employer connection

Change to Non-Network Reimbursement for Hospitals in California

Good news! Blue Shield is helping to reduce the cost of health care with a new change to the way we reimburse non-network hospitals.

Payment for covered non-network hospital services will no longer be based on billed charges. Instead, we will pay them based on a region-based fee schedule developed by Blue Shield. This change is effective December 1, 2009 for new or renewing November and December 2009 groups. For groups new or renewing January 1, 2010 or later, this change will apply on your effective date.

This change applies to covered non-network PPO hospital emergency services and non-network HMO authorized hospital services (including emergency care) on all fully insured Blue Shield Mid/Large Groups of 51+ eligibles.  It does not include ASO or Medicare groups.

For more information, please see our employer letter (PDF, 42KB) and member letter (PDF, 34KB).