UCSF Medical Group and Hill Physicians Medical Group formed a new contractual affiliation to serve the healthcare needs of HMO members whose primary care physician (PCP) is based in the San Francisco area. This new healthcare option becomes effective January 1, 2010.

UCSF Medical Center and UCSF Children’s Hospital will be in both Hill Physicians Medical Group and Brown & Toland Medical Group’s networks after January 1, 2010.

After January 1, 2010, only Hill Physicians Medical Group will market and have UCSF primary care physicians in their network. On that date, Brown & Toland Medical Group will no longer offer UCSF primary care physicians in their network and will begin a ‘referral-only’ type relationship with the specialists at UCSF Medical Group and UCSF Medical Center. All access to UCSF services for Brown & Toland members, will require prior authorization and administrative review.

What changes will occur for the physicians of UCSF Medical Group?

The doctors who are affiliated with UCSF Medical Group include the faculty of the clinical departments of the UCSF School of Medicine. These physicians also practice at UCSF Medical Center and/or UCSF Children’s Hospital. As of January 1, 2010, the doctors from UCSF Medical Group will become participating physicians of Hill Physicians Medical Group and ‘referral only’ physicians of Brown & Toland Medical Group.

How will HMO members be affected by UCSF’s decision to enter into an arrangement with Hill Physicians Medical Group?

HMO members assigned to a UCSF Medical Group primary care physician through Brown & Toland Medical Group (approximately 2,400 members) will be affected by this new arrangement. Members will be given an option to either remain with their current UCSF Primary Care Physician by selecting Hill Physicians Medical Group as their new IPA, or selecting a new Primary Care Physician through Brown & Toland Medical Group.

Note:  Members with Anthem Blue Cross are not the only ones affected by this new arrangement. HMO members with other health plans are also affected by UCSF’s new arrangement with Hill Physicians Medical Group.

Will Anthem Blue Cross notify members about these changes?

Yes.  Anthem Blue Cross will send a letter (on or before October 1, 2009) to all members who are currently assigned to one of UCSFs primary care physicians through Brown & Toland Medical Group (approximately 2,400 members) and advise them to contact Customer Service prior to January 1, 2010, to inform us their Primary Care Selection (details explained in questions 7 & 8 below).  Members, who do not respond to the letter by contacting Customer Service, will be reassigned to a Brown & Toland primary care physician effective January 1, 2010.

When can the affected members call Customer Service to make their primary care physician change?

We are targeting October 1, 2009 to have all of the UCSF primary care physicians loaded to Anthem’s system as Hill Physicians Medical Group providers (for the effective date of January 1, 2010).  Affected members will receive a letter from Anthem Blue Cross when our system has been updated and is ready to make the appropriate enrollment changes.

What about HMO members assigned to Brown & Toland who receive emergency medical care from a UCSF facility after December 31, 2009?

Emergency medical services do not require pre-authorization, regardless of where they are delivered. Hospitals must still provide services for members requiring emergency care. Coverage will be provided according to the member’s policy benefits.

What should an HMO member do if they wish to remain assigned to their UCSF primary care physician?

HMO members who wish to remain assigned to a UCSF Medical Group primary care physician after December 31, 2009 should call Customer Service at the toll-free number on their Anthem Blue Cross membership card prior to December 31, 2009 and request to remain a patient of their current assigned primary care physician by changing groups to Hill Physicians Medical Group, in San Francisco (site code 0UC).

For more information, and updates we will be posting a part 2 of this article.

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