Blue Shield Will Drop Sansum Clinic from Medicare Advantage HMO List

Patients Can Change Insurance Plans During Medicare Enrollment Period Through December 7

Credit: Jérôme Rommé - stock.adobe.com

A significant change is on the horizon for thousands of patients in the greater Santa Barbara community as Blue Shield of California will no longer include Sansum Clinic in its Medicare Advantage HMO network starting January 1, 2025. Approximately 3,200 patients will be affected, and they now must navigate new coverage options if they wish to continue seeing their doctors at Sansum, one of the largest medical groups in Santa Barbara County.

Sansum Clinic, through a spokesperson, expressed disappointment that Blue Shield was excluding Sansum from its in-network HMO for Medicare Advantage patients. Sansum did not know why Blue Shield Advantage had dropped their network of doctors. The timing aligned with the typical year-end review of insurance contracts, but the specific reasons behind the exclusion were unclear.

With the contract set to expire on December 31, 2024, Medicare Advantage HMO members have a limited window to switch plans during Medicare’s Annual Enrollment Period, which ends on December 7, 2024. According to Sansum and Blue Shield, the following are the options available:

AARP Medicare Advantage (UHC CA-0024 PPO)
Aetna Medicare Core (PPO)
Aetna Medicare Eagle Plus (PPO)
Original Medicare

Blue Shield Advantage HMO members who do not select a plan will be reassigned to non-Sansum doctors beginning on January 1, 2025, according to Sansum.

Sansum Clinic is assisting affected patients through outreach efforts, including in-person events and webinars. These sessions, conducted in partnership with local licensed insurance agents, aim to educate Medicare-eligible patients about their coverage options. A full schedule of these events can be found here.

For patients with urgent or ongoing medical needs, there is a lifeline. Sansum Clinic has a provision for Continuity of Care, which allows patients to continue their treatments with their current Sansum doctors even after December 31, 2024, with prior approval from Blue Shield. This applies to those with serious chronic conditions, terminal illnesses, or scheduled surgeries.

Sansum Clinic remains in Blue Shield’s commercial HMO, EPO, and PPO plans. Patients with Sutter Health, which formalized its partnership with the Santa Barbara–based Sansum in October 2023, are unaffected.

In the midst of this transition, some Blue Shield members received incorrect notifications from the insurance provider. Approximately 700 of the 5,200 commercial HMO members were mistakenly informed that they would be reassigned to non-Sansum doctors in 2025. Blue Shield has since acknowledged the error and will send correction letters to clarify that these patients can continue seeing their Sansum doctors, since this termination does not apply to commercial plan members.