FAQ: UCSF and Hill Physicians

For patients who get their health care in San Francisco, UCSF Medical Center and UCSF Medical Group entered an affiliation with Hill Physicians Medical Group for health maintenance organization (HMO) and point of service (POS) insurance plans. Hill Physicians is the largest group of independent doctors in Northern California. Check with your HMO and POS plan, your doctor and your employer's benefits office and read our frequently asked questions below for additional information. (Kaiser Permanente members are not affected.)

UCSF ended its affiliation with Brown & Toland Medical Group on Dec. 31, 2009 and now has a contract with with Brown & Toland for tertiary, or specialized, referral care only.

How do I know if this change affects me and my family?

If you're a member of an HMO or POS plan (including Medicare HMO plans and excluding Kaiser Permanente) and have a primary care doctor in San Francisco, this change affects you. For more information about your situation, talk to your doctor, HMO and your employer's benefits office. Use online resources such as your health plan's web site and www.HillPhysicians.com/UCSF. Or call UCSF at (888) 689-UCSF and a representative will answer your questions.

I currently see a UCSF primary care doctor. How can I continue to see my doctor?

If you're an HMO or POS plan member of Aetna, Blue Shield, CIGNA, and Health Net and have a UCSF primary care doctor, you were re-assigned to Hill Physicians as your medical group, unless you opt-out. If you want to continue seeing your UCSF primary care doctor, there's nothing you need to do.

If you're an HMO or POS plan member of Anthem/Blue Cross or United/PacifiCare, you were asked to re-select your primary care doctor and medical group.

For more information, please contact your health plan.

My primary care doctor is not at UCSF Medical Center. How can I ensure that I can continue to see my UCSF specialist?

As of Jan. 1, 2010, UCSF doctors are no longer "in network" for patients whose doctors are members of Brown & Toland Medical Group. Referrals from Brown & Toland primary care doctors require "prior authorization" to access UCSF specialty care. Exceptions include pediatric specialty and obstetrical care patients who may see a UCSF specialist without prior authorization.

Patients also may be eligible for what's called "continuity of care" or "transition of care," under state law. For more information about your patient rights under state regulations, contact your health plan or see the state Department of Managed Health Care site.

To ensure the easiest access to UCSF specialists, choose a primary care doctor who is a member of Hill Physicians in San Francisco. If you choose a primary care doctor with another medical group, a referral to a UCSF specialist likely will be subject to prior authorization and approval. (Please note that some primary care doctors will be members of both Hill Physicians and other medical groups but you must choose Hill Physicians as your medical group to retain unrestricted access to UCSF.)

What if my primary care doctor doesn't join Hill Physicians?

If your primary care doctor doesn't join Hill Physicians, your access to a UCSF specialist may be limited. Contact your doctors and your HMO or POS plan for more information about your options.

I'm currently being treated for cancer. Can I continue seeing my UCSF cancer specialists if my primary care doctor doesn't join Hill Physicians?

Generally, patients with serious conditions can continue seeing their UCSF specialists for as long as their condition persists. This is a provision, under state law, called "continuity of care." To receive continuity of care, you must call your health plan to ask for continuity of care and your doctor or hospital must agree to continue your treatment.

For more information about continuity of care, check with your doctors and HMO. Information also is available on the California Department of Managed Healthcare Web site

Referrals from Brown & Toland primary care doctors require "prior authorization" to access UCSF specialty care. Exceptions include pediatric specialty and obstetrical care. Those patients may see a UCSF specialist without prior authorization.

I currently don't get care at UCSF but would like to in the future. What should I do?

Choose a primary care doctor who is a member of Hill Physicians. Each HMO and POS plan member must select a primary care doctor from a participating medical group. Your primary care doctor coordinates your care, including referrals to specialists for consultations and procedures. Ask your employer's benefits office or health plan what you need to do to change your medical group.

Can I switch medical groups if I become sick and want access to a UCSF specialist?

Check with your employer's benefits office to determine what options you have. Depending on your health plan, you may be able to switch to a Hill Physicians primary care doctor after open enrollment.

If your plan allows you to switch medical groups, it may take up to 45 days to make the change. Then, once the change is made, you must choose and see a new primary care doctor before a referral to a UCSF specialist can be scheduled. To prevent possible delays, choose Hill Physicians as your medical group now.

Can members of my family belong to different medical groups?

Yes, most HMO and POS plans allow you to choose a different medical group for different members of your family as long as the different medical groups are included in your plan's provider network. Please check with your insurance plan or your employer's benefits office to confirm.

What if I change HMO plans during open enrollment?

If you change HMO or POS plans, make sure to choose a primary care doctor in Hill Physicians in San Francisco if you want to continue receiving care at UCSF. Contact your health plan for more information.

Can I access UCSF doctors more easily if I switch from an HMO or POS to a preferred provider organization (PPO)?

Most PPOs allow you to schedule consultations with specialists including those at UCSF without prior insurance approval or review. Generally, most San Francisco doctors can refer you to UCSF specialists if you enroll in a PPO. However, co-pays, deductibles and premiums for a PPO may vary considerably from an HMO.

When is the deadline for choosing my medical group?

Contact your employer's Human Resources department or health insurance plan about the timing and procedures for open enrollment or for changing medical groups.

What is Hill Physicians Medical Group?

Hill Physicians is the largest medical group of independent physicians in Northern California. Hill Physicians is affiliated with UCSF as well as Dignity Health Care, formerly Catholic Healthcare West (CHW), a hospital network that includes St. Mary's Medical Center and St. Francis Memorial Hospital in San Francisco. For more information about Hill Physicians Medical Group, visit www.HillPhysicians.com.

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