Blue & Gold HMO. Health Net. Network Directory. Commercial. Participating Physician Groups and Primary Care Physicians, Hospitals and Specialists

Transcription

1 Commercial Health Net Blue & Gold HMO Network Directory Participating Physician Groups and Primary Care Physicians, Hospitals and Specialists 2013 Karen Boyd Health Net Blue & Gold HMO Southern California Orange, Riverside, San Bernardino and San Diego counties

2 Introduction / Introducción Introduction / Introducción Introduction Use this directory to choose a primary care physician and participating physician group. Primary care physicians are grouped according to city within this guide, and the Participating Physician Group Index is located near the back to further help you find a physician. We ve also included information on how to enroll either by written form or online, provided information about our services such as Rapid Access, and answered some frequently asked questions. For more details about your plan benefits and terms of your group s coverage, please refer to your Summary of Benefits/Disclosure Form or Evidence of Coverage. Note: Updates this directory ar continuously m and we make e effort to ensure accuracy. Howe we cannot guar this edition is u in all cases. Ple How to Enroll Choose your doctor and physician group To enroll, you must select a primary care physician. If you are enrolling online, you will need to enter the 10-digit ID number, made up of the physician group and physician ID numbers. By availability of your current doctor Refer to the Primary Care Physician Index. Available primary care physicians and the pages to reference for further enrollment information are listed in alphabetical order. By location of doctor s office Refer to the listing of primary care physicians by city. The name of each primary care physician is grouped in alphabetical order by the city in which his or her office is located. By doctor s physician group affiliation Refer to the Participating Physician Group Index. The names of Health Net contracting physician groups are in alphabetical order. An overview of affiliated primary care physicians and hospitals is provided for each physician group, in addition to information regarding Rapid Access and Wellness program availability. By doctor s hospital affiliation Refer to the hospital index. Hospitals affiliated with Health Net are in alphabetical order. Next to the name of each hospital is a list of affiliated physician groups. From this list, you can choose a physician group and turn to the Participating Physician Group Index to select your primary care physician. By affiliation with a particular specialist Although you can t select a specialist as your primary care physician, you can select a primary care physician who belongs to the same physician group as the specialist. To confirm a physi participation pr to receiving ser If the doctor yo currently seeing listed in our dir as not acceptin patients, you ca continue to see current physicia as a member o Health Net. You can also ac up-to-date dire listings over the Internet at > ProviderSear 3

3 Note: Members may self-refer for an annual exam, but only to an OB/GYN in their assigned physician group.. our website at After you ve located the name, find the physician group(s) the specialist is affiliated with, and choose a primary care physician who belongs to the same physician group as the specialist. Special services Rapid Access Utilize self-referral or obtain direct referrals to specialists with this service. You can directly contact a specialist affiliated with your physician group for consultation or evaluation. (Your physician group must still authorize any procedures the specialist may recommend.) With direct referral, your primary care physician can refer you directly without prior authorization from your physician group. As of this publication, 49 specialties are represented in the Rapid Access program. Not all physician groups offer access to the same specialties, so check the Participating Physician Group Index or call a specific physician group for a listing of specialists available. Special note regarding obstetrics/gynecology: Member self-referral to an OB/GYN is available at all of Health Net s contracting physician groups. Note: Members may self-refer for an annual exam, but only to an OB/GYN in their assigned physician group. Parents-to-be programs Health Net members automatically have access to our Early Prenatal Program at their participating physician groups. Moms-to-be can learn how to have a healthy pregnancy and receive additional prenatal educatio and parenting programs such as Childb Preparation, Breastfeeding and Baby Ba Health Net also offers self-study progra members who are unable to attend a pr at their physician group. For details, con your medical group or Health Net s Cus Contact at Outpatient Surgical Facility Utilizing outpatient surgical facilities is and cost-effective approach to outpatie surgery performed in a hospital. The ch to use an outpatient surgical facility beg with a thorough physical examination, completion of necessary laboratory test a consultation with your doctor to discu related risks. Based on the doctor s disc with the patient, he or she will select th optimal procedure, anesthesia and choi facility in which to perform the procedu Since overnight stays are not permitted this type of facility, postoperative recov done at home. Depending on the proce patients should have a responsible adul available to drive them home and assist with recovery for approximately Note: Some procedures performed in the outpatient setting may require prior authorization, and a copayment is requ Please check with your physician to con that your medical group has an arrange with an outpatient surgical facility. Refe to your Evidence of Coverage or call ou Customer Contact at Also visit for on resources and additional information a 4

4 Introduction / Introducción Bariatric Surgery Performance Bariatric surgery is provided for the treatment of morbid obesity. It is covered when medically necessary, authorized by Health Net and performed at one of the following Health Net Bariatric Surgery Performance s: Facility name Address City State ZIP Phone Methodist Hospital, Arcadia 300 West Arcadia CA (626) Huntington Dr. Providence St. Joseph Medical 501 South Buena Burbank CA (818) Vista St. Peninsula Surgical Specialists 1501 Trousdale Dr. Burlingame CA (650) Medical Group, Inc. West Hills Hospital Medical 7300 Medical Canoga Park CA (818) Dr. Community Medical of 2755 Herndon Ave. Clovis CA (559) Clovis Fountain Valley Life Euclid St. Fountain Valley CA Dimensions Bariatrics Fountain Valley Regional Euclid St. Fountain Valley CA (714) Hospital Orange Coast Memorial 9920 Talbert Ave. Fountain Valley CA (714) Medical Fresno Heart Hospital 15 East Audubon Dr. Fresno CA (559) Ronald Reagan UCLA Medical 757 Westwood Pl. Los Angeles CA University of California, Los 757 Westwood Pl. Los Angeles CA Angeles (UCLA) Medical University of Southern 1500 San Pablo St. Los Angeles CA (323) California (USC) USC University Physicians 1500 San Pablo St. Los Angeles CA Memorial Hospitals Association 1700 Coffee Rd. Modesto CA El Camino Hospital 2500 Grant Rd. Mountain View CA (650) Alta Bates Summit Medical 350 Hawthorne Ave. Oakland CA (510) Chapman Medical 2601 East Orange CA (714) Chapman Ave. St. John s Regional Hospital 1600 North Oxnard CA (805) Rose Ave. Stanford Hospital and Clinic 300 Pasteur Dr. Palo Alto CA (650) Huntington Memorial Hospital 100 West California Pasadena CA (626) Blvd. Pomerado Hospital Pomerado Rd. Poway CA (858)

5 Facility name Address City State ZIP Phone Sacramento Advanced 1 Medical Plaza Roseville CA Laparoscopic Surgical Association Sutter Roseville Medical 1 Medical Plaza Roseville CA (916) 781 UC Davis Medical 2315 Stockton Blvd. Sacramento CA (916) 734 St. Bernardine Medical 2101 North San Bernardino CA (909) 883 Waterman Ave. Alvarado Hospital Medical 6655 Alvarado Rd San Diego CA (619) 680 Sharp Memorial Hospital 7901 Frost St. San Diego CA (858) 541 University of California, 200 West Arbor Dr. San Diego CA (619) 543 San Diego Medical UCSF Medical 505 Parnassus Ave. San Francisco CA (415) 353 Mills Peninsula 100 South San San Mateo CA (650) 652 Mateo Dr. Santa Barbara Cottage Hospital 2400 Bath St. Santa Barbara CA (805) 682 Southwest Healthcare System Inland Wildomar CA (951) 677 Inland Valley Medical Valley Dr. Sutter General Hospital 2801 L St. Sacramento CA (916) 568 Transplant Performance Health Net has a specific network of designated Transplant Performance s to perform organ, tissue and bone marrow transplants. You will be directed to one of the following Health Net Transplant s at the time authorization is obtained. Northern California Transplant type Patient type Stem Cell Alta Bates Medical Berkeley Children s Hospital & Research Oakland Sutter Medical Sacramento Allogeneic UC Davis Sacramento 6

6 Introduction / Introducción Northern California (continued) Transplant type Patient type Stem Cell elated Heart* California Pacific Medical San Francisco Sutter Medical Sacramento Heart-Lung* Kidney California Pacific Medical San Francisco Sutter Medical Sacramento UC Davis Sacramento Cadaveric and Kidney-Pancreas California Pacific Medical San Francisco Liver California Pacific Medical San Francisco Lung Pancreas California Pacific Medical San Francisco 7

7 Southern California Transplant type Patient type Stem Cell Cedars-Sinai Medical Los Angeles Children s Hospital Los Angeles Children s Hospital of Orange County Orange Rady Children s Hospital San Diego Allogeneic Related Scripps Health San Diego Allogeneic Related UC San Diego San Diego Allogeneic Related Heart* Cedars-Sinai Medical Los Angeles Children s Hospital Los Angeles Loma Linda University Medical Loma Linda Sharp Healthcare System USC Los Angeles Heart-Lung* Children s Hospital Los Angeles USC Los Angeles Kidney Cedars-Sinai Medical Los Angeles Loma Linda University Medical Loma Linda Rady Children s Hospital San Diego Sharp Memorial Hospital St. Joseph Hospital of Orange UC San Diego San Diego USC Los Angeles Kidney-Pancreas Loma Linda University Medical Loma Linda 8

8 Introduction / Introducción Southern California (continued) Transplant type Patient type Liver Cedars-Sinai Medical Los Angeles Children s Hospital Los Angeles Loma Linda University Medical Loma Linda Rady Children s Hospital Scripps Health San Diego UC San Diego San Diego USC Los Angeles Lung Children s Hospital Los Angeles UC San Diego San Diego USC Los Angeles Pancreas Loma Linda University Medical Loma Linda Small Bowel *Heart-Lung: Transplant is individually negotiated by Letter of Agreement. 9

9 Frequently Asked Questions What is a participating physician group? A participating physician group is a team of physicians from various specialties assisted by nurses, technicians and other health care professionals contracted with Health Net to perform services for Health Net members. You may notice that some of our physician group listings include the words Medical Group, PMG, Independent Physicians Association or IPA in the physician name. Typically, in the physician groups that include the term medical group or PMG, most of the primary care physicians have their offices at one principal location. In an IPA, the primary care physicians typically practice at different locations. What is an affiliate office and how does it affect my selection of a primary care physician? Affiliate office locations often have limited physician availability and different office hours. It s also possible that your doctor offers office hours in more than one location. Affiliates will often refer patients to the primary location of a physician group for laboratory and urgent care services. medical care and authorizing all special treatment or hospitalization. As a mem of Health Net, you must obtain a referr from your primary care physician to see specialist. Referral specialists are not av for selection as your primary care physi What s the difference between emergen care and urgent care? Emergency care is for a sudden, serious and unexpected illness, injury or condit including severe pain that a reasonable with an average knowledge of health an medicine would believe requires immed medical attention. Health Net covers ca received from any licensed provider or treatment center anywhere in the world emergency situation. Urgent care is provided for medical conditions that require treatment withi several days but are not considered immediately life threatening. These may include sprains and fractures, a sudden high fever or pneumonia, or a flare-up chronic condition such as asthma. Situa requiring urgent care are covered when received from the member s primary ca physician and physician group while in group s service area, and from any licen provider or treatment center while out of the area. All non-emergency care mu be provided by or through the member primary care physician and physician g How is a referral specialist different from a primary care physician? Your primary care physician is your main medical provider. He or she is the doctor who i ibl f di ti ll f What is an outpatient surgical facility An outpatient surgical facility is a settin other than a medical or dental office, w main function is performing surgical 10

10 Introduction / Introducción be licensed as an outpatient clinic according to state and local laws and must meet all requirements of an outpatient clinic providing surgical services. The patient is admitted to and discharged from the facility within the same working day. Overnight stays are not permitted. Am I allowed to change to a new doctor once I enroll? You may switch to another primary care physician in the same physician group at any time and for any reason by calling Health Net at or by going online to If you want to select a new primary care physician affiliated with a different group, you can make the change on a monthly basis. If you choose a new doctor and physician group before the 15th of the month, you can begin seeing the new doctor anytime after the 1st of the next month. If you choose a new doctor after the 15th, you ll need to wait as long as six weeks (the first of the month after one full month has gone by after making the change) before you can begin seeing the new doctor. How can I obtain information on doctors who are in the Health Net network? Information is available in our directories, on our website, or by calling the Health Net Customer Contact. You can learn whether your doctor is board certified, where he or she attended medical school and performed the residency, the office address and phone number, whether your doctor participates in a Health Net HMO or Health Net Blue & Gold HMO, the hospital(s) at which your doctor practices, and which languages (in addition to English) that your doctor may speak. Where can I find specialist listings? Use the ProviderSearch function on Health Net s website at call Member Services at the toll-free number listed on your Health Net ID card, or ask your Health Net contracted physician or physician group. Additional Health Net Information About your Health Net ID card After you enroll in Health Net, you will receive a Health Net ID card. This card is what you need to receive all of your care as a Health Net member. Because it s so important, it s a good idea to keep your Health Net ID card with you at all times. If you lose your ID card, call our Customer Contact or order a new one online. Go to Hospitalization Your primary care physician or referral specialist may find it necessary to refer you to a hospital for further care, on either an inpatient or outpatient basis. You will usually be hospitalized where your physician has admitting privileges. (See your primary care physician s group listing in this directory for a list of hospitals where he or she has admitting privileges.) 11

11 Note: Your primary care physician or authorized referral specialist must first be contacted for initial treatment and consultation before you receive any care or treatment through a hospital. Your primary care physician or authorized referral specialist will be responsible for determining the most appropriate site and location for your additional care. Admission to, and treatment rendered by, any hospital listed in this directory must be authorized by your selected primary care physician or authorized referral specialist. 12