Blue Shield of California and Stanford Health have been engaged in discussions to renegotiate the terms of Stanford's hospital agreement (HMO/PPO) for Stanford Medical Center/Stanford Healthcare-University Healthcare Alliance PPO professional services, Valleycare Medical Center, and Valley Memorial Hospital serving Alameda and Santa Clara counties.


Although both parties are still actively involved in negotiations, the current contract for Stanford Medical Center/Stanford Healthcare-University Healthcare Alliance PPO professional services expired at 11:59 pm on April 30, 2018.  The contracts for Valleycare Medical Center, and Valley Memorial Hospital remain in effect through May 31, 2018. Lucile Salter Packard Children's Hospital is not part of this contract termination.  


Members who have used Stanford Medical Center/Stanford Healthcare-University Healthcare Alliance PPO professional services in the last 12-month period will receive notification of this termination on May 4, 2018, providing them with alternate network facilities and advising of continuation of covered services options.


Affinity Medical Group (now part of Stanford Health) is also part of the contract negotiation. Though the current contract for Affinity Medical Group remains in effect until June 30, 2018, the Department of Managed Health Care regulations require Blue Shield to notify HMO members of a change to their medical group and if applicable, primary care physician (PCP), 60 days in advance of a potential termination. Therefore, because Blue Shield has not reached an agreement with Stanford Health, letters were mailed to HMO members assigned to Affinity Medical Group on May 1, 2018. If they reach an agreement later, members will be notified and may request to be assigned back to the Affinity Medical Group and their Affinity PCP.


Please click here to view the affected facilities and medical group as well as our complete listing of alternate providers.


Continuity of Care
HMO members who are currently in a course of treatment or who have a procedure scheduled at a Stanford Medical Center/Stanford Healthcare-University Healthcare Alliance PPO professional services within 180 days of May 1, 2018, can request continuity of care by calling the Member Services number on the back of their Blue Shield ID card. If eligible for continuity of care, applicable network copays will apply.  


PPO members who are currently receiving or who have a procedure scheduled at a Stanford Medical Center/Stanford Healthcare-University Healthcare Alliance PPO professional services within 180 days of May 1, 2018, can request continuity of care for an ongoing course of treatment, and if eligible, receive the higher, preferred benefit level. These members can call the Blue Shield customer service telephone number on their Blue Shield ID card. They may also access Blue Shield's Continuity of Care online.  


Blue Shield's Point of Service (POS) plans combine both HMO and PPO service delivery features. A POS member's network determination or eligibility for continuity of care would be governed according to either the HMO or PPO definitions above, depending on which network the member is accessing. 

Communications

  • Letters to commercial HMO/POS members assigned to an Affinity Medical Group or PCP were sent on May 1, 2018.
  • An employer notification will be sent via email to employers with affected members on May 3, 2018.
  • Letters to members who have used Stanford Medical Center/Stanford Healthcare-University Healthcare Alliance PPO professional services in the most recent 12-month period will be sent within five days of termination, or no later than May 4, 2018.
  • Members who have used Valleycare Medical Center or Valley Memorial Hospital in the most recent 12-month period will be sent within five days of termination or no later than June 5, 2018.

To review the regulated member letter sent to those with an Affinity PCP, or to access the regulated member letter send to those who have used Stanford Medical Center/Stanford Healthcare-University Healthcare Alliance PPO professional services, please use the appropriate links.