For several months, Hoag has been actively negotiating with Blue Shield California in good faith to establish fair reimbursement rates for the care we provide to Blue Shield members like you. Unfortunately, we have not yet reached an agreement.
We understand these negotiations can be concerning for our patients and their families. Please know that we are working diligently with Blue Shield and remain hopeful that we will reach a fair resolution.
Meantime, here are answers to frequently asked questions:
General Information
Q: Why did I receive a letter saying Hoag may no longer be in-network with Blue Shield?
A: California law requires insurance companies to notify members at least 60 days in advance if a hospital or physician group may become out-of-network. While Hoag and Blue Shield have been negotiating in good faith, an agreement has not yet been reached.
Q: Is Hoag currently out of network with Blue Shield?
A: No. Hoag remains in-network with Blue Shield today. However, if negotiations are unsuccessful, Hoag hospitals, clinics, and physicians could become out-of-network for Blue Shield members beginning July 1, 2025.
Q: Which Hoag facilities could be affected if an agreement is not reached?
A: If Hoag becomes out-of-network, access to services at Hoag hospitals, clinics, and specialty centers — including Hoag Hospital Newport Beach, Hoag Hospital Irvine, Hoag Medical Group, Hoag Orthopedic Institute, and other Hoag specialty institutes — could be significantly limited for Blue Shield members.
Q: Will I still be able to receive emergency care at Hoag?
A: Yes. Regardless of network status, your right to access emergency medical care at Hoag Hospitals will not be affected. Emergency care is always considered in-network and would not be affected by this change. If you or a family member experience a medical emergency, please visit the nearest emergency department.
For Blue Shield Commercial HMO Members
Q: I have a Hoag primary care physician (PCP). What could happen if an agreement is not reached?
A: If no agreement is reached, Blue Shield may reassign Commercial HMO members to a non-Hoag primary care physician (PCP) during May or June 2025 in preparation for a potential network change on July 1, 2025.
Q: Could I continue seeing my Hoag doctors if Hoag becomes out-of-network?
A: Your ability to continue seeing Hoag providers may be limited if Hoag becomes out-of-network. However, you may qualify for Continuity of Care benefits depending on your medical situation.
Continuity of Care and Options
Q: What is Continuity of Care, and how could it help me?
A: If you are receiving active treatment for conditions such as pregnancy, cancer, chronic illnesses, or recent surgeries, you may have the right to request Continuity of Care through Blue Shield. This could allow you to temporarily continue seeing your current Hoag providers even after a contract termination.
Q: How do I request Continuity of Care?
A: If Hoag becomes out-of-network, you can contact Blue Shield’s customer service department (the number is on the back of your member ID card) to apply for Continuity of Care services. Eligibility is determined by Blue Shield.
Q: Can I switch insurance plans to continue accessing Hoag?
A: You may be able to switch to another health plan that includes Hoag in its network during your employer’s next Open Enrollment period. We encourage you to discuss your options with your employer, insurance broker, or benefits representative if maintaining access to Hoag is important to you. You can find a list of insurance plans accepted by Hoag at www.hoag.org/insurance.
Additional Support
Q: Who should I contact if I have questions?
A: We want to support you in this process. A host of options are available to you.
- Blue Shield Customer Service: See number on back of your Blue Shield ID card
- Hoag Patient Support Line: 800-400-4624 (HOAG)
- Hoag Insurance Updates Website: www.hoag.org/blueshield
- Hoag Email Support: me*************@ho**.org
- California Department of Managed Health Care (DMHC): 1-888-HMO-2219 or visit www.hmohelp.ca.gov
Q: Where can I get the latest updates?
A: Hoag will continue to provide updates here at www.hoag.org/blueshield through direct communication and our insurance updates website. Please check back regularly for the latest information.
