San Francisco HMO Members: Act Now to Protect Your Choice of Physicians

Upcoming changes in San Francisco’s medical groups will affect access to your doctors.  Here’s what’s happening and what you need to do to make sure you are able to see the doctors who are most important to your health care.

What’s Happening?

The doctors of UCSF Medical Center and UCSF Children’s Hospital are becoming part of Hill Physicians Medical Group effective January 1st.  The UCSF doctors’ contract with Brown & Toland Medical Group will terminate at the end of 2009. Brown & Toland is largely composed of physicians associated with California Pacific Medical Center. 

This contract termination affects all HMO users of Brown & Toland doctors, regardless of which company is your insurer.  Blue Shield, Anthem Blue Cross, HealthNet, and Aetna HMO members are all affected.  If you remain a member of Brown & Toland after the transition, you will not be referred to UCSF doctors in 2010. This means your HMO insurance will not cover visits to UCSF doctors, regardless of whether you are an established patient or a new referral.

Hill Physicians is also expanding and contracting with new doctors affiliated with Saint Francis Memorial Hospital and St. Mary’s Medical Center. 

What You Need to Do:

First check to see whether your current primary care doctor is also associated with Hill Physicians through their website.  If your doctor is in both medical groups, it’s simple.  Just call your insurance company and change to Hill Physicians, effective January 1st. 

If your primary care doctor is not associated with Hill Physicians, you have a decision to make.  If your choose to maintain your relationship with your primary care doctor through Brown & Toland, then call his/her office as soon as possible.  Request a referral to new specialists within the Brown & Toland Medical group and make your first appointment.  Good doctors are in short supply.  Other patients will also be looking for new doctors so act now and get ahead of the line.

If you decide that you prefer to continue with UCSF specialists, you will need to select a new primary care doctor in the Hill Physicians Group.  Ask for referrals and review doctors’ backgrounds and qualifications on the Hill Physicians website.   Notify your insurance company that you want to change to Hill and sign up for your new primary care doctor.  Remember to act as soon as possible so that you can assure the best choice of physicians.  While Hill Physicians is expanding, it has a smaller number of SF based primary care doctors. 

What if your priority is to keep all your current doctors?  Most employers offer a choice of HMO and PPO coverage.  You can sign up for your company’s PPO plan during your next open enrollment period.   With PPO coverage, you have the choice of all the physicians in your insurance company’s network.  It is very likely that your doctors will be in the PPO network.  But, of course, check the website before making the change.

And what if you are already using the Hill Physicians Medical Group? Effective January 1st,   you will have access to a significantly expanded list of specialists.  Talk to your primary care doctor and discuss whether your health needs could be better served by consulting with one of the new physicians available to you. 

Contact Information

www.brownandtoland.com

e-mail  customerservice@btmg.com

or call 800.225.5637 between 8 a.m. and 5 p.m., Monday through Thursday, or on Friday between 9 a.m. and 5 p.m.
www.hillphysicians.com