How to make sure your doctor is in-network for 2016
14 Oct 2015

How to make sure your doctor is in-network for 2016

14 Oct 2015

10/30/2015 update: Prescription drug formulary search links added below for all PPO carriers.

The problems patients have had with inaccurate provider data, especially in the last two years, got noticed. Just a few days ago, Governor Jerry Brown signed a bill into law requiring insurers to update their online directories on a weekly basis. Read more details on the new law from the Los Angeles Daily News and the Sacramento Business Journal. The law will not go into effect until July, 2016.

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 preferred doctors, hospitals, medical groups and other facilities to find out if they intend to participate in-network in 2016.

Anthem Blue Cross of CAsearch providers here and Rx drug formulary here

PPO network: Pathway PPO / Pathway X PPO and Pathway Tiered PPO
Notable exclusions: Sutter Health (including Palo Alto Medical Foundation and California Pacific – CPMC); Stanford Health
What’s changed from 2015: Eliminated the limited access “EPO” plans; reinstated national BlueCard PPO access for all PPO plans
Out of state access for non-emergency?: Yes, through national BlueCard PPO

Ask your doctor: “Are you a participating provider in Anthem’s Pathway PPO network in 2016?”

Blue Shield of California – search providers here and Rx drug formulary here

PPO network: 2016 PPO for Individuals & Families (including Covered California)
Notable exclusions: Stanford Health
What’s changed from 2015: New contracts signed with Sutter Health (through 2016) and UC Medical (through June, 2018)
Out of state access for non-emergency?: Yes, through national BlueCard PPO network.

Ask your doctor: “Are you a participating provider in Blue Shield of CA’s Individual PPO for Individuals & Families in 2016?”

Cignasearch providers here and Rx drug formulary here

Network: LocalPlus PPO
Notable exclusions: Sutter Health (including Palo Alto Medical Foundation and California Pacific – CPMC)
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 2016?”

Health Net – search providers here and Rx drug formulary here

Network: 2016 PPO – Individual & Family (not available through Covered CA)
Notable exclusions: Health Net’s direct PPO plans will offer the largest network of providers in 2016; 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 2016?”

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 five 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, Sutter Health Plus, United Health, 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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  1. Bradley April 18th, 2016 5:32PM

    Fixed, thank you.

  2. Craig Harris December 4th, 2015 3:24PM

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

    Shouldn’t this be 2016 instead of 2015?

  3. Nancy November 21st, 2015 11:51AM

    I love your site. Maybe Covered CA could hire you to give us all some clear, concise answers. Just wanted to point out a typo in Blue Shield of California.
    It states:
    Ask your doctor: “Are you a participating provider in Blue Shield of CA’s Individual PPO/EPO for Individuals & Families in 2015?”

    It should be “in 2016”.

    Keep up the good work.

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