Dec 22, 2023
UPDATE: Blue Shield of CA and Adventist Health reach a successful contract negotiation.
Blue Shield of California and Blue Shield of California Promise Health have reached a contract agreement with Adventist Health hospital facilities. Blue Shield is pleased to share this update, and believe the agreement reached is equitable and sustainably affordable for customers. The new contract is effective retroactive to 12/1/23, without any gap for members’ coverage within the network.
Members who received contract termination letters regarding Adventist Health will receive “good news” communications in the next week with information on the successful negotiation. Claims for services rendered during the termination period (12/1/23 - 12/21/23) will be processed as in-network according to the terms of the new agreement.
Blue Shield appreciates your patience while they worked to secure the best possible outcome for members.
Please reach out to your Amwins team for more information. We are here to help.
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Prior Article Dec 5, 2023
The Adventist Health hospital facilities contract with Blue Shield ended on November 30, 2023.
Despite nearly a year of good faith negotiations with Adventist Health, Blue Shield was not able to reach a reasonable agreement on reimbursement rates and contractual terms that were beneficial for both parties and would keep care sustainably affordable for Blue Shield members.
Adventist Health medical groups (e.g., capitated agreements) have separate contracts, currently through April 30, 2024.
Blue Shield is notifying impacted members, as is required, regarding this network change:
- Impacted Medicare members were notified 30 days in advance – November 1, 2023.
- Impacted HMO and PPO IFP, Small Business, and Large Group members - those who have received care in the last 12 months and/or PPO members within a 15-mile radius of an Adventist facility - will be notified five days post contract termination (December 5, 2023).
Please see list of the nearest alternate facilities, here.
Blue Shield has taken steps to ensure members will continue to have uninterrupted access to quality medical care in their area. Blue Shield has an extensive hospital network that is available to serve members who previously received care through the Adventist Health hospital facilities. Blue Shield will work with our providers and members to ensure a smooth transition.
Blue Shield will continue to act consistently with our not-for-profit mission of providing access to quality health care that is sustainably affordable. Blue Shield seeks financial arrangements with providers that are sufficient to cover their cost of providing health care, provide them with a fair margin and enable us to offer competitively priced coverage to employers and members.
Members can use the Find a Doctor tool to search other facilities and hospitals or call the Member Services number on their Blue Shield member ID card for assistance.
