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UCLA/Blue Shield Contract Update
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On December 12, 2011, MPI was notified by Blue Shield of California that it had reached a contract impasse with UCLA over terms for a new contract beginning on January 1, 2012.
At this time, Blue Shield and UCLA do not
have a contract which means that MPI Participants who receive services from UCLA Medical Group
(including Santa Monica Bay Physicians (SMBP)),
Ronald Reagan UCLA Medical Center, or Santa Monica UCLA Medical Center on or after January 1, 2012,
will be required to pay a larger portion of the health costs incurred because the claims are “out-of-network.”
FOR ACTIVE PARTICIPANTS AND NON-MEDICARE RETIRED PARTICIPANTS
Out-of-network claims are generally paid by MPI at 50% of the allowed amount and the Participant is responsible
for any applicable co-pay plus any outstanding balance required by the provider, with no out-of-pocket maximum.
FOR RETIRED PARTICIPANTS WITH MEDICARE
MPI pays claims after Medicare has paid their portion (generally 80% of Medicare contracted rates) and the Participant
has paid any applicable co-pay. There is no out-of-pocket maximum for out-of-network charges.
For Participants with certain limited health conditions who began receiving treatment from UCLA prior to January 1, 2012,
MPI has established Continuity of Care (CoC) guidelines for continued treatment of the same condition. The patient’s condition
must meet the requirements included in the CoC guidelines established by the MPI Board of Directors. A CoC request can be made
by the patient’s treating physician, and it must be approved by MPI/Blue Shield prior to services being rendered. Patients approved
for CoC may continue treatment through UCLA and have their approved claims paid according to the CoC rate schedule.
Participants who receive care from UCLA providers or hospitals after January 1, 2012, will be responsible for paying a larger portion
of any charges incurred unless the claims are pre-approved for Continuity of Care. Click here
for a copy of the CoC Guidelines and Request Form.
For more information about Continuity of Care or to speak with a representative about finding a new provider,
please call Blue Shield at (800) 219-0030 (option 1, then 1 again).
For more information about how medical claims are paid by MPI
please click on the links below for the Active and Retiree Summary Plan descriptions.
Active Health Plan - Summary Plan Description.
Retiree Health Plan - Summary Plan Description.
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