TO: All Participants Enrolled in PPO Options Plan A or Plan B under the Fresno Unified School District’s Health Care Plan
DATE: September 12, 2014
This letter provides important information about changes in network providers under the Anthem Blue Cross preferred provider network. Effective September 8, 2014, Stanford Health Care (“Stanford”, formally known as Stanford University Medical Center) and their associated Clinics and Physician Practices are no longer participating providers in the Anthem Blue Cross provider network used by the Fresno Unified School District Employee Health Plan. These changes were the result of a contract dispute between the hospital and physicians noted above and Anthem Blue Cross. Please note, this does NOT affect Lucile Packard Children’s Hospital.
To check the participating status of Anthem Blue Cross hospital and physician providers, please consult Anthem Blue Cross’ website at anthem.com/ca. We have also compiled the following list of alternative, in-network general acute care hospitals within a 30-minute driving distance from Stanford:
- El Camino Hospital
- Good Samaritan Hospital
- Menlo Park Surgical Hospital
- Mills Hospital
- O’Connor Hospital
- Peninsula Hospital and Medical Center
- Santa Clara Valley Medical Center
- Sequoia Health Services
- UCSF Medical Center
- Washington Hospital
Continuity of Care
To ensure our member’s care is not interrupted, the Joint Health Management Board (“JHMB”) of the Fresno Unified School District Employee Health Plan has made the following accommodations:
Hospital Services
If a member was inpatient in Stanford Health Care at 11:59 PM on September 7, 2014, the facility claim will be processed at the in-network benefit level until he or she is discharged; however, care provided on or after September 8, 2014 will be allowed by the Plan only as a non-network provider, which could result in significant out-of-pocket costs to the member that will not be reimbursed by the Plan.
Professional/Physician Services
Members currently undergoing a course of treatment will have a 30 day grace period, until October 8, 2014, to complete treatment and/or find an alternate contracting provider. The in-network benefit level will be applied to the Usual and Customary Rates (“UCR”) for claims incurred through October 8, 2014. Members will be responsible for any amount billed over UCR. Non-network benefits and UCR will apply to claims incurred on or after October 9, 2014.
All other facility and professional claims incurred on or after September 8, 2014 will be processed at non-network benefit levels and UCR allowances will be applied when Plan benefits are paid. This may result in significant out-of-pocket expenses for the member that will not be reimbursed by the Plan.
If you receive a bill from Stanford Hospitals that exceeds the amount indicated as the member responsibility on the Explanation of Benefits you receive from Delta Health Systems for services rendered after September 8, 2014, please contact Delta Health Systems at the toll free number on your ID card, so that it may be handled appropriately.