Overview from Jeff Smith | Rate changes | Product and network news | Selling Trio HMO | Medical benefit changes | Specialty benefit changes | Client notifications | Sales materials
With the addition of Pomona Valley Medical Group to our ACO network, we've been able to increase the footprint of our Trio HMO network. This adds 175 primary care physicians and 193 specialists to the network in Los Angeles and San Bernardino counties.
We continue to see significant growth, including in our most competitive regions (3, 12, 15, and 17). These regions in particular allow you to offer both prospects and current PPO clients a lower price option and access to a quality Trio HMO network.
By switching your clients to Trio HMO (and by adding new members), you are eligible for Trio HMO bonuses.
Remember: Trio HMO comes with our exclusive Shield Concierge service, which can help reduce any servicing you need to give to clients who enroll in the plan. Our Shield Concierge representatives will be on hand for your clients to resolve any issues and answer questions they may have about their new plan.
Los Robles Health System is now part of our Exclusive PPO Network, giving your clients access to its renowned facilities, including the only Level II Trauma Center in Eastern Ventura County. Los Robles offers your clients access to a variety of urgent care clinics, providing a more cost-effective option for non-emergencies than the ER.
Heal program expansion
We’ve expanded our HealTM, 1 physician home visit program to the Sacramento area and Inland Empire. This significantly extends the areas we already cover through Heal (Long Beach, Los Angeles, Orange County, San Diego, San Francisco and the Bay Area, and Silicon Valley).
Heal is part of our suite of home care program offerings that support our goal to provide all members access to high-quality, affordable care when and where they need it. Another benefit of Heal is that it may help reduce unnecessary emergency room visits and hospital admissions/readmissions.
In most cases, a Heal physician home visit will be the same member cost share as an office visit for your PPO clients.
If you have clients in the Heal coverage area, you can share this flier with them.
Starting in 2019, covered healthcare services received outside of California through the BlueCard® Program will be limited to:
Any other non-emergency services will not be covered unless prior authorized by Blue Shield.
Alternative care options while out of state
If the need arises, your clients have other ways to access non-emergency care when they are out of state:
• With Teladoc, your clients can talk to a board-certified doctor any time, day or night, over the phone or via video chat.
• NurseHelp 24/7SM, 2 can provide your clients with immediate and reliable health advice from a registered nurse any time, day or night, over the phone or via online chat.
Your clients can view their care options at blueshieldca.com/getcare.
1 Heal is a trademark of Get Heal, Inc
2 NurseHelp 24/7 is a service mark of Blue Shield of California. Blue Shield and the Shield symbol are registered trademarks of the Blue Cross Blue Shield Association, an association of Independent Blue Cross and Blue Shield plans.
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