joec, I have a Blue Shield of CA Platinum PPO from Covered CA. It took a l-o-o-ong time to get my membership card, but so far, I am happy with it and they have paid 90% of the bill for one “expensive test” so far in 2014 and all my current providers take the plan. I just found out that Sharp Rees Stealy is not on their provider list (not sure about Sharp hospitals) when I tried to access care in a local Sharp Rees Stealy Urgent Care clinic a few weeks ago on a weekend. They sent me to a nearby “US Healthworks” urgent care clinic who treated my minor injury just fine and I’m all healed up now.
IIRC, Sharp Platinum EPO was going to be ~$125 per month more for me and I needed national provider access, due to being on the road several weeks per year. Blue Shield of CA belongs to the BCBS National Provider Directory in the 48 contiguous states and even worldwide:
Absent needed emergency care while out of county, Sharp EPO only covers the bills of providers within their EPO …. all located in San Diego County.[/quote]
Thanks for sharing…and confirming what I found out since in December, Anthem actually listed them as a provider as well.
We wanted to use the Sharp Rees-Stealy hospitals (and also Rady’s Children) since my kids have been going there since birth and Anthem Blue Cross and Blue Shield just didn’t offer them at all…so we switched.
Glad to hear you’ve been happy with it so far and your current medical professionals still takes your Blue Shield.
Just hate dealing with any issues with the Blue companies since it takes so long to get anyone on the phone.[/quote]joec, I just sent for a Blue Shield PPO Provider Directory for San Diego County and it was instantly e-mailed to me. ALL the hospitals in the county are in their network, including Rady Children’s and Sharp Mary Birch (Sharp’s specialty hospitals), including ALL standalone surgical centers and facilities in the county.
Blue Shield’s Urgent care providers are either US Healthworks or Doctor’s Express (and a few independents here and there where neither of these two exist). Sharp Rees Stealy and Sharp Mission Park providers work exclusively for Sharp (EPO) and thus are not on Blue Shield’s provider list.
I think Blue Shield has to cover all facilities because they have a very wide range of providers in each specialty, some of whom have been practicing for decades and have rights to practice at multiple hospitals and so they have to follow where the providers on their list choose to practice for a particular procedure.
Blue Shield of CA PPO definitely has more providers to choose from than any other healthplan on the exchange and was available in more regions than any other carrier. HOWEVER, Sharp EPO’s computer system amongst themselves ties together the care of a single patient at multiple facilities and therefore likely prevents mistakes. It’s a good system IF you are not planning on leaving the county, don’t travel for weeks at a time by road and generally don’t spend too long at a time away from home (“home” being SD County). The Gold and Platinum Sharp EPO plans are very pricey (esp for my demographic).
And yes, Blue Shield takes a l-o-o-o-ng time to answer the phone … or at least they did before April 30. (I used to put them on speakerphone and keep working.) They are HQ in SF but they opened up a HUGE warehouse-like call-center in Lodi last September where they hired thousands of newbies to take calls from Covered CA applicants. It was a real mess for a few months because their computer and Covered CA’s computer weren’t able to “talk” to each other. I haven’t called lately because I finally got taken care of. It took 120 days to get my membership card from my October 2013 application date. And I still didn’t have pharmacy benefits until the end of April, but they reimbursed me for my out-of-pocket expense in the interim.
You were with Anthem (HMO or EPO) and that is a completely different animal than Blue Shield of CA PPO. In CA, the two organizations are not related to one another (as they are in other states).
