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Important Information for Patients with Blue Shield of California Insurance Plans

Background

The current agreement with Blue Shield of California (BSC) for all University of California (UC) hospitals, clinics, and health care providers to be in-network will end as of 11:59 PM on July 9, 2025, unless a new agreement is reached.

If you are a patient with a BSC PPO plan, you will no longer have in-network access to care at UCR Health and all other UC Health locations beginning July 10, 2025, if a new agreement is not reached.

If you are a patient with a BSC HMO plan, your current benefits are not impacted. BSC HMO members remain eligible for UCR Health services under existing contracted IPA affiliations including Regal Medical Group, Oasis IPA, and Optum Care.

Why It Matters

Unless a new agreement is reached before July 10, 2025, BSC PPO plans will no longer consider UCR Health to be part of its network.

Continuity of Care for PPO Patients

State law provides patients the opportunity to continue care related to certain medical conditions even if a physician is no longer in your health plan. Examples of PPO patients who may be eligible for Continuity of Care services include:

  • Patients who are pregnant
  • Newborn children between birth and 36 months
  • Patients who are awaiting a transplant or have received a transplant
  • Patients who have an upcoming scheduled surgery or procedure
  • Patients who have certain acute conditions, serious chronic medical conditions including behavioral health, or terminal illnesses

If you have been receiving care from UCR Health, you may have a right to keep your provider for a designated time period. Please contact Blue Shield of California’s member service department, and if you have further questions, you are encouraged to contact the Department of Managed Health Care, which protects consumers, by telephone at its toll-free number, 1-888-466-2219, or at a TDD number for the hearing and speech impaired at 1-877-688-9891, or online at www.dmhc.ca.gov

What if I have an appointment scheduled with a UCR Health provider before July 10, 2025?

Care you receive at UCR Health before July 10, 2025, will still be considered in-network by BSC.

What should I do if I have a medical appointment with UCR Health on or after July 10, 2025?

We want to help you avoid disruptions in care or unanticipated expenses. Determine your Continuity of Care eligibility by calling the BSC member services number on your insurance card. Please do this before coming to your scheduled appointment at UCR Health. Patients with BSC PPO health plans could face significantly higher out-of-pocket expenses – or even find that BSC will no longer cover their health care costs through UCR Health at all.

How do I apply for Continuity of Care Services?

Call the member/customer service number on the back of your BSC insurance card to discuss your options. The health plan is responsible for decisions about Continuity of Care. You may be eligible to continue your care with UCR Health for a period of time, as determined by BSC, for continuity of care. Download the application from BSC’s website, in the preferred language below:

The form must be completed and returned to BSC if you decide to request continued in-network access to your current UCR Health care team. Please note that submitting the form is not considered approval. You will need to follow up with BSC on the status of your request. 

Continuity of Care steps are especially important for patients who have a medical appointment scheduled with UCR Health on or after July 10 that cannot be rescheduled to an earlier date.

What happens if I qualify for Continuity of Care services?

For patients whom BSC determines to qualify for Continuity of Care services, UCR Health will honor in-network rates for the pre-determined period of time, even if BSC considers UCR Health out-of-network. Those patients should not have any increased out-of-pocket costs for Continuity of Care services provided by UCR Health.

What happens if I do not qualify for Continuity of Care services?

For patients who BSC determines do not qualify for Continuity of Care services, out-of-pocket expenses may increase because care provided by UCR Health will be out-of-network and/or may not be covered at all.

What should I do if BSC denies Continuity of Care services?

You should call the member/customer service number on your insurance card and work with BSC to understand your options. The health plan is responsible for decisions about Continuity of Care. If you are a PPO member, you may call the California Department of Insurance consumer hotline at 1-800-927-4357.

How can I stay up to date on negotiations?

We value our patients and want to help you understand what is happening and how to avoid potential disruptions in care and unanticipated expenses. Please monitor the website for updates: https://www.ucrhealth.org/blueshield/

I have an Anthem Blue Cross health plan. Will my coverage be affected?

No, Anthem Blue Cross is a separate organization from BSC. Anthem Blue Cross members are not impacted.

Have Questions? 

As a valued patient, we want to help you understand what is happening. Should you have any questions or concerns, please contact 844-827-8000.