The California individual and family plan market place will be changing quite a bit in 2017. Next to confirming if your favorite doctors are covered by the new health plans, many consumers want to make sure their chosen hospital is in-network as well. From information provided by Covered California and the health plans, I have put together a table of California hospitals by region and the health plans they accept.
Not all hospitals are in all new health plans
The major health insurance companies of Anthem Blue Cross, Blue Shield of California, and Health Net will all be offering a variety of different plan types (EPO, HCSP, HMO, PPO) in 2017. Just because a hospital was in your 2016 Anthem Blue Cross Tiered PPO plan doesn’t mean it will be in their new 2017 EPO product. Blue Shield is adding an HMO plan to many regions of California alongside their PPO plans. But that doesn’t mean both plan types will have the same hospitals either. Hospital network status is getting as confusing as confirming if your doctor is in-network.
Visit: Hospitals by Region by Health Plan to see the full table listing.
For example, in Region 16, Barlow Respiratory Hospital will be in-network for Anthem’s EPO and Blue Shield’s HMO Region 16. But Barlow will not be a preferred provider for the Anthem HMO or the Blue Shield PPO plans. Community Hospital in Los Angeles will be in-network for Health Net’s HCSP (Health Care Service Plan), but not for their HMO plan. While admitted Emergency Room care is always covered as in-network at any hospital, having a voluntary procedure done at an out-of-network hospital may not be covered by your health plan.
Not all health plans service the full county or region
One limitation of the hospital network table is that not all health plans are available in all parts of the region or county where they are shown as being in-network. You must first determine if your zip code is eligible for enrollment in some plans. So even if the hospital is listed for the region or county, you still may not be able to access it if you live outside of the service area for the health plan. One example is that Sutter Amador hospital is not in-network for Sutter Health Plus plans. That is because Sutter Health Plus doesn’t offer an individual and family plan in that region.
Kaiser is not listed in the table except for Region 9. Kaiser members can only receive care at Kaiser facilities unless they have a special referral to another hospital. However, in Region 9, Monterey, San Benito, and Santa Cruz counties, Kaiser will have a special collaboration with the Watsonville Community Hospital for inpatient and ambulatory specialty care for Kaiser members.
There may be distance restrictions on hospital availability
In 2016, Health Net EPOs had a radius restriction for in-network providers. Members could see any in-network provider as long as the provider was within a 30 mile radius of the member’s home. Consult your Evidence of Coverage for your health plan to determine if you are subject to any distance or regional restrictions for using in-network providers.
Fortunately, hospital affiliation with health plans usually doesn’t change often. Consequently, most of the hospitals listed as a network provider for a specific health plan should remain stable throughout 2017, unlike doctors who tend to move around. However, always check with your health plan to confirm that your hospital, even if it is listed on the table, is truly in-network, AND, for which plan you are considering enrolling into.
Covered California Hospital Health Plan Affiliation
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