Attention Blue Shield HMO Members:
Please be advised that starting May 1, 2012, Blue Shield will no longer have an HMO contract with our local IPA carrier, Monarch Healthcare. This change in status is causing significant concerns to patients, parents, providers and brokers. These contract issues are completely out of our control. The quality of care to our patients is very important to us, as is the continuity of care. Please refer to the information listed below for answers to common questions, and what you can do to AVOID any delay in care to your child. As always, we are here to help you. If you still have questions, please contact our office directly, so we can be of further assistance in this time of transition from one plan to another. We are hopeful that you will be able to remain a member of our SOCPA family, and this event will not affect the care of your child.
How will this affect our SOCPA patients?
Unfortunately, this decision will no longer allow you to choose one of our SOCPA providers as an “in network” primary care physician for your child; which could include care to other network specialists. This will not affect patients that carry a Blue Shield PPO contract. This decision ONLY affects the Blue Shield HMO members. Our contract remains in effect for all other HMO plans contracted with Monarch Healthcare, and most major PPO carriers.
What are the options available to our Blue Shield HMO Members?
As far as we know, the Blue Shield HMO contract with Monarch Healthcare will remain in effect until April 30, 2012. Up until this date, we will continue seeing our Blue Shield HMO patients. We will do our best to notify all of our parents/patients of these changes, so each member can take corrective action to retain our physicians as the primary care physician for the care of the patient. Each patient will be asked to sign a waiver form at the time of check in, should any coverage issues present themselves in the future. After May 1, 2012, SOCPA would gladly continue to provide care for your child with coverage through other HMO carriers (Aetna, Blue Cross, Caloptima, Cigna, Health Net and United Healthcare) along with most major PPO plans. Blue Shield HMO members seen after May 1, 2012 will be considered a “cash patient.”
As a parent/patient, what can you do?
Continuity of care is of top concern to our practice. We would encourage you to seek other options for coverage that would allow you to stay with your child’s primary care physician. Contact your human resource department or broker and VOICE YOUR CONCERNS. Most importantly, don’t be afraid to contact Blue Shield directly. Monarch Healthcare is also proactively assisting members with other options. For more information on high-quality plans that will guarantee access to your providers of choice, please visit DontLoseYourDoc.com.
We are anxiously awaiting a contractual resolution between the two parties (Blue Shield and Monarch Healthcare) but, until then, we want you to be informed. We look forward to providing uninterrupted care to the patients of our community.
Please click here for a printable version of this insurance update.