Even though the health plans may be the same, the doctor and hospital networks for individual and family health insurance in California are not. Covered California has been trying to provide more information to consumers about provider networks for each health plan offered. They have compiled a list of hospitals in-network by county and region for health plans offered through the exchange.
The hospital list was compiled in August of 2018. Always check with the health plan to make sure the hospitals listed are still in-network for the 2019 plan year. In general, Kaiser facilities are not included on the county list because only Kaiser members can go to Kaiser hospitals. However, Kaiser does contract with some non-Kaiser hospitals in some counties. From the Covered California list, Kaiser is contracting with Adventist Health in Kern County and Watsonville Community in Santa Cruz County.
County Hospitals In-Network For Health Insurance
If your county is not shown, it’s possible that there are no contracted hospitals in the county by any of the health plans. Some counties will only show one carrier as contracting with the variety of hospitals, even though there may be other carriers offered to residents in that county. For example, in Placer County, Sutter Auburn Faith and Sutter Roseville are only shown as being in-network with Blue Shield. In addition to Kaiser, Health Net and Western Health Advantage offer plans in parts of Placer County. But their contracted hospitals will be in the adjacent county of Sacramento.
You can’t assume that all hospitals part of a larger network are all in-network with the same carrier if one is in-network. In Butte County, Blue Shield contracts with all the Enloe associated hospitals. But Anthem Blue Cross only contacts with Enloe Medical Center – Esplanade. The converse is also true. Blue Cross doesn’t typically contract with Sutter hospitals for their individual and family plans. However, in Amador County, Sutter Amador is an in-network hospital for Blue Cross.
Similarly, we can’t assume that each type of a carrier’s offered health plans (EPO, HMO, and PPO) all have the same hospitals in-network. L.A.C Harbor-UCLA Medical Center is in-network for the Blue Shield PPO plans but not their HMO plans. Some HMO plans may have more hospitals than the carrier’s PPO counterpart. In Region 16 of Los Angeles County the Health Net HMO plan has 22 hospitals in-network compared to only 16 for their PPO plan.
The hospital network by carrier is the same whether the plan is purchased through Covered California or directly from the health insurance company. Even if the carrier offers other plans not sold through Covered California, the network will be the same. The exception to this is the Health Net PPO (as opposed to their EnhancedCare PPO plan) The Health Net PPO has a much larger network of hospitals and doctors and is only available off-exchange direct from the carrier.
If you have to change health plans from 2018 to 2019 and are in the middle of treatment at an out-of-network hospital, there is continuity of care provisions. Usually you will have to file a continuity of care form with the new health plan requesting they cover continued health care services at the out-of-network facility or medical group. All the health plans will cover claims for emergency health care services at any hospital.