TO: Fresno Unified School District Employee Health Care Plan Participants in PPO Plan Options A and B
DATE: September 1, 2019
As of midnight, September 1, 2019, Anthem Blue Cross and Stanford Hospital and Lucile Packard Children’s Hospital Stanford (collectively “Stanford”) were not able to reach a new agreement before their contract expired. At this time, Stanford is no longer an in-network provider for Plan Options A and B under the District’s medical plans. Any services provided at Stanford on or after September 1, 2019, will be charged at the out-of-network rate (except for approved continuity of care services).
Please note that out-of-network rates will result in significant out-of-pocket costs that are not reimbursed by the District’s medical plan. If you or your dependent(s) have any services scheduled at Stanford on or after September 1, 2019, you may wish to consult with your medical provider to discuss potential alternatives.
Continuity of Care – Eligibility & Provisions
In-Patient Services: If a member was in-patient at 11:59 PM on August 31, 2019, then the member shall continue to receive uninterrupted care at Stanford until he or she is discharged. The member’s in-network benefit levels will apply for the entire in-patient stay.
Existing Courses of Treatment: In addition, if a member began a course of treatment at Stanford before September 1, 2019, the member (or his/her physician) can request continuity of care. Conditions that may be eligible for continuity of care include the following
- Members in an active course of treatment for an acute medical condition
- Members in an active course of treatment for a serious chronic condition
- Members who are pregnant, regardless of trimester
- Members with a terminal illness
- Members who are newborn children between the ages of birth and 36 months
- Members with a surgery or other procedure that was authorized by Anthem Blue Cross prior to the termination date and scheduled to occur within 180 days after the termination date.
Requesting Continuity of Care: If a member’s condition is consistent with one of those listed above, please contact Delta Health Systems at (800) 807-0820 to request the Continuity of Care/Transition of Care Request Form. The member and his/her physician will need to complete the form and return it to Anthem as specified on the form.
NOTE: Continuity of care services will be considered by the Anthem Blue Cross Transition Assistance Department on a case-by-case basis. If a case is approved, the claim will be processed at in-network benefit levels.
Alternate Providers Located Near Stanford
To check the participating status of Anthem Blue Cross hospital and physician providers, please consult Anthem Blue Cross’ website at www.anthem.com/ca. The following is a partial list of alternate participating general acute care hospitals within a 30-minute drive of the Stanford service area:
Stanford Hospital:
- El Camino Hospital-Mountain View, 2500 Grant Road, Mountain View, CA 94040
- Sequoia Hospital, 170 Alameda De Las Pulgas, Redwood City, CA 94062
- St. Rose Hospital, 27200 Calaroga Ave., Hayward, CA 94545
- UCSF Benioff Children’s Hospital, 505 Parnassus Ave., San Francisco, CA 94143
- UCSF Medical Center, 505 Parnassus Ave., San Francisco, CA 94143
Lucile Packard Children’s Hospital Stanford:
- El Camino Hospital-Mountain View, 2500 Grant Road, Mountain View, CA 94040
- El Camino Hospital-Los Gatos, 815 Pollard Road, Los Gatos, CA 95032
- O’Connor Hospital, 2105 Forest Ave., San Jose, CA 95128
- Regional Medical Center of San Jose, 225 N. Jackson Ave., San Jose, CA 95116
- Santa Clara Valley Medical Center, 751 S. Bascom Ave., San Jose, CA 95128
- Sequoia Hospital, 170 Alameda De Las Pulgas, Redwood City, CA 94062
- St. Rose Hospital, 27200 Calaroga Ave., Hayward, CA 94545
- UCSF Benioff Children’s Hospital-Oakland, 747 52nd St., Oakland, CA 94609
- UCSF Benioff Children’s Hospital-SF, 505 Parnassus Ave., San Francisco, CA 94143
- Washington Hospital, 2000 Mowry Ave., Fremont, CA 94538
NOTE: Always verify with both the provider and the Anthem Blue Cross website at www.anthem.com/ca that the provider is participating in your benefit plan network.
Stay Tuned for More Information
The Joint Health Management Board strives to ensure its members are informed and responsible health care consumers. Though this situation remains out of our control, we will continue to do our best to keep you informed as it unfolds.
Should Anthem Blue Cross and Stanford reach an agreement in the coming days and weeks, we will provide a formal notice at that time. Until then, you may find the most up-to-date information at the JHMB’s website (www.JHMBHealthConnect.com).
We appreciate your patience and understanding. We will continue to manage and maintain the highest quality health and wellness benefits on behalf of the District’s employees, retirees, and their families.
