NEW - UCSF Referral Agreement with Brown & Toland

UCSF Medical Center and UCSF Medical Group, representing UCSF doctors, have negotiated a referral agreement with Brown & Toland Medical Group that covers patients who are members of health maintenance organizations (HMO). The new two-year contract is effective Jan. 1, 2010. This may affect UC faculty, staff and retirees in Anthem Blue Cross Plus and Health Net HMO plans.  (This includes clinical fellows, postdocs and residents enrolled in HMOs.) UC employees enrolled in other UC-sponsored medical plans are not affected.

Except as noted below, referrals from Brown & Toland primary care physicians will require prior authorization to access UCSF specialty care. (Please remember that it is the patient’s responsibility to obtain authorization prior to receiving out-of-network services.)

Exceptions are pediatric specialty and obstetrical care, patients covered under state-defined continuity of care provisions, and patients who saw a UCSF specialist for care from July 1, 2009 through December 31, 2009 and require continuing care in 2010. Those patients may see a UCSF specialist without prior authorization.

What is happening?

Effective January 1, 2010, all doctors in the UCSF Medical Group will join Hill Physicians Medical Group in San Francisco, and will no longer be “in-network” for Brown and Toland Medical Group enrollees. This change could affect how you and your family members access care at the UCSF Medical Center. 

Who is affected?

• Employees/retirees enrolled in the UC-sponsored Health Net HMO, Health Net Seniority Plus or Anthem Blue Cross PLUS (non-Medicare and Medicare members) may be affected if your current medical group is Brown & Toland.
• Residents/Fellows enrolled in the UC-sponsored Health Net HMO may be affected if your current medical group is Brown & Toland.
• Postdocs enrolled in UC-sponsored Health Net HMO may be affected if your current medical group is Brown & Toland.

Not Affected...

• Employees/retirees enrolled in Anthem Blue Cross PPO, Kaiser Permanente-CA, CIGNA, Western Health Advantage, High Option (retirees only) and Core ARE NOT affected by this change.
• Residents/Fellows enrolled in Anthem Blue Cross PPO ARE NOT affected by this change.
• Post-docs enrolled in Health Net PPO ARE NOT affected by this change.

How do I change my provider and/or medical group?

Generally, you can change your medical group and/or PCP throughout the year.  If you contact your medical plan and request the change by the 15th of a month, that change will be effective the first of the following month.

Employees (faculty, staff, medical center)/Retirees

Residents/Fellows

Postdocs

Learn More

HMO 101

Better understand the relationship between your medical plan and medical group

Transition (Continuity) of Care Assistance