Sep 29, 2021
The agreement between Blue Shield of California and AmericasHealth Plan is terminating; members will receive the required notices
AmericasHealth Plan (located in Los Angeles County) submitted a termination notice to Blue Shield and upon review, Blue Shield has accepted the termination and the contract will expire at 11:59 p.m. on November 30, 2021. The first day out of network for AmericasHealth Plan is December 1, 2021. Blue Shield is reassigning members to alternate network IPAs in the area to help ensure uninterrupted access to care.
Department of Managed Health Care (DMHC) regulations require Blue Shield to notify commercial HMO members of a change to their medical group and, if applicable, primary care physician (PCP), 60 days in advance of a termination. Therefore, they are sending letters to members who were assigned to AmericasHealth Plan on September 30, 2021.
The contract termination affects 65 members and the following lines of business: Small Business, Core, and Premier.
What Blue Shield members need to know
Since the contract with AmericasHealth Plan expires November 30, 2021, Blue Shield HMO members who are currently assigned to AmericasHealth Plan will need to know the following:
- On September 30, 2021, Blue Shield sent notifications to HMO members assigned to AmericasHealth Plan PCPs. The notification advises members that they will be reassigned to alternate medical groups for a December 1, 2021, effective date. Members can call the Member Services number on their Blue Shield member ID card to self-select a PCP or IPA, or they can go online to the Find a Doctor tool.
- The receiving medical groups are Regal Ventura County, Seaview IPA, and Valley Care IPA. There is no PCP crossover.
- Blue Shield members assigned to AmericasHealth Plan who are receiving care on November 30, 2021, or who have a procedure scheduled to be performed by an AmericasHealth Plan provider within 180 days of November 30, 2021, can request continuation of covered services through Blue Shield for ongoing treatment with their provider. These members can call the Member Services telephone number on their Blue Shield ID card. Members may also access Blue Shield’s continuity of care policy online.
PPO Members:
- PPO members may continue to seek professional and/or hospital services from an AmericasHealth Plan professional providers after the contract termination date.
- PPO members, who wish to have their provider care / visits covered at the higher, preferred benefit level, must receive care from a Blue Shield Preferred (contracted) provider.
Emergency services
Blue Shield members who need emergency services should call 911 or seek care at the nearest emergency room. Blue Shield will provide the full emergency care level of benefits for these services.
They encourage members to make informed decisions about when to use urgent care, as opposed to emergency room care. Urgent care is appropriate when a member needs a physician’s attention for a non–life threatening conditions. Any member needing urgent care, but whose physician or network provider is unavailable, should go to the nearest urgent care facility. Members can view a list of nearby urgent care facilities online at Blue Shield’s Find a Doctor page.
Blue Shield's commitment to affordably priced health coverage
Consistent with Blue Shield's not-for-profit mission of providing access to quality health care at an affordable price, 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. Blue Shield has an extensive hospital provider network throughout the state which is available to serve members who previously received care at AmericasHealth Plan. They will work with our members, brokers and employer groups to ensure a smooth transition.
Communications
- Letters will be sent to HMO members assigned to AmericasHealth Plan on September 30, 2021, assigning them to alternative IPAs.
- Employer notification will be sent to those with affected employees on September 29, 2021.
