Blue Shield Offers Transition Aid
By Sarah Arnquist, The Tribune, San Luis Obispo, Calif.
Feb. 3–Blue Shield of California will send customer service representatives next week to San Luis Obispo to help its HMO members adapt to their new physician network.
Sen. Abel Maldonado, R-Santa Maria, asked Blue Shield to provide additional customer support after hearing from several people whose care was interrupted following the Jan. 1 transition.
“Transferring doctors can be a very sensitive issue, particularly for people who are receiving ongoing treatment for a chronic condition or are in the middle of a pregnancy,” Maldonado said in a statement.
Blue Shield, the largest HMO in the county, has at least 13,000 HMO members, including 12,500 who belong to CalPERS, the benefits and retirement system for state employees.
Barring a few exceptions, Blue Shield HMO members must now see the doctors who belong to the SLO Select IPA, which is owned by local physicians.
HMO members were sent a letter in December describing the change, but some did not realize what it meant for them until January when they went to see a doctor who no longer took their insurance.
This move to a more traditional HMO model — in which doctors are paid a set amount per patient per year — is designed to reduce costs and improve patient care coordination, CalPERS spokeswoman Karen Perkins wrote in an e-mail to The Tribune.
CalPERS’ health care costs are 12.5 percent higher here than other counties where it offers HMOs.
When David Silberberger re-enrolled his family last September in the Blue Shield HMO, he did not know the health plan was negotiating with a new physician network and come Jan. 1, his wife could no longer see her gynecologist.
Silberberger, a Caltrans project manager in San Luis Obispo, said he feels deceived.
“They waited (to tell us) until just after we couldn’t do anything about it,” he said.
HMO members were not informed of the negotiations between Blue Shield and SLO Select in September because the contract was not final until December, Perkins wrote.
“Can you imagine what would have happened,” Perkins wrote, “if we would have gone out and told members in the fall of 2006 that their HMO might change, and they switched to a PPO, and then for some unforeseen reason Blue Cross was not able to reach an agreement with SLO Select IPA?
“Those members would have been stuck paying PPO premiums, and I don’t think they would be very happy about it,” she added, referring to preferred-provider organizations, which are less restrictive than HMOs but typically require patients to pay a higher share of cost for care.
CalPERS will not re-open the enrollment period.
Silberberger said he knows his choices are limited with an HMO, but the lack of openness leaves him feeling like he has no control over his health care.
A transition of more than 13,000 patients is bound to have some glitches, but for most patients their care has been seamless, said Dan Culhane, medical director for the SLO Select IPA.
“As far as I can tell, everyone is getting the care they need,” he said. “We’ve bent over backwards to help people.”
SLO Select has hired more staff to help during the transition, Culhane said, and is working closely with Blue Shield to help patients who are being treated for ongoing conditions by doctors not in the group.
Read the original story about the changes at Blue Shield at sanluisobispo.com.
(Blue shield change-up surprises thousands, By Sarah Arnquist, 01/25/2007) http://www.sanluisobispo.com/mld/sanluisobispo/16541108.htm
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Copyright (c) 2007, The Tribune, San Luis Obispo, Calif.
Distributed by McClatchy-Tribune Business News.
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