09 Dec 2013

Is my Doctor / Hospital / Lab / Urgent Care / Pharmacy In-Network in 2014?

09 Dec 2013

2/6/2014 Update:

As patients begin using their new health insurance, a number of people have been surprised/disappointed/upset to find that their provider is not in their new 2014 network. Regulators at the state and federal levels are now looking at ways to force insurers to broaden their networks, but it may not be an easy fix.  Read more at the Wall Street Journal (subscription required) and Bloomberg News on this issue.


Change is coming, and one of the most critical questions for those who purchase their health insurance coverage on the individual market, is: “Will my preferred provider be in-network with my plan?”  See our previous post, Beware the Narrow Network on this topic.

With this in mind, I wanted to put together a single client resource here, as well as provide a few pieces of advice:

  • Confirm any search results directly with your provider(s). Errors are possible, and it makes sense to confirm at the point of service. Remember to ask whether the provider is a participating provider, i.e., are they in-network. Doctors will sometimes say they “accept” PPO insurance, meaning that they will be your carrier as an out of network provider. Big difference.
  • Be clear with your doctor about which carrier, which plan (PPO or EPO?), and whether you are purchasing it through Covered CA or directly from the carrier in 2014. Though most carrier networks are the same on- and off-exchange, there may be some variations.

Links to Online Provider Searches:

Note: Choose the Pathway (direct from Anthem) or Pathway X (Covered CA) network to define your search, depending on whether you are purchasing direct from Anthem, or through the state Marketplace (eXchange). Remember that your Anthem plan may be the Exclusive Provider network (EPO) depending on your county of residence.

Blue Shield of CA
Note: Blue Shield’s 2014 network will not distinguish between those who purchase coverage on/off exchange. But do make sure to choose the “2014” network, and make sure to correctly select either the PPO or EPO option, depending on what is available in your county.

Note: You can search Cigna’s 2013 (Open Access Plus) and 2014 (Local Access) PPO networks from this starting point. If you are currently enrolled with Cigna, or switch to Cigna by December 15, you will be grandfathered into the larger Open Access Plus network for all of 2014.

Health Net
Note: When selecting a plan network, there are two “PPO for Individuals and Families” options – choose the one under “Standard Plans” or “Covered California Plans” depending on the source of your coverage.


Leave a comment
More Posts