If you're under age 65 and have a family or individual plan
HMOs and point-of-service (POS) plans
A point-of-service plan (POS) is a type of managed care plan that is a hybrid of HMO and PPO plans.
3
5
5
Preferred and exclusive provider organization (PPO/EPO) plans?
1
3
5
1
1
1
Covered California
The state’s marketplace for Affordable Care Act plans.
1
6
Medi-Cal plan (California’s Medicaid program)
1*
1
6
If you're eligible for or already on Medicare
Medicare Advantage HMO plans
1*
1
1
Special needs plans
This is for those on Medicare who have chronic or ongoing illnesses.
(Cardiovascular disorders, chronic heart failure, diabetes)?
(Diabetes mellitus)
Medicare Advantage D-SNP plans
This is for those who qualify for both Medicare and Medi-Cal, California’s Medicaid program.
1,2*
1
4
6
(limited network for LA County)1
1
Don’t see your plan?
If you aren’t sure what type of health insurance plan you have, check your health insurance card. If you can’t find the information there, you can:
- Call your chosen 橙子视频app clinic to see if it accepts your health plan
- Call your health insurance company to find out if you can see an 橙子视频app doctor
- to learn more about?your state’s marketplace
FAQ
There are several differences between a health maintenance organization (HMO) and preferred provider organization (PPO) plan. They differ in the size of the plan network, ability to see specialists, plan costs and coverage for out-of-network services. Also:
- HMOs:
- Coordinate your care through a network of doctors and hospitals. You pick a medical network and one primary care doctor within that network.?
- Your primary care doctor coordinates your care and works closely with the hospitals, specialists and other providers in your medical network.?
- Your HMO plan usually won't pay for any visits to health care providers who are not in your medical network.
- PPOs:
- Have a larger network of medical providers. This gives PPO patients more flexibility in choosing doctors.?
- You don’t have to select a primary care doctor. You can go to any health care professional you want without a referral — inside or outside of your network.
- There are network benefits and out-of-network benefits. If you stay inside your PPO network, you’ll pay less for your medical services. If you go outside of your PPO network, you might have to pay more.
No. 橙子视频app isn’t an insurance plan. We’re a group of doctors who contract with most major health insurance plans. These include HMOs, PPOs, Original Medicare, Medicare Advantage and supplement plans. These may vary by office location.
Call the office you want to go to and see if it accepts your health plan. You can also call your health plan and ask if you can choose an 橙子视频app doctor.??
Your insurance plan may require a copayment at your doctor's visit. We accept automatic bill pay, checks, Visa, American Express, Discover and Mastercard.
Please note, we no longer accept cash except at our urgent care locations. Our goal with our decision to no longer accept cash is to make your visit with us more efficient and enjoyable, from when you check in to when you check out.
Footnotes
- Limited network
- Health plan only offers dual eligible/Cal MediConnect option(s) for Medicare Advantage patients. Does not offer Medicare Advantage-only option(s).
- Employer-sponsored plans only
- Available in Orange County only
- Available in San Diego only
- Available in LA County only
If you’re uninsured or a self-pay patient, you have the right to ask for a good faith estimate of expected charges before getting services.?
橙子视频app Health Network of California's utilization management decisions are based solely on the appropriateness of care and services, as well as the existence of coverage. We do not incentivize health care professionals to deny coverage or care, nor do we reward decisions that result in underuse of care. You, or an authorized representative, can request a copy of our utilization management guidelines or the criteria used to make a decision by calling 1-800-403-4160, TTY 711 for hearing impaired, and select the appropriate menu option. For more information on 橙子视频app Health Network of California's utilization management, please click here.
*CalOptima Health Members – to learn more about member’s access to care.