Provider Directories
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HI Steve:
Why can’t I find my specialist doctors listed when I search Blue Shield 65 plus site?
I do find primary care doctors at UCLA Health in Santa Clarita but not my specialists Donin (Urology) and Smith (Pulmonology) who I see at the UCLA Health Santa Clarita Primary and Specialty Care clinic.
I see them as a traditional Medicare patient, which I switched to from Blue Shield 65 plus because at the time UCLA would not accept Blue Shield 65 plus.
I understand from your video that now they do.
My concern is whether the primary care physician is going to direct me to see some other doctor at that clinic who also practices the same specialty but not the doctors I have been seeing because I am a ” UCLA Medicare Advantage” patient instead of a traditional medicare patient.
What is your view about this?
Thanks so much for your help, Steve.
Neil R
Please when stating facts, provide the screen shots, exact URL’s, etc. It takes us time to duplicate what you are referring to.
I’m surprised that you can search for 2021 MD’s, as it’s my understanding that 2021 information can’t be released to the public until October 1st. https://medicare.healthreformquotes.com/mapd/regulations/
It often seems that Medicare Advantage rules are there, just so that agents can go to jail at the Federal Governments whim.
We do see Blue Shield 65 Plus, Vital & Inspire on UCLA’s list of accepted Health Plans, but don’t know if that’s for 2021.
Which facility are you using?
When using Blue Shield Provider Finder
https://www.blueshieldca.com/fad/home
you can set the filter to which MD’s accept Blue Shield
Working “backwards” UCLA shows Dr. Donin MD as accepting Blue Shield. Give me a couple of days to see why he doesn’t show on Blue Shield’s provider finder.
He does show in their print directory on page 640
https://www.uclahealth.org/nicholas-donin
Is it Malcolm Smith you’re going to?
https://www.uclahealth.org/malcolm-smith
He’s on page 632 of the pdf directory
Reply from Blue Shield broker support
I can confirm Dr. Nicholas Donin is constructed with 65 plus / Inspire under UCLA Medicare Advantage ( Medical Group).
Practioner id showing contracted with UCLA Medicare Advantage & 65 Plus/Inspire : 100323139008.
If your member’s Primary Care physician is attached to UCLA Medicare Advantage then the member can request this Urologist.
If its not, I would recommend speaking with your member as for HMO Policies, most procedures and specialists need to be authorized by medical group and they always refer out from their own doctors.
See page 42 of EOC for more details on getting referred to specialists.
2nd reply from Blue Shield broker services:
[we will] request for the Find a Provider page to be updated.
Thanks for the information.
After spending a lot of time talking to UCLA and Blue Shield, I decided that if I wanted someone else to manage my care and didn’t care about how they did or didn’t do that, I should go back to the Medicare Advantage plan I was on for 4 years before I switched to original Medicare! [Parts A Hospital & B Doctor Visits]
Thanks for your help.
I have no changes planned for my supplement (F extra) so it will automatically renew
Did you see our video and pdf # 12026 on Understanding Advantage Plans on our Blue Shield Advantage Plan Page?
The Introduction to Medi Gap Publication # 02110on our Blue Shield Medi Gap Page?
IMHO those video’s and official Government brochures explain how Medicare Advantage tries to save $$$ by “managing” your care.
We are authorized Blue Shield Medi Gap brokers and can assist you with anything that comes up. When you appoint us as your Broker, Blue Shield compensates us at no additional charge to you, as it saves them time on the phone with you not having to call them. Here’s the form to appoint us. How much time did we spend helping you?
We can get you enrolled in Blue Shield Medicare Advantage starting on October 15th for a January 1st effective date.
Informational Materials will be released to the public on October 1st. If an agent is able to see anything before that time, it’s more secret that anything else I know of.
Check our Blue Shield MAPD webpage for 2021 information and enrollment then. There is no extra charge for our services. The Federal Government provides for agent compensation from the fees they pay the Insurance Companies to take care of you.