by Negotiations
The contracts being negotiated apply to the following Health Net plan types:
- Commercial HMO/POS
- Large Group HMO
- Small Group HMO
- Blue and Gold Network
- Large POS
- Small POS
- Flex-Funded HMO
- Medicare
- Medicare COB
- PPO/EPO/POS
Continuity of Care – Our Commitment to Members in the Event of a Sutter Termination
While we continue to negotiate with Sutter Health, our ultimate goal is to ensure our affected members experience seamless access to quality health care through continuity of care. Please advise your clients to call us if any of their Health Net members are currently under treatment with a Sutter Health provider. We will help make sure they continue to get the care they need.
What About Emergency Care?
In case of emergency, members should go to the nearest emergency or urgent care facility, even if it’s not a contracted Health Net provider. Members, or their family, should contact Health Net as soon as possible after care is received.
Sutter Health providers are located in the following California counties:
| Sutter Health Counties | |||
| Alameda | Nevada | San Mateo | Stanislaus |
| Amador | Placer | Santa Barbara1 | Sutter |
| Contra Costa | Sacramento | Santa Clara | Yolo |
| Del Norte | San Diego1 | Santa Cruz | Yuba |
| Lake | San Francisco | Shasta | |
| Marin | San Joaquin | Solano | |
| Merced | San Louis Obispo1 | Sonoma | |
1Surgery Center location only.
The contracts currently being negotiated include the following Sutter Health provider groups:
| SUTTER MEDICAL FOUNDATION |
| SMG – Sac/Placer Division |
| SMG – Yolo Division |
| Sutter Independent Physicians |
| Sutter North Medical Foundation |
| SMG – Solano Division |
| SUTTER GOULD MEDICAL FOUNDATION |
| Sutter Gould Medical Foundation |
| Sutter Gould – San Joaquin |
| Sutter Gould — Los Banos |
| Central Valley Medical Group |
| SUTTER PACIFIC MEDICAL FOUNDATION |
| Sutter Medical Group of the Redwoods |
| Physician Found Med Associates |
| SMGR – Marin Headlands Med Grp |
| PALO ALTO MEDICAL FOUNDATION |
| Palo Alto Medical Clinic |
| Camino Medical Group |
| Santa Cruz Medical Clinic |
| PAMF – MPD/MPMG |
| SUTTER EAST BAY MEDICAL FOUNDATION |
| Sutter East Bay Medical Foundation |
| SEBMF – Diablo Division |
The contracts currently being negotiated include the following Sutter Health hospitals:
| Sutter Health Hospitals | |
| Sutter Medical Center – Castro Valley (d.b.a. Eden Medical Center) |
California Pacific Medical Center-Davies Campus |
| Alta Bates Summit Medical Center – Alta Bates Campus |
California Pacific Medical Center -Pacific Campus |
| Alta Bates Summit Medical Center – Summit Campus |
St. Luke’s Hospital |
| Sutter Amador Hospital | Sutter Tracy Community Hospital |
| Sutter Delta Medical Center | Mills Health Center (Mills Hospital) |
| Sutter Coast Hospital | Menlo Park Surgical Hospital (MPSH) |
| Sutter Lakeside Hospital | Peninsula Hospital |
| Novato Community Hospital | Sutter Maternity and Surgery Center of Santa Cruz |
| Memorial Hospital Los Banos | Sutter Solano Medical Center |
| Suter Auburn Faith | Sutter Santa Rosa Regional Hospital |
| Sutter Roseville Medical Center | Memorial Medical Center |
| Sutter Medical Center Sacramento | Sutter Surgical Hospital – North Valley |
| California Pacific Medical Center-California Campus | Sutter Davis Hospital |