Should I care that my UCSF doctor is joining Hill Physicans?

October 1, 2009 1:09 PM

All of UC-San Francisco's physicians will shortly end their affiliation with Brown & Toland and become members of Hill Physicians Group. What will this mean for patients?

I have been bombarded with news that my primary care doctor, along with all of UCSF's doctors, will, as of 1/1/10, be switching affiliations to become a member of the Hill Physicians Group. Apart from having to switch my health insurance from Healthnet/B&T to Healthnet/HPG during Open Enrollment if I want to continue to see UCSF doctors is there some reason I should care? I guess Hill is part of the Catholic Healthcare West network. Is that significant? Does this switch have any benefits to the consumer or is it just some procedural paperwork that should be somewhat transparent from a user standpoint?

posted by otherwordlyglow to health & fitness (4 comments total)

I don't like the tone of the scaremongering commercials, that's for sure. There are some links in this article which may be helpful and maybe this one. The commercials seemed to say that if yoiu want to keep your UCSF doctors, you must join a PPO, instead of an HMO. But I could be wrong. It's worth calling your insurance company ask (or see if they have a "Frequently Asked Questions" about the issue). Or call your doctor's office.

If you have a HR department, ask them to find out.
posted by potsmokinghippieoverlord at 4:09 PM on October 1

The commercials seemed to say that if yoiu want to keep your UCSF doctors, you must join a PPO, instead of an HMO.
Huh, I thought it was the opposite. It's all so ridiculously confusing but I agree that the tone of all the propoganda I've seen so far has been a bit scaremonger-y. And the truth is that I work for UCSF (in a totally non-medical capacity) and the info I get from them, including from HR, is just as confusing.
posted by otherwordlyglow at 4:36 PM on October 1

I don't know anything about the UCSF situation, but just generally, I'd beware of Hill Physicians Group. I had to use doctors within that group as part of my insurance when I worked in the Bay Area and both the customer service and claims processing were absolute and complete nightmares. The doctor choice was fairly bad as well, though if you get to keep your same PCP, that shouldn't matter so much.

But I would be concerned, yes. I also had Brown and Toland at one point, and it wasn't much better (IMO), but Hill was the pits.
posted by blucevalo at 7:08 AM on October 2

If you have a PPO, you can generally see specialists and physicians outside your network, according to the PPO's terms, regardless of your insurance company or physicians groups. So, these changes don't affect people with PPO coverage.

HMOs are more restrictive, and only provide coverage for physicians and specialists within that group. If you're on a group HMO with a primary care physician, you'll only be covered if that physician refers you to other physicians or specialists within that group.

The practical impact here is since UCSF is changing groups from Brown and Toland to Hill Physicians, those individuals on HMOs with primary care physicians who are with Brown and Toland will not be able to referred to Hill Physicians specialists.

So, there are two options if you want to see a specialist at UCSF:

1) Join a PPO, and you can kind of see whoever you want wherever, according to the terms of the plan
2) Switch to a primary care physician who is within the Hill Physicians group, and that PCP can refer you to UCSF doctors.

Those on HMOs with a PCP in the Brown and Toland group are still allowed by law to see specialists who have switched to Hill Physicians until the end of 2010.

What I want to know is how this physicians group business took over San Francisco. It really makes everything miserable when trying to manage health care and get reimbursement. I may post my own question abou that.
posted by eschatfische at 8:15 AM on October 2