Updated May 15th, 2025
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 for commercial PPO and HMO plans. Additionally, the contract between Hoag and Blue Shield for Medicare Advantage HMO members will expire on June 30, 2025.
We understand these negotiations can be concerning for our patients and their families.
To be clear, these negotiations are not about Hoag seeking higher profits. It’s about ensuring the ability to deliver care without compromise. Hoag is asking for fair, sustainable reimbursement that reflects the actual cost required to deliver the quality of care you know and expect from Hoag.
If you’d like to advocate for your access to Hoag facilities, doctors and nurses, you can email Blue Shield Interim President Mike Stuart at mi*********@bl**********.com.
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 June 30, 2025. This means Hoag will no longer be in-network for Blue Shield Medicare Advantage HMO members starting July 1, 2025.
Q: What does this mean for my care?
A: Blue Shield will assign you a new primary care physician (PCP) who is not affiliated with Hoag during May and June 2025. Starting July 1, 2025, you will no longer have access to Hoag specialists or elective services at Hoag facilities.
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: It’s possible through a Special Enrollment Period (see more below) and by switching to a Medicare Advantage HMO plan that still includes Hoag. These plans include:
Anthem
- Anthem Select (HMO-POS)
- Anthem Medicare Advantage (HMO-POS)
- Anthem Prime (HMO-POS)
Scan: 833-712-3897
- 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 a Special Enrollment Period?
A: Generally, one can only change their medical plan during specific time periods without a penalty. However, some situations allow for this change outside of these windows. This is called a Special Enrollment Period. This special period helps ensure patients don’t have gaps in healthcare coverage or endure penalties.
To request a Special Enrollment Plan and explore your coverage options, call 1-800-MEDICARE (1-800-633-4227). Please mention that you received a notice stating Hoag is leaving the network. This Medicare help line is available 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.
General Information for Commercial PPO & HMO members
Q: Why did I receive a letter saying Hoag may no longer be in-network with Blue Shield?
A: California law requires health plans 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.
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. You may also contact Blue Shield’s HMO customer service department at the number on the back of your member ID card if you need more information. If you have further questions, for commercial HMO and PPO plans, you are encouraged to call the Department of Managed Health Care (“DMHC”), which protects HMO/PPO consumers, by telephone at its toll-free number, 1-888-HMO-2219, or at a TDD number for the hearing impaired at 1-877-688-9891, or online at www.hmohelp.ca.gov.
Q: Can I switch health 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 plans accepted by Hoag at www.hoag.org/insurance.
Continuity of Care and Options
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: 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 health plans to continue accessing Hoag?
A: You may be able to switch to original Medicare or 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 Medicare Advantage Plans accepted by Hoag at www.hoag.org/insurance.
You may also contact Blue Shield’s HMO customer service department listed on the back of your member ID card, if you have further questions. For commercial HMO and PPO plans, you are also encouraged to call the Department of Managed Health Care (“DMHC”), which protects HMO/PPO consumers, by telephone at its toll-free number, 1-888-HMO-2219, or at a TDD number for the hearing impaired at 1-877-688-9891, or online at www.hmohelp.ca.gov.
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
- For commercial members, California Department of Managed Health Care (DMHC): 1-888-HMO-2219 or visit www.hmohelp.ca.gov
- For Medicare members: 1-800-MEDICARE (1-800-633-4227)
Q: Where can I get the latest updates?
A: Hoag will continue to provide updates at www.hoag.org/blueshield through direct communication and our insurance updates website. Please check back regularly for the latest information.
