Blue Shield Network Update - Rady Children's and Choice Medical Group

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Blue Shield Network Update – Rady Children’s and Choice Medical Group

Dec 12, 2022, 2 Minute Read

Blue Shield of California has not yet reached an agreement on rates and terms of contracts with Rady Children’s Health Network (RHCN), Rady Children’s Hospitals in San Diego, and Choice Medical Group. Without an agreement, the terminations will become effective as follows:

Rady Children’s Hospital membership termination will be effective December 31, 2022.
- Members receiving/having received services at Rady Children’s Hospital will be notified by mail within five days following the contract termination.
- PPO and POS members using PPO benefits may continue to seek hospital services after the contract termination date. However, reimbursement for any such services, other than emergency services, will be reimbursed at the lower “Non-Preferred Provider” benefit level.

Rady Children’s Health Network membership termination will be effective January 31, 2023.
- HMO and POS group members with an assigned RCHN primary care physician (PCP) will receive a notification 60 days prior to the network termination. Should an agreement be reached before January 31, 2023, members will be updated by mail and have the option to remain with their PCP.

Choice Medical Group’s membership termination will become effective February 1, 2023.
- HMO and POS group members, with a Choice Medical Group PCP, will receive a notification 60 days prior to the network termination. Should an agreement be reached before February 1, 2023, members will be updated by mail. Members receiving/having received services from a Choice Medical Group provider will be notified by mail within five days following the contract termination.

Blue Shield is preparing a smooth transition to alternate PCPs and medical groups so members will continue to have uninterrupted access to quality care. If a member’s PCP is part of another in-network medical group, they’ll be assigned that same PCP. Otherwise, members will be assigned a new PCP based on geography and availability. PCP reassignment will not occur until the end of the contract period. Members may change their PCP at any time by using the Blue Shield Find a Doctor tool.

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