If you assume that your 2014 health insurance plan will cover you like your plan did last year, you might be wrong. Gone are the days of PPO plans providing you coverage with 85% of the doctors in Southern California. Be prepared before your next physician visit.
- Take a copy of your card and send it to your physician’s office before you set your appointment.
- Find out where you should go for urgent care needs. Your health insurance web page will help.
- Don’t stop there. I suggest you call your insurance company’s membership department and verify your physician’s status in the network your policy states.
FURTHERMORE do not assume that your insurance company’s membership department and the insurance company’s on line directory will be the final proof. If your doctor says they don’t take your insurance, believe them. I have found physician groups that refuse to take the insurance company’s member even when their management has signed an agreement with the insurance company.
Here are broad stroke basics for the individual plans in San Diego.
- Sharp Rees Stealy takes Anthem, HealthNet and Cigna.
- Sharp Community Health Group takes …not sure.
- Blue Shield will take you to Scripps. The good news is that Blue Shield still offers an out of network benefit. If you make a mistake and go to your Sharp physician with your Blue Shield card, you will get some help paying the bill. With Anthem you will not get any help if you do the reverse and go to Scripps.
By now you should have noticed that our county has been divided down the middle. Anthem with Sharp and Blue Shield with Scripps I was warned by HealthNet that they contract with the physicians independently of the group. I don’t know about Cigna.
I don’t want to be a Debbie Downer, however forewarned is far better than being surprised by a bill after you have seen your doctor. Verify. Verify. Verify.
- Copy your insurance card and send it to your doctor.
- Call your insurance company’s membership department and ask for assistance in verifying your doctor’s acceptance of your plan. Ask them to go onto their web page with you. Get their name and internal documentation number for your conversation.
- Find out where you need to go for urgent care needs.
Next we will address the Micro Networks that have formed within the small company insurance plans.