Western Health Advantage and UC Davis Health

Q:  What is going on with Western Health Advantage (WHA) and UC Davis Health? What is the change in the relationship?

A:   After serving as a primary care provider group for Western Health Advantage (WHA) members for the past 20 years, UC Davis Health is modifying its participation in WHA’s commercial health care network.

UC Davis Health will provide primary care services to WHA’s employer group and individual plan members until December 31, 2017.

UC Davis Health intends to remain available after December 31, 2017 to provide specialty and hospital care to WHA members.

Q:  Doesn’t UC Office of the President have a contract or relationship with WHA? Doesn’t WHA provide UC employees with health insurance coverage? What’s happening with them?

A:   The UC Office of the President has again contracted with WHA to provide health benefits for UC employees for 2018. UC employees (as well as retirees and family members) who currently receive coverage through WHA can continue with that coverage for both UC Davis primary and specialty care in 2018 if they choose.

UC employees and retirees who currently have WHA insurance should receive a letter from WHA with more information about fall open enrollment. If you have not received such a letter, please contact Western Health Advantage Member Services at 916-563-2250 or 888-563-2250.

UC employees or retirees can also refer to the information included in the open enrollment materials that the university system mails to their homes.   

Q:  When will UC Davis Health stop providing care to WHA’s commercial members?

A:   Health care services for all WHA members currently assigned to and receiving medical services from UC Davis Health providers will continue through December 31, 2017. As appropriate and determined by WHA, continuity of care considerations may be available based on medical necessity after December 31, 2017. WHA members will need to choose a new provider group in WHA’s network or new health plan during upcoming open enrollment periods and prior to January 1, 2018. Open enrollment is typically in the early fall.

Q:  Why did UC Davis Health make the decision to modify its provider network within WHA?

A:   UC Davis Health was a founding member of WHA in 1996, and since that time the health system has contracted with WHA as a provider of primary, specialty and hospital care. The decision to narrow our participation in WHA’s commercial health care network was made following years of due diligence, discussion and reviews with both WHA management and UC leadership. With today’s health care environment so challenging and uncertain, we cannot risk our ability to continue providing high quality care to every patient we serve. After months of analysis, we concluded that our most prudent financial strategy was to modify participation in WHA’s commercial network.

UC Davis Health remains dedicated to our role as inland Northern California’s only academic medical center and its only level 1 trauma center, serving more than 6 million residents throughout the region. Our health care services remain available through contracts with approximately 30 other health plans.

Q:  I am affected by this change, as is my family. What do I do now?

A:   Members affected by this decision will have the opportunity to select another provider group in WHA’s network or enroll in a different health plan during the next open enrollment period in early fall 2017. Our commitment to WHA members currently assigned to UC Davis Health physicians is to make this transition as seamless as possible. UC Davis Health staff, case managers and physicians are focused on this goal. Patient information and guidelines are available at each clinical location. You may also call UC Davis Health’s Consumer Resource Center at 800-282-3284

Q:  I am not a UC employee and will be affected by this change. Is there another way to receive care from UC Davis Health providers?

A:   UC Davis Health remains a contracted provider with many health plans that serve Northern California. Depending on how you receive your insurance coverage, you may be able to maintain access to your UC Davis Health providers through one of these other health plans. If you receive your health care insurance through your employer, your benefits office will be able to help you evaluate the options.

Q:  I am currently receiving cancer care or other highly specialized care at UC Davis. What happens to me now?

A:   Health maintenance organizations (HMOs) in the State of California are regulated by the Department of Managed Health Care (DMHC). In certain circumstances, patients are able to keep their doctor or hospital. These circumstances are described here: https://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/ContinuityofCare.aspx#.WThMNPnyuUk.

You need to contact WHA to find out if you qualify.  According to the DMHC, you are entitled to ask for a copy of WHA’s policy on continuity of care.

Q:  If I decide to keep my Western Health Advantage (WHA) health insurance, how long will I be able to see my current UC Davis primary care doctor?

A:   Unless your insurance situation changes, you can continue with your physician until the end of the 2017 calendar year. If you stay with WHA after December 31, 2017, you will need to choose another provider group during the health insurance signup or “open enrollment” period for 2018. Open enrollment for 2018 usually occurs this fall (2017) — but make sure to double-check the timing with your employer’s benefits office or your health insurance broker.

The new primary care provider that you chose during open enrollment would begin providing your care in January 2018.

Q:  Are there exceptions that will allow me to stay longer with my current doctor?

A:   Under state law, in some cases you may be able to keep your UC Davis primary care doctor for a limited time. This is called "continuity of care." Only people with certain kinds of health problems or conditions can get continuity of care.

Q:   How do I find out whether I qualify for continuity of care?

A:    Check with your health plan to find out if you qualify for continuity of care. You will need to provide the name of your doctor or hospital, your medical condition, and the treatments you are receiving. You can ask for a copy your health plan's policy on continuing existing care at any time. It’s called the “Continuity of Care” policy.

The conditions and lengths of time for continuity of care are also listed on the California Department of Managed Health Care website at https://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/ContinuityofCare.aspx#.WThMNPnyuUk.

If you have any problems asking for continuity of care or have any questions please contact the Department of Managed Care Help Center at 1-888-466-2219.

Q:  How do I ask for continuity of care?

A:   According to the California Department of Managed Health Care, you must call your health plan to ask if you can get continuity of care. You must give the name of your doctor, and explain your medical condition and treatments.

Q:  Will I still be able to pursue appointments or procedures with my existing UC Davis Health specialists in 2017? For example, I also have an existing relationship with a UC Davis cardiologist.

A:   Your care until the end of 2017 will remain as it has been up until now. You should see no changes in your care.

Q:  Will I still be able to pursue appointments or procedures with new UC Davis Health specialists in 2017? For example, my physicians may decide that a heart procedure is best for me, and I’d like to have it performed at UC Davis.

A:   Your UC Davis Health primary care provider will make referrals that he or she determines to be most appropriate for your care needs.

Q:  Will I still be able to pursue appointments or procedures with my existing UC Davis Health specialists in 2018?

A:   As is currently the case, your new primary care provider will refer you for specialty care. UC Davis Health intends to remain available to WHA members for specialty care in 2018.

Q:  Will I still be able to pursue appointments or procedures with new UC Davis Health specialists in 2018?

A:   As is currently the case, your new primary care provider will refer you for specialty care. UC Davis Health intends to remain available to WHA members for specialty care in 2018.

Q:  Will you transfer my medical records?                  

A:   Yes. Your new doctor may access your UC Davis medical record online, by using a secure system further explained below. UC Davis can also provide you with an electronic copy of your medical records. Our Health Information Management Department handles requests for medical records and releases of information. Request forms and instructions are available on the department's website at http://www.ucdmc.ucdavis.edu/him/roi/roi_new.html

In many cases your new physician or medical group will automatically work to obtain your medical records, and will advise you if they need more information or permission from you in that process.

If your new primary care physician is an external doctor, they qualify to receive access to your entire patient medical record electronically. Once you have registered with your new physician, your electronic patient record will automatically be made available to them through the EPIC Physician Connect system, if the doctor is already an affiliated user with the UC Davis EPIC Physician Connect system. If your new primary care physician is a member of a health system that already uses the EPIC electronic medical record system, they can also use the EPIC CareEverywhere module to automatically view and pull your UC Davis Health medical records online.

If your new doctor is not a current user of UC Davis Health’s EPIC Physician Connect system, they can enroll online at http://www.ucdmc.ucdavis.edu/referrals/ so that your online medical chart can be made available online to them.

If you or your new physician have questions about medical records, please contact UC Davis Health’s Health Information Management Department at 916-734-5205 (hours are Monday to Friday 8 a.m. to 4 p.m., excluding holidays).

Q:  Who can I speak to if I have questions or concerns?

A:   You can direct questions to Western Health Advantage Member Services at 916-563-2250 or 888-563-2250 toll-free. You may also call UC Davis Health’s Consumer Resource Center at 800-282-3284

Q:  I am helping someone whose primary language is not English. Are these materials available in other languages?

A:   UC Davis provides interpreting and translation services over the telephone. You can contact Interpreting and Translation Services at 916-734-2321.