Stanford Hospitals no longer participating in Anthem Blue Cross provider network

This letter provides important changes in network providers under the Anthem Blue Cross preferred provider network. Effective September 1, 2011, Stanford University Hospital and Lucile Salter Packard Children’s Hospital (“Stanford Hospitals”) and their associated Physician Medical Groups are no longer participating providers in the Anthem Blue Cross provider network used by the Fresno Unified School District (“FUSD”) Health Plan. These changes were the result of the contract dispute between the hospital and physicians noted above and Anthem Blue Cross.

To check the participating status of Anthem Blue Cross hospital and physician providers, please consult Anthem Blue Cross’ website at We have also compiled the following list of alternative, in-network general acute care hospitals within a 30-minute driving distance from Stanford:

• Children’s Hospital Oakland
• El Camino Hospital
• Good Samaritan Hospital
• Menlo Park Surgical Hospital
• Mills Hospital
• O’Connor Hospital
• Peninsula Hospital and Medical Center
• San Mateo County General Hospital
• 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 FUSD Health Plan has made the following accommodations:

If a member was inpatient in one of the facilities noted above at 11:59 PM on August 31, 2011, the facility claim from either of the Stanford Hospitals will be processed at the Hospital Services in-network benefit level until he or she is discharged; however, care provided on or after September 1, 2011 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

All other facility and professional claims incurred on or after September 1, 2011 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. , until September 30, 2011, 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 September 30, 2011. Members will be responsible for any amount billed over UCR. Non-network benefits and UCR will apply to claims incurred on or after October 1, 2011.

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 August 31, 2011, please contact Delta Health Systems at the toll free number on your ID card, so that it may be handled appropriately.

Joint Health Management Board of the Fresno Unified School District Health Plan

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