Covered California insurance plans have been raising a lot of questions for our patients. It’s been difficult for patients to get correct answers about which physicians in their area are participating in the various Covered California plans. They check physician rosters on the insurance companies’s websites or look at CoveredCA.com but get conflicting or incorrect information. Then in good faith they attempt to schedule an appointment with a listed physician, only to find that the physician is not in their plan. It’s a frustrating situation, and it has been impacting our patients and our practice.
This is especially surprising to patients who are in new Small Group plans that aren’t explained to be Covered California plans, but actually are. Sometimes even their insurance broker doesn’t realize they’re putting their clients into a Covered California plan – with quite small networks of participating providers.
Central Coast Orthopedics and Covered California Insurance Plans in our Region
Patients living in San Luis Obispo, Santa Barbara and Ventura Counties (Region 12) are only offered Covered California insurance plans by Anthem Blue Cross and Blue Shield of California.
Central Coast Orthopedic Medical Group does not participate in any of these plans.
We are correctly listed as HealthNet Covered California providers, but they don’t offer a Covered California plan for patients living in our region – only for those visiting from adjacent counties. That doesn’t help our local patients.
We are working with Anthem Blue Cross and Blue Shield on this issue, and hope to reach agreement to be network providers of orthopedic services to patients in their Covered California plans. However, at this point we can not do so. We accept almost every other insurance plan, but not these.
Q: But I’ve been a patient of yours for years. Is there any way I could still see my doctor?
A: Yes, there are two possibilities.
- See us as an Out-Of-Network provider. You will be asked to pre-pay the entire amount of your treatment on the day of service, then have your insurance company reimburse you according to their out-of-network terms. Your portion of the bill will be higher because your insurance company will not pay as much to an out-of-network physician – and you will have to pay the rest. How much your insurance company will cover for an Out-Of-Network provider will depend on which Covered California policy you have. If you choose this option, we will treat you as a Cash Pay customer (described next), and you’ll receive the same discounts and payment options they receive.
- See us as a Cash Pay customer. You’ll pay the entire bill yourself, with no involvement by an insurance company. We’ve developed a special discounted fee structure for patients who have no insurance, pay cash or cannot use their medical insurance with us.
All services may be paid for by cash, Visa, MasterCard and Discover cards. Ask to speak to our Practice Manager.
Q: I want to be a Cash Pay customer, but I can’t afford to pay for the entire treatment at once. Can I make payments?
A: Talk to us. If you can’t afford to pay all at once, we can set up a time payment plan where you make automatic payments every month from your credit card.