By: Health Insurance
Submitted: 2009-09-28 14:27:44 | Word Count: 556
If you're an HMO patient who visited a UCSF clinic over the past 18 months, you probably received a letter letting you know that UCSF is breaking up with Brown & Toland, its long-time medical group.
OK, so the letter doesn't actually say they "broke up." It says that, as of Jan. 1, 2010, UCSF and Brown & Toland are "changing their relationship."
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I know. We've all heard that before. But UCSF says coyly that Brown & Toland wanted to change the "nature" of their relationship in a way that UCSF didn't like, so UCSF hooked up with Hill Physicians Medical Group, a 2,600-doctor group based in San Ramon. They're calling it an "affiliation."
So what does this new "affiliation" mean to you? First off, it only affects you if you're a member of an HMO such as Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net or United/PacifiCare. If you're covered through a PPO, or preferred provider organization, your access to UCSF doctors will be unaffected.
Under the previous arrangement, Brown & Toland primary-care doctors could freely refer HMO patients to specialists in the 1,500-physician UCSF Medical Group. Next year, only those physicians affiliated with Hill Physicians will be able to do so. UCSF is trying to negotiate an "out-of-network" agreement with B&T, but the bottom line is, you should check and see if your primary care physician is also a Hill physician (doctors may be part of more than one group). If not, you may have to go through an out-of-network referral process in order to see specialists at UCSF.
Dr. Sam Hawgood, who last week was named the new dean of UCSF Medical School, told Chron Rx that UCSF has just started a marketing campaign aimed at letting people know about the change, which could affect as many as 160,000 patients. He said UCSF is working with Hill Physicians to expand its network of primary-care physicians in San Francisco.
"I am surprised at how little coverage this change has been receiving. It affects nearly all the HMO patients in San Francisco--or close to a third of the city's population. At a time when health care is at the top of everyone's agenda, you'd think that having access to the best hospital in the city would be front page news! Goes to show the problem that health care legislation faces: people don't want to deal with it because the battles are fought in the details, and the details are very complicated and don't make interesting news. Not sure what the solution is--just wanted to point out that this issue is a microcosm of the national health care debate... "
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