Blue Shield of California Sends Termination Notice to Encompass Medical Group Effective June 1, 2018

Blue Shield of California has issued a termination notice to Encompass Medical Group (Encompass) effective June 1, 2018. Due to issues that were revealed in a recent audit of the medical group, Blue Shield has decided to reassign affected HMO members to alternate network IPAs in the area to help ensure uninterrupted access to care, effective June 1, 2018. This contract termination affects the following lines of business: Small Business, Large Group, Premier, CalPERS, and FEP.

Currently, there are 319 commercial HMO members who will be transferred to alternate medical groups. DMHC regulations require Blue Shield to notify commercial HMO members of a change to their medical group and, if applicable, primary care physician (PCP), 60 days in advance of a termination. However, DMHC accepted a waiver of this requirement to allow a shortened period of 15 days for this specific case.

  • Letters to commercial HMO/POS members assigned to an Encompass PCP were sent on May 16, 2018.
  • An employer notification will be sent via email to employers with affected members on May 18, 2018.

Important Information for Blue Shield Members Currently Assigned to Encompass Medical Group:

  • On May 16, 2018, Blue Shield will send notifications to commercial HMO/POS members assigned to Encompass PCPs. The notifications advise members that they will be reassigned to alternate medical groups for a June 1, 2018, effective date. Members can call the Member Services number on their Blue Shield member ID card to self-select a PCP or IPA or they can go online to the Find a Doctor tool.
  • The receiving medical groups include: Mercy Physicians Medical Group, Scripps Physicians Medical Group, and Sharp Community Medical Group San Diego.
  • Blue Shield members assigned to Encompass who are receiving care on June 1, 2018, or who have a procedure scheduled to be performed by Encompass within 180 days of June 1, 2018, can request continuation of covered services through Blue Shield for ongoing treatment with their provider. These members can call the Member Services telephone number on their Blue Shield ID card. They may also refer to the Blue Shield Continuity of Care Brochure and the Blue Shield Continuity of Care Services Request Form.