December 30, 2005

 

California Department of Managed Health Care Orders Blue Cross of California to let its members remain with Beaver Medical Group

Earlier contract termination negotiations led to confusion for more than 16,000 Inland Empire and southern California health plan members

(Sacramento) - The California Department of Managed Health Care (DMHC) has ordered Blue Cross of California to stop a planned reassignment on January 1 of a portion of more than 16,000 Inland Empire and southern California health plan enrollees of Beaver Medical Group (BMG) to new primary care doctors. An earlier contract dispute, which has since been resolved between Blue Cross and BMG, triggered the automatic reassignment.

“Confusion among Blue Cross enrollees of Beaver Medical Group about the effects of the earlier contract dispute and what they need to do to keep their current doctors has compelled us to put the brakes on the January 1 reassignment deadline,” said Cindy Ehnes, Director of the DMHC. “The most important thing is that enrollees know their rights and are given ample time to make a decision about their future medical care.”

Current law requires health plans to notify affected enrollees of any anticipated medical group contract termination that they will automatically be reassigned to a new primary care doctor if the contract is terminated. However, should the two parties come to an agreement before the contract termination date, the reassignment is not automatically reversed. The enrollees are required to notify the health plan if they want to return to their original primary care providers.

Due to the confusion that this requirement has caused for Blue Cross enrollees in Beaver Medical Group during the recent contract termination negotiations, the DMHC has ordered Blue Cross to reinstate BMG enrollees to their original doctors.

A further problem developed when 6,000 BMG enrollees, who had previously informed Blue Cross that they wanted to remain with their original doctors, received a letter from Blue Cross erroneously assigning them to a new doctor. The DMHC has also ordered that Blue Cross automatically reinstate these enrollees back to BMG. Enrollees or physicians with questions may call Blue Cross at 1-866-806-5068.

Enrollees with questions or complaints can contact the DMHC HMO Help Center at 1-888-HMO-2219, or at a TDD number for the hearing impaired at 1-877-688-9891, or online at www.hmohelp.ca.gov .

The California Department of Managed Health Care is the only stand-alone HMO watchdog agency in the nation, touching the lives of more than 21 million enrollees. The DMHC educates consumers on health care rights and responsibilities, and has assisted nearly 650,000 Californians through its 24-hour HMO Help Center to resolve their HMO problems.


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