Updated June 13, 2025
After several months of negotiations with Blue Shield of California (Blue Shield), Hoag is pleased to announce we have reached a mutually beneficial agreement with commercial PPO and HMO and Medicare PPO plan.
This means that all commercial HMO, PPO and Medicare PPO lines of business will remain contracted and there will be no disruption to patient care.
However, the contract between Hoag and Blue Shield for Medicare Advantage HMO members will end Dec. 31, 2025. This will not change.
We want to help; here are answers to frequently asked questions:
General Information for Blue Shield Medicare Advantage HMO Members
Q: What is happening between Hoag and Blue Shield?
A: The contract between Hoag and Blue Shield of California for Medicare Advantage HMO members is set to expire on Dec. 31, 2025. This means Hoag will no longer be in-network for Blue Shield Medicare Advantage HMO members starting Jan. 1, 2026. The contract’s termination date was originally July 1, 2025 but was extended.
Q: What does this mean for my care?
A: Blue Shield and Hoag have sent letters notifying members that they can remain with their Hoag provider through the end of the year. Members who wish to remain with Hoag beginning Jan. 1, 2026 will need to select a new plan or traditional Medicare during the open enrollment period, which begins Oct. 15, 2025.
Q: Can I still go to Hoag in an emergency?
A: Yes. Emergency care is always covered, regardless of your network. If you or a family member has a medical emergency, you can still visit any Hoag emergency department.
Q: What if I’m already being treated by a Hoag doctor?
A: You may qualify for “Continuity of Care,” which lets you continue seeing your current Hoag provider for a limited time, depending on Blue Shield’s guidelines. Contact Blue Shield directly to see if you’re eligible and see more below.
Q: Can I keep my Hoag doctors and access to Hoag facilities?
A: Yes. Members who wish to remain with Hoag beginning Jan. 1, 2026 will need to select a new plan or traditional Medicare during the open enrollment period which begins Oct. 15, 2025.
Medicare Advantage HMO plans wherein Hoag is in network include:
Anthem
- Anthem Select (HMO-POS)
- Anthem Medicare Advantage (HMO-POS)
- Anthem Prime (HMO-POS)
Scan: 833-712-3897 | Scan health plan finder
- Scan Classic
- Scan Affirm
- Scan Balance
- Scan Prime
- Scan Inspired
United Healthcare: 844-236-3281 | www.Shopuhc.com
- AARP Medicare Advantage UHC CA 004P-6P
- AARP Medicare Advantage Giveback UHC CA 19-21
- United Healthcare Group Medicare Advantage
Q: What is Continuity of Care (COC), 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: When 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: 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 Email Support: me*************@ho**.org
- For Medicare members: 1-800-MEDICARE (1-800-633-4227)
General Information for Commercial PPO & HMO members and Medicare PPO Members
Q: Has Hoag reached an agreement with Blue Shield?
A: Yes. Hoag and Blue Shield of California have successfully reached a new agreement. Hoag hospitals, Hoag Orthopedics Institute, clinics and physicians will remain in-network for Blue Shield commercial HMO and PPO members, as well as Medicare PPO members.
Q: What does this mean for my access to care?
A: There will be no disruption. You can continue seeing your Hoag primary care physicians and specialists, and accessing services at Hoag facilities as usual.
Q: Do I need to do anything?
A: No. You do not need to take any action. Your provider network and health plan access remain unchanged.
Q: I received a letter from Blue Shield about Hoag leaving the network: What should I do?
A: That letter was required by state law during the negotiation period. Now that an agreement has been reached, you can disregard that communication.
Q: Which Hoag services and locations are included in the Blue Shield network?
A: All the Hoag facilities and services you know and trust remain in-network, including:
- Hoag Hospital Newport Beach
- Hoag Hospital Irvine
- Hoag Orthopedic Institute
- Hoag Medical Group
- Hoag Physician Partners
- Hoag Family Cancer Institute
- Jeffrey M. Carlton Heart and Vascular Institute
- Hoag Digestive Health Institute
- Hoag Women’s Health Institute
- And more
Q: Who should I contact if I have questions?
A: Hoag is here to support you in this process. A host of options are available to you.
- Hoag Patient Support Line: 800-400-4624 (HOAG)
- Hoag Insurance Updates Website: www.hoag.org/blueshield
- Hoag Email Support: me*************@ho**.org
Q: Why did this negotiation happen in the first place?
A: Health systems and hospitals regularly negotiate with insurance providers to ensure fair and sustainable reimbursement rates that allow them to continue delivering high-quality care to our patients. We’re pleased this matter was resolved without disrupting your care.
