The new billing system addresses many issues and complaints that have frustrated both consumers and Blue Shield for several years. The grandfathered members were moved to the new billing system in 2017. Beginning in February, Blue Shield will begin to notify off-exchange members in individual and family plans of the change. On March 10th and 11th Blue Shield will begin to transition the off-exchange members into the new billing system off-exchange.
With the exit of Anthem Blue Cross in many regions of California, Blue Shield is working to make the transition for consumers who have enrolled in one of their health plans. They have released a bulletin about continuing care under a former health plan and transferring prescriptions to the new Blue Shield health plan.
The California Department of Managed Health Care (DMHC) has taken enforcement actions including a $322,500 fine against California Physicians’ Service (Blue Shield of California) and a $135,000 fine against Care 1st Health Plan for failing to identify, timely process, and resolve consumer grievances. The plans have also failed to fully and timely provide information to the Department during the investigation of these consumer complaints.
In addition, your out-of-pocket expenses will be counted separately for covered services received from network providers and non-network providers. Any expenses you pay to see a network doctor will be counted toward your network out-of-pocket maximum, and expenses you pay to see a non-network doctor will be counted toward your non-network out-of-pocket maximum.
As we previously reported, new off-exchange enrollees into individual and family plans in California will not have the 15th of the month payment option in their enrollment materials. In addition, the automatic payment option through Easy$PaySM will be temporarily unavailable until later in 2018.
The Blue Shield Trio HMO plans include such medical groups as Dignity Health, Hoag Memorial, John Muir, Providence St. Joseph, St. Jude, and UC San Francisco. Your PCP will refer you to specialists within the network of doctors and providers within his or her medical group. Trio HMO plan will be available in 24 California counties. Trio HMO plan will also include the BlueCard program for urgent care outside of California similar to the PPO plans.
The membership of our grandfathered plans continues to get smaller every year. When a plan’s membership drops below 500 members, we need to review our portfolio and consider changes that benefit all Blue Shield members. Therefore, we are withdrawing the following Blue Shield of California grandfathered plans from the Individual and Family Plans market.
When individuals go to an in-network facility for care but receive services from an out-of-network doctor or healthcare provider, they only have to pay their in-network cost-sharing amount that counts toward the annual deductible and annual out-of-pocket maximum limits according to their health plan.
the AHCA as currently drafted is flawed as well. The tax credits it provides do not vary based on either a person’s income or the cost of care where they live. There is no help with deductibles and co-pays for those with lower incomes. Millions of people, particularly older Americans, would not be able to afford health insurance or to get care when they need it. In addition, the recent amendments could return us to a time when people who were born with a birth defect or who became sick could not purchase or afford insurance, and when benefits were not there when people needed them the most.
Beginning in April, we will transition to a new payment system that will offer our members the same convenient choices with an improved online payment experience. Members will notice some changes if they pay their bill online or are enrolled in Easy$PaySM, our automatic payment program.