April 05, 2019
Area(s) of Interest: Commercial Payors Patient Care Practice Management
The California Medical Association (CMA) has learned that two health plans serving Napa and Sonoma counties—Western Health Advantage and SCAN—have moved patients from Meritage Medical Network primary care physicians (PCPs) to St. Joseph’s Health Medical Network PCPs effective April 1, 2019. This transfer was initiated when a group of local physicians left Meritage and went to work for St. Josephs.
This transition affects approximately 2,000 patients covered by Western Health Advantage or SCAN Health Plan (Medicare Advantage). Affected patients were given the option to stay with Meritage and select a new PCP or move to St. Josephs Health Medical Network with their current PCP. Meritage Medical Network PCPs will require a referral to send members to St. Joseph’s specialists.
Patients with questions can call the following numbers:
- Meritage: Kimberley Gustafson, (415) 884-1854
- St. Josephs: Colleen Monfross, (707) 387-3936
- Western Health Advantage: Glenn Hamburg, (888) 563-2250 or (916) 563-2250
- SCAN (Medicare Advantage plan): SCAN Member Services, (800) 559-3500
St Joseph’s has said it will honor previously approved authorizations not older than six months old through their expiration date, even if after the April 1 transition.
Patients may also be able to continue to see their physicians, even if they are not contracted with the patient’s new delegated group, under California’s continuity of care law. Under continuity of care laws, patients with an acute condition, serious chronic condition, duration of a pregnancy, duration of a terminal illness, care of children between birth and 36 months, or for the performance of a surgery or other procedure that has been authorized, may qualify to request continuity of care. To request continuity of care, patients should call the health plan number on the back of their ID cards.
For more information on continuity of care requirements, see CMA health law library document #7051, “Contract Termination By Physicians and Continuity of Care Provisions.”
Practices that are experiencing problems with this transition are encouraged to contact CMA’s Reimbursement Helpline at (888) 401-5911 or email@example.com.