Adventist Health and Blue Shield of California ended ties across 17 hospitals, impacting commercial, Medicare Advantage, and managed Medicaid plans. The split, effective December 1, involves nonprofit Adventist’s 26 hospitals in California, Oregon, and Hawaii. Blue Shield, with 4.8 million members, faces its third-largest health insurer status in California. While open to future talks, negotiations over reimbursement rates and terms led to the contract’s expiration, prompting patient inconveniences.
The alliance between Roseville, Calif.-based Adventist Health and Blue Shield of California has severed ties across 17 hospitals. Although both entities are open to future negotiations, they officially terminated their partnership on December 1 for patients covered by commercial, Medicare Advantage, and managed Medicaid health plans.
Adventist, a nonprofit operating 26 hospitals and 400 clinics in California, Oregon, and Hawaii, stands in contrast to Blue Shield of California, a nonprofit health insurer with 4.8 million members. Despite being the state’s third-largest health insurer, Blue Shield is now out of network with the mentioned hospitals, joining Kaiser Permanente and Anthem Blue Cross in the California market.
The list of hospitals affected by this change includes Adventist facilities such as Bakersfield, Clear Lake, Delano, Glendale, Hanford, Howard Memorial, Lodi Memorial, Mendocino, Reedley, Selma, Simi Valley, Sonora, St. Helena, Tulare, Tehachapi Valley, Ukiah Valley, and White Memorial.
To ease the transition, Blue Shield may offer some patients continuity of care services, allowing them to receive care from Adventist for a limited period.
A spokesperson from Blue Shield expressed disappointment at not reaching a new agreement with Adventist Health before the contract expired, citing prolonged negotiations over reimbursement rates and contractual terms aimed at ensuring sustainable and affordable care for their members and customers.