We are pleased to announce that Blue Shield and Sutter Health have signed a new 3-year agreement effective January 1, 2017. This means that Sutter Health hospitals and providers are part of Blue Shield’s statewide network.
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). Though we are still actively involved in negotiations, the current contract expired at 11:59 p.m. on December 31, 2016 and Sutter Health is no longer Blue Shield’s in-network provider effective January 1, 2017.
Blue Shield of California has experienced ongoing system issues that have recently been corrected. As a result of these issues, some Individual and Family Plan members received past billing statements showing incorrect amounts due. Affected members will receive a detailed statement of corrections for these past months and, in some cases, previous years, in their January billing statements. Those who have been over billed will be credited, and those who have been under billed will only be responsible for adjustments to the December premium, not for past months of accrued charges.
After the presidential election, it is likely that you will receive questions regarding the future of the Affordable Care Act (ACA) and how it could affect our customers. While we do not yet know the full outcome, we do know that the ACA and Covered California is working for over 21 million Americans and repealing or replacing it would not be a simple or fast process.
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.
In 2017, we will be selecting a primary care physician (PCP) for you so you can begin building a relationship with your doctor. As a PPO member, read our frequently asked questions about choosing a PCP.
Blue Shield has entered into an agreement with CVS Health to support manufacturer rebate and pharmacy network contracting for its outpatient pharmacy benefit and has received approval from the Department of Managed Health Care.
The California Office of the Patient Advocate (OPA) has released their health plan quality report cards in time for the 2017 open enrollment period. Now in its 16th year, the 2016/2017 OPA Health Care Quality Report Cards are available online at www.opa.ca.gov. This timely release of the Report Cards is critical as consumers prepare in making the important decision of choosing a new health plan for themselves and their families during 2017 open enrollment. Quality matters when consumers choose a health plan or medical group, and this free tool helps ensure they have the information they need to make an educated decision.
Blue Shield of California will make Teladoc consultations a $5 copayment for members of their individual and family plans. The $5 Teladoc consultation will be available to both Blue Shield’s HMO and PPO non-grandfathered plans in 2017.
We are notifying the members in the following closed plans that their prescription drug coverage will be considered non-creditable in 2017, which is a change from 2016, when their prescription drug coverage was considered creditable. This means that the coverage offered by their plan is not expected to pay out as much as standard Medicare prescription drug coverage pays.