Note: Providence’s contract with Blue Shield covers commercial HMO members including Trio HMO members, Blue Shield PPO members and Blue Shield POS members in California. It also covers Blue Shield Medicare Advantage members enrolled with Saint John’s Physician Partners. Our Blue Shield Medicare Advantage members enrolled with PHN through Facey Medical Group and Providence Medical Associates and the Providence Affiliates are currently not impacted by this pending termination. In addition, Providence caregivers enrolled with Blue Shield through Providence will not be impacted.
I received a letter from Blue Shield saying they are in contract negotiations with Providence. I have a scheduled appointment at Providence. Can I keep the appointment?
- There is no change in care delivery at Providence hospitals, clinics and medical groups until the contract terminates on May 31/June 1.
- If you have a scheduled procedure or appointment on or after June 1, call Blue Shield to understand your options and so you can determine whether you want to keep the appointment/scheduled procedure with us or reschedule with another provider covered by Blue Shield. If you choose to keep your appointment, you may be required to pay out-of-network copays/co-insurance, based on the health insurance plan you have with Blue Shield. Call Blue Shield to understand your out-of-pocket costs.
- If you are pregnant or getting active treatment for a chronic condition you may qualify for extended in-network access, also known as “Continuity of Care” through Blue Shield. If you think you may qualify, call the number on the back of your insurance card.
- As always, Providence will continue to provide care to anyone who walks through our doors. Our hospitals and clinics serve everyone, and patients can always access our services.
- Providence offers financial assistance for those who need help with out-of-pocket costs. Patients can call 855-229-6466 for help or visit providence.org/financialhelp.
What are my options for continuing to see my Providence doctors?
- Starting June 1, 2024, Providence hospitals, clinics and medical groups may be out of network.
- If you have commercial HMO benefits, including Blue Shield Trio, and your employer group offers an alternate plan that’s contracted with Providence, you can switch plans during open enrollment.
- If you purchased insurance directly, either on-exchange via Covered California, or off-exchange directly from Blue Shield, you can switch to a new plan during the annual open enrollment period.
- If you have PPO benefits, you can continue to receive services by accessing your out-of-network benefits.
- If you have a Medicare Advantage plan through Saint John’s Physician Partners, you may be able to switch to a new plan via a special enrollment period.
- Call Blue Shield customer service at 800-541-6652 with questions about how your insurance coverage may be affected if our contract expires.
What does out of network mean?
- “Out of network” means Providence does not have a contract with Blue Shield, and you might pay a different amount based on the health insurance plan you have with Blue Shield.
What is happening between Providence and Blue Shield?
- For months, Providence has negotiated in good faith with Blue Shield of California for fair and equitable rate increases.
- Providence has also asked Blue Shield to stop denying or delaying coverage for necessary patient care. Many patients are being denied treatment for essential care, including medications, therapies and procedures.
- Denials increased by almost $250 million from 2019 to 2023. In 2024, Blue Shield denials are already up 11.7%.
- Additionally, Providence accounts receivable balance due from Blue Shield has increased from 24.9% in 2019 to almost 37% in 2023, resulting in delayed payment to the health system for care provided to their members.
- We know contract negotiations can be disruptive for many of our patients and providers, and we don’t make our decisions to negotiate contracts lightly.
- Read our press release.
