How to Make Sure Your Health Plan Includes Providence

With the Affordable Care Act and all of the changes in health insurance, choosing a health plan can get a little confusing. We’d like to explain your choices and how you can continue receiving care at Providence with the best possible insurance benefits.


How do I make sure my care at Providence is covered?

For Those Who Currently Have an Individual Plan

To be certain your individual plan includes Providence, contact your insurance company. You also can call Providence at 866-909-DOCS (3627). We can confirm most of the health insurance companies that include Providence in their provider networks, as well as let you know if a specific doctor is on the plan. To find out if a doctor or hospital is in the Providence network, you can also check here.  If your current plan does not include Providence, consider switching to a plan that does.

For Those Planning to Purchase a new Plan Through Covered California

When a healthcare provider is “in-network,” it means the insurance company will cover a greater portion of your health care charges. When a provider is “out-of-network,” you will pay significantly more out of pocket. In addition, some insurance plans don’t cover any services received out of the network. Providence accepts the following Covered California plans:

  • Anthem Blue Cross HMO Covered California
  • Blue Shield Covered California Shop
  • Blue Shield HMO Covered California
  • Blue Shield PPO Covered California
  • Health Net Covered California – all products
  • LA Care Covered California

If you have questions, please call Providence Customer Service at 866-909-DOCS (3627). Specialists are available to help 7 a.m. to 8 p.m., Monday through Friday, and 9 a.m. to 2 p.m. Saturday.


Do I need to choose a new health insurance plan?

If you fall into one of these groups, you may need to choose a new plan:

  • You don’t currently have health insurance.
  • You have an individual plan, but your insurance company is discontinuing that policy.
  • You’re insured under your spouse’s plan at work, but spouses won’t be covered in the future.
  • If your current plan does not include coverage within the Providence network, you may want to consider a plan that does. Providence accepts many different health insurance plans, whether you are on Medicare, Medi-Cal or Cal MediConnect (Medicare and Medi-Cal), or have an individual plan or a group employer plan.

If you have questions, please call Providence Customer Service at 866-909-DOCS (3627). Specialists are available to help 7 a.m. to 8 p.m., Monday through Friday, and 9 a.m. to 2 p.m. Saturday.


If I need a new plan, what’s the timeline for choosing it?

For Those Who Currently Have an Individual Plan

Open Enrollment for Covered California is Nov. 1, 2015, through Jan. 31, 2016. The Affordable Care Act says that all insurance plans need to meet certain minimum requirements. For instance, all health plans must cover you even if you have a medical condition at the time you sign up. Also, preventive care, prescription drugs, maternity care and more now must be covered by all plans. Shop the plans at Covered California and compare benefits. Providence accepts these plans through Covered California:

  • Anthem Blue Cross HMO Covered California
  • Blue Shield Covered California Shop
  • Blue Shield HMO Covered California
  • Blue Shield PPO Covered California
  • Health Net Covered California – all products
  • LA Care Covered California

For Those Who Don’t Currently Have Health Insurance

Under the Affordable Care Act, everyone is required to have health insurance or risk paying a tax penalty. Fortunately, if you don’t have health insurance because you can’t afford it, you may be eligible for a subsidized insurance plan. Depending upon your income, you may qualify for free or low-cost health care through Medi-Cal, or for premium subsidies through Covered California. Determining eligibility is easy. There are three ways to apply: in person at your local county human services agency, over the phone by calling 800-300-1506 or online at Covered California. If you are eligible for Medi-Cal, you will receive a packet of health plans to choose from. Medi-Cal open enrollment is year-round. Providence accepts these Medi-Cal plans:

  • Americas Health Plan
  • Anthem Blue Cross Medi-Cal, Healthy Families, Access for Infants and Mothers (AIM)
  • Care 1st Medi-Cal
  • Gold Coast Health Plan
  • Health Net Medi-Cal
  • LA Care Medi-Cal
  • Molina Medi-Cal and Health Families

If you are not eligible for Medi-Cal, you still may qualify for premium subsidies. The Covered California application will tell you how much your premium and any subsidies might be. Open enrollment is Nov. 1, 2015, through Jan. 31, 2016, and Covered California wants to help you sign up. Get free, confidential, in-person help in your area and details about free informational events. Click here for extra help applying. Remember, to use Providence facilities and doctors, you must sign up for a plan that accepts Providence:

  • Anthem Blue Cross HMO Covered California
  • Blue Shield Covered California Shop
  • Blue Shield HMO Covered California
  • Blue Shield PPO Covered California
  • Health Net Covered California – all products
  • LA Care Covered California


Which insurance companies include Providence?

Most major insurance companies that offer individual plan coverage in Los Angeles County include Providence in their provider networks. For example, plans with Aetna, Anthem Blue Cross, Humana, Health Net, United Healthcare and several other companies have Providence in their network. See a full list of health plans here.

To be absolutely certain that a plan you’re considering includes Providence, contact your insurance company. You also can call Providence Customer Service at 866-909-DOCS (3627). Specialists are available to help 7 a.m. to 8 p.m., Monday through Friday, and 9 a.m. to 2 p.m. Saturday. We can confirm most of the health plans that include Providence in their networks.


Why is it important to choose a plan that includes Providence?

If you’ve been receiving care from Providence, it makes good sense to continue your care with Providence. You’ll will be able to continue seeing physicians who are familiar with you and your family, and you will have the same access to advanced medical technology. In addition, your medical records will be readily available.

An equally important reason to choose a plan that includes Providence is that there’s a limit to the maximum amount you’ll be required to pay each year for care with Providence. For instance, once you’ve paid a certain amount in copays, coinsurance and deductibles (the amount varies depending on the plan you choose), your insurance will take over and pay 100 percent of your bills. That means no more out-of-pocket costs for you.

However, if you go with an insurance plan that does not include Providence and continue to seek care with Providence, there may be no limits on your annual out-of-pocket expenses. For people with serious, chronic conditions such as cancer or heart disease, out-of-pocket costs could easily amount to many thousands of dollars.

Even if you’re in great health, choosing a health plan that includes Providence is a smart idea. When Providence is in your health plan’s network, thousands of the area’s top physicians and the latest medical technology are available to you. Providence has been taking care of California families for more than 100 years. And there’s nothing we’d like more than to continue to serve you and your family.

If you have questions, please call Providence Customer Service at 866-909-DOCS (3627). Specialists are available to help 7 a.m. to 8 p.m., Monday through Friday, and 9 a.m. to 2 p.m. Saturday.


What if my insurance company doesn't include Providence?

If you choose a plan that does not include Providence in its network, you’ll pay significantly higher out-of-pocket costs for care received at Providence facilities and from Providence providers. In addition, some insurance plans don’t cover any services received outside their network. For your convenience and to receive the best benefits, it generally makes the most sense to switch to a plan that has Providence in its network.

If you have questions, please call Providence Customer Service at 866-909-DOCS (3627). Specialists are available to help 7 a.m. to 8 p.m., Monday through Friday, and 9 a.m. to 2 p.m. Saturday.


What if I want to receive care at a Providence clinic or hospital?

If you have questions about a Providence provider, clinic or hospital, call Providence Customer Service at 866-909-DOCS (3627). Specialists are available to help 7 a.m. to 8 p.m., Monday through Friday, and 9 a.m. to 2 p.m. Saturday. 


What if I have more questions?

If you still aren’t 100% clear on your options or whether you need to make any changes to your insurance (and we’d hardly blame you), we’d be happy to answer your questions.  Please call Providence Customer Service at 866-909-DOCS (3627). Specialists are available to help 7 a.m. to 8 p.m., Monday through Friday, and 9 a.m. to 2 p.m. Saturday.