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BLUE SHIELD AND SUTTER CONTRACT DISPUTE
January 14, 2015
As of January 1, 2015, Blue Shield of California was unable to reach an agreement on new contract terms and rates with Sutter Health Systems. The California Department of Managed Health Care (DMHC) has approved a transition plan for eliminating Sutter from the Blue Shield network. According to Blue Shield contract discussions with Sutter are continuing, and this contract dispute may be resolved before any network changes take effect. If the contract negotiations are unsuccessful the following changes will take place:

Blue Shield Access+ HMO

  • HSS members who have a Brown & Toland or Alta Bates Medical Group personal physician can continue to receive care from their Brown & Toland physicians. However, effective July 1, 2015, Brown & Toland medical group physicians will no longer be admitting Blue Shield enrollees to Sutter hospitals and facilities.
  • Effective April 1, 2015, HSS members who have a Sutter-affiliated personal physician (not in Brown & Toland or Alta Bates Medical Group) will be reassigned a new physician and medical group. These members will not be able to obtain service from Sutter-affiliated physicians or hospitals as of April 1, 2015. From now until March 31, 2015 these HSS members may continue to receive services from Sutter physicians and hospitals.
  • Hill Physicians Medical Group and other medical groups not affiliated with Sutter are not affected by this contract dispute.
Access+ enrollees should call Blue Shield at 1-800-642-6155 if they need more information about the following:
  • To confirm they will be required to change a Primary Care Physician, medical group and/or hospital network
  • To learn which non-Sutter physicians, medical groups and hospitals are available in their service area
  • To review Blue Shield’s planned reassignment of a Primary Care Physician, medical group or hospital network
  • To receive information about how to apply for Blue Shield’s Continuity of Care
Details have not yet been released to HSS on any changes that may affect enrollees in Blue Shield 65 Plus Medicare Advantage (MAPD) plan. Members in 65 Plus can call Blue Shield at 1-800-776-4466.

Blue Shield members who need emergency services should call 911 or seek care at the nearest hospital. The Blue Shield plan continues to provide coverage for emergency room services, including services provided at Sutter facilities.

Blue Shield has issued the following information to address member concerns:
https://www.blueshieldca.com/employer/knowledge-center/features/sutter.sp









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