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Adventist Health Hospitals No Longer in Blue Shield of California Provider Network

by Patty Gonzalez, VP, Network Management and Provider Partnerships

Almost a year ago, Adventist Health notified Blue Shield of California that it wanted to end our network relationship and negotiate a new contract for its hospital facilities. Throughout 2023, we have been negotiating in good faith with Adventist Health leadership to establish a new contract that was sufficient to cover the cost of providing access to quality health care and that would enable us to offer competitively priced coverage to our members.

Unfortunately, Adventist Health’s requests did not make that possible. As a tax paying, nonprofit health plan, Blue Shield’s mission is to provide access to quality health care at an affordable price, and we have met our limit on what Blue Shield is able, and our members are willing, to pay for health care. This means that as of Friday, December 1, 2023, Adventist Health hospital facilities are no longer part of Blue Shield’s network.

We are disappointed to have not been able to reach a new agreement with Adventist Health following their notice to terminate our existing contract, and we regret the inconvenience this causes our customers and members. 

We have notified our members and taken steps to ensure they will have uninterrupted access to quality medical care in their area. Blue Shield has an extensive provider network that is available to serve members who previously received care through Adventist Health, and we will work with our providers and members to ensure a smooth transition.

What comes next?

Our sincere hope is that we can continue the dialogue with Adventist Health leadership and establish a new contract that enables our members to access high quality care at Adventist Health hospitals at an affordable price.

For our affected members looking for alternative hospitals, please don’t hesitate to reach out to our customer service center using the number on the back of your Blue Shield member card.

Below are some additional questions and answers to assist our members and customers.

What was being negotiated? 

Our goal was to negotiate terms for a new contract that would allow us to continue offering our customers access to Adventist Health hospitals without jeopardizing the long-term affordability of healthcare coverage in California. Adventist Health medical groups have not been part of the negotiation.  

Will Adventist Health emergency services still be available?  

Blue Shield members who need emergency services should call 911 or seek care at the nearest emergency room. Blue Shield will provide the full emergency care level of benefits for these services, including if the emergency services are provided at an Adventist Health facility.  

How will Blue Shield of California HMO members be affected by the Adventist Health Hospitals’ contract termination?

All non-emergency hospital services must be approved by the member’s medical group. If approved, Blue Shield of California will cover the claim at the member’s in-network benefit levels. If not approved by the member’s medical group, the claim will be denied, as stated in the member’s Evidence of Coverage (EOC).

How do members know if their doctor will be affected by this contract expiration?

Many doctors have admitting privileges at more than one hospital. Just because a member’s doctor may have admitting privileges at an Adventist Health hospital does not necessarily mean that a doctor cannot still treat his or her patients at another Blue Shield of California network-participating hospital. 

Will Blue Shield of California assist physicians in acquiring admitting privileges at an alternate hospital?

Blue Shield of California is ready and willing to assist our physician and medical group partners in acquiring admitting privileges at a participating hospital if necessary. If a member’s physician cannot admit to an alternate hospital after a contract expiration, then Blue Shield of California will work with the physician or other healthcare professional to admit members to an in-network facility.