14 Nov 2014

How to Search Your 2015 Provider Network (and what to ask your doctor’s office)

14 Nov 2014

Allpointe provides the information below as a convenience to consumers who are choosing from among health plans. We make every effort to update this with accurate data as we get it, but provider networks do change. We strongly recommend you check directly with your providers to find out if they intend to participate in-network in 2015.

Anthem Blue Cross of CAsearch providers here

PPO network: Pathway PPO / Pathway X PPO
EPO network: Pathway – Tiered EPO /Pathway X – Tiered EPO
Notable exclusions: Sutter Health (2015 update: some Sutter hospitals will be included in Anthem’s 2015 Pathway networks, including CPMC, St. Luke’s, Alta Bates Summit, and Novato Community Hospitals – some Sutter doctors may be covered as well – please check with them directly); Palo Alto Medical Foundation; Stanford Health (contract resolved 11/20/14 update: the contract resolution does not apply to Anthem individual Pathway PPO or EPO plans)
Out of state access for non-emergency?: Yes, through national BlueCard PPO/EPO

Ask your doctor: “Are you a participating provider in Anthem’s Pathway PPO or EPO network in 2015?”

Assurant Healthsearch providers here

Network: Aetna Signature Administrators PPO
Notable exclusions: None – Assurant will offer the widest network of health providers to California individuals and families in 2015
Out of state access for non-emergency?: Yes, Assurant provides a strong national network through the ASA and other partner networks

Ask your doctor: “Are you a participating provider in the Aetna Signature Administrators PPO network in 2015?  I am considering an Assurant Health plan and they contract with Aetna to use their PPO network.”

Blue Shield of California – search providers here

PPO network: 2015 PPO for Individuals & Families (including Covered California)
EPO network: 2015 EPO for Individuals & Families (including Covered California)
Notable exclusions: University of California hospital and provider networks; PPO subscribers are typically unable to access EPO providers in neighboring counties and vice-versa.  1/5/2015 update: Blue Shield ends contract negotiations to continue with Sutter Health as an in-network provider.
Out of state access for non-emergency?: Yes, through national BlueCard PPO/EPO network.

Ask your doctor: “Are you a participating provider in Blue Shield of CA’s Individual PPO/EPO for Individuals & Families in 2015?”

Cignasearch providers here

Network: LocalPlus PPO
Notable exclusions: Sutter Health, California Pacific Medical Centers, St. Luke’s Hospital, Palo Alto Medical Foundation
Out of state access for non-emergency?: Yes, subscribers get access to Cigna’s strong Open Access Plus PPO network when traveling to regions without a Local Plus network

Ask your doctor: “Are you a participating provider in Cigna’s LocalPlus PPO network in 2015?”

Health Net – search providers here

Network: 2015 PPO – Individual & Family (not available through Covered CA)
Notable exclusions: Health Net’s direct PPO plans will offer the second-best network to Assurant; AVOID: Health Net’s Covered CA EPO plans
Out of state access for non-emergency?: Yes, subscribers get access to Health Net’s national PPO through First Health

Ask your doctor: “Are you a participating provider in Health Net’s off-exchange individual PPO network in 2015?”

Kaiser Permanente – search providers here

Network: HMO, by region – Northern California / Southern California
Notable exclusions: Members exclusively use Kaiser’s HMO network of providers
Out of state access for non-emergency?: No, only for emergencies.

Ask your doctor: “Are you available for me to choose as my Primary Care Physician?”

Regional Carriers and Other Network Variations

Please note we have provided information here for the six major California insurance carriers, and the networks that they offer primarily in Northern California. Please contact us if you have questions about the regional carrier networks (e.g., Chinese Community Health Plan, Western Health Advantage, Sharp, etc.), or network variations from the major players (e.g., Anthem or Health Net HMO networks in some regions of the state).

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