Blue & Gold HMO - Health Net
CommercialHealth NetBlue & Gold HMONetwork DirectoryParticipating Physician Groups andPrimary Care Physicians, Hospitals and Specialists2013Karen BoydHealth NetBlue & Gold HMO – Southern CaliforniaOrange, Riverside, San Bernardino and San Diego counties
Introduction /IntroducciónIntroduction / IntroducciónIntroductionUse this directory to choose a primary care physician and participatingphysician group. Primary care physicians are grouped according tocity within this guide, and the Participating Physician Group Index islocated near the back to further help you find a physician. We’ve alsoincluded information on how to enroll either by written form or online, Note: Updatesthis directory arcontinuously mand we make eprovided information about our services such as Rapid Access, andeffort to ensureanswered some frequently asked questions. For more details about youraccuracy. Howeplan benefits and terms of your group’s coverage, please refer to yourwe cannot guarSummary of Benefits/Disclosure Form or Evidence of Coverage.this edition is uin all cases. PleHow to EnrollChoose your doctorand physician groupTo enroll, you must select aprimary care physician. If you are enrollingonline, you will need to enter the 10-digit IDnumber, made up of the physician group andphysician ID numbers.By availability of your current doctorRefer to the Primary Care Physician Index.Available primary care physicians and thepages to reference for further enrollmentinformation are listed in alphabetical order.By location of doctor’s officeRefer to the listing of primary care physiciansby city. The name of each primary carephysician is grouped in alphabetical order bythe city in which his or her office is located.By doctor’s physician group affiliationRefer to the Participating Physician GroupIndex. The names of Health Net contractingphysician groups are in alphabeticalorder. An overview of affiliated primarycare physicians and hospitals is providedfor each physician group, in additionto information regarding Rapid Accessand Wellness program availability.By doctor’s hospital affiliationRefer to the hospital index. Hospitalsaffiliated with Health Net are in alphabeticalorder. Next to the name of each hospital is alist of affiliated physician groups. From thislist, you can choose a physician group andturn to the Participating Physician GroupIndex to select your primary care physician.confirm a physiparticipation prto receiving serIf the doctor yocurrently seeinglisted in our diras not acceptinpatients, you cacontinue to seecurrent physiciaas a member oHealth Net.You can also acup-to-date direlistings over theBy affiliation with a particular specialistInternet atAlthough you can’t select a specialist as yourprimary care physician, you can select aprimary care physician who belongs to thesame physician group as the specialist. Towww.healthnet ProviderSear3
our website at www.healthnet.com/uc. Afteryou’ve located the name, find the physiciangroup(s) the specialist is affiliated with, andchoose a primary care physician who belongsto the same physician group as the specialist.Special servicesRapid Access Note: Members mayself-refer for anannual exam, butonly to an OB/GYNin their assignedphysician group.Utilize self-referral or obtain direct referralsto specialists with this service. You candirectly contact a specialist affiliated withyour physician group for consultation orevaluation. (Your physician group muststill authorize any procedures the specialistmay recommend.) With direct referral, yourprimary care physician can refer you directlywithout prior authorization from yourphysician group.As of this publication, 49 specialties arerepresented in the Rapid Access program.Not all physician groups offer access to thesame specialties, so check the ParticipatingPhysician Group Index or call a specificphysician group for a listing of specialistsavailable.Special note regarding obstetrics/gynecology:Member self-referral to an OB/GYN isavailable at all of Health Net’s contractingphysician groups.Note: Members may self-refer for an annualexam, but only to an OB/GYN in theirassigned physician group.Parents-to-be programsHealth Net members automatically haveaccess to our Early Prenatal Program at theirparticipating physician groups. Moms-to-becan learn how to have a healthy pregnancy4and receive additional prenatal educatioand parenting programs such as ChildbPreparation, Breastfeeding and Baby BaHealth Net also offers self-study programembers who are unable to attend a prat their physician group. For details, conyour medical group or Health Net’s CusContact Center at 1-800-539-4072.Outpatient Surgical FacilityUtilizing outpatient surgical facilities isand cost-effective approach to outpatiesurgery performed in a hospital. The chto use an outpatient surgical facility begwith a thorough physical examination,completion of necessary laboratory testa consultation with your doctor to discurelated risks. Based on the doctor’s discwith the patient, he or she will select thoptimal procedure, anesthesia and choifacility in which to perform the proceduSince overnight stays are not permittedthis type of facility, postoperative recovdone at home. Depending on the procepatients should have a responsible adulavailable to drive them home and assistwith recovery for approximately 24–48Note: Some procedures performed inthe outpatient setting may require priorauthorization, and a copayment is requPlease check with your physician to conthat your medical group has an arrangewith an outpatient surgical facility. Refeto your Evidence of Coverage or call ouCustomer Contact Center at1-800-539-4072.Also visit www.healthnet.com/uc for onresources and additional information a
Introduction /IntroducciónBariatric Surgery Performance CenterBariatric surgery is provided for thetreatment of morbid obesity. It is coveredwhen medically necessary, authorized byHealth Net and performed at one of thefollowing Health Net Bariatric SurgeryPerformance Centers:Facility nameAddressCityState ZIPMethodist Hospital, Arcadia300 WestHuntington Dr.ArcadiaCA91007-3402 (626) 445-4441PhoneProvidence St. Joseph MedicalCenterPeninsula Surgical SpecialistsMedical Group, Inc.West Hills Hospital MedicalCenterCommunity Medical Center ofClovisFountain Valley LifeDimensions BariatricsFountain Valley RegionalHospitalOrange Coast MemorialMedical CenterFresno Heart HospitalRonald Reagan UCLA MedicalCenterUniversity of California, LosAngeles (UCLA) MedicalCenterUniversity of SouthernCalifornia (USC)USC University PhysiciansMemorial Hospitals AssociationEl Camino HospitalAlta Bates Summit MedicalCenterChapman Medical Center501 South BuenaVista St.BurbankCA91505-4809 (818) 843-51111501 Trousdale Dr.BurlingameCA94010-4506 (650) 652-30007300 MedicalCenter Dr.Canoga ParkCA91307-1902 (818) 884-70602755 Herndon Ave.ClovisCA93611-6800 (559) 323-400017100 Euclid St.Fountain Valley CA9270817100 Euclid St.Fountain Valley CA927089920 Talbert Ave.Fountain Valley CA92708-5153 (714) 378-7000St. John’s Regional Hospital(714) 979-121115 East Audubon Dr. FresnoCA93720-1542 (559) 433-8000757 Westwood Pl.Los AngelesCA90095757 Westwood Pl.Los AngelesCA900951500 San Pablo St.Los AngelesCA90033-5313 (323) 442-85001500 San Pablo St.Los AngelesCA90033-53131700 Coffee Rd.ModestoCA2500 Grant Rd.Mountain View CA9535594040-4302 (650) 940-7000350 Hawthorne Ave. OaklandCA94609-3108 (510) 204-40002601 EastChapman Ave.OrangeCA92869-3206 (714) 633-00111600 NorthRose Ave.OxnardCA93030-3722 (805) 988-2500Palo AltoCA94304-2203 (650) 498-7200PasadenaCA91105-3103 (626) 397-5000CA92064-2405 (858) 613-4000Stanford Hospital and Clinic300 Pasteur Dr.Huntington Memorial Hospital 100 West CaliforniaBlvd.Pomerado Hospital15615 Pomerado Rd. Poway5
Facility nameAddressCityState ZIPSacramento AdvancedLaparoscopic SurgicalAssociationSutter Roseville Medical CenterUC Davis Medical CenterSt. Bernardine Medical Center1 Medical PlazaRosevilleCA95661-30371 Medical PlazaRosevilleCA95661-3037 (916) 781CA95817-2201 (916) 7342101 NorthWaterman Ave.San Bernardino CA92404Alvarado Hospital MedicalCenterSharp Memorial HospitalUniversity of California,San Diego Medical CenterUCSF Medical CenterMills Peninsula6655 Alvarado RdSan DiegoCA92120-5208 (619) 6807901 Frost St.San DiegoCA92123-2701 (858) 541200 West Arbor Dr.San DiegoCA92103-9000 (619) 543505 Parnassus Ave.San FranciscoCA94143-2204 (415) 353100 South SanMateo Dr.San MateoCA94401-3805 (650) 652Santa Barbara Cottage HospitalSouthwest Healthcare SystemInland Valley Medical CenterSutter General Hospital2400 Bath St.Santa BarbaraCA93105-4351 (805) 68236485 InlandValley Dr.WildomarCA92595(951) 6772801 L St.SacramentoCA95816(916) 5682315 Stockton Blvd. SacramentoPhone(909) 883Transplant Performance CenterHealth Net has a specific network ofdesignated Transplant Performance Centersto perform organ, tissue and bone marrowtransplants. You will be directed to one of thefollowing Health Net Transplant Centers atthe time authorization is obtained.Northern CaliforniaTransplant type CenterStem CellPatient typeAlta Bates Medical Center – BerkeleyAdult AutologousChildren’s Hospital & Research Center – OaklandPediatricAutologousAllogeneic Related and UnrLucile Packard Children’s HospitalPediatricAutologousAllogeneic Related and UnrStanford University Hospital – Palo AltoAdultAutologousAllogeneic Related and UnrSutter Medical Center – SacramentoAdult AllogeneicUC Davis – SacramentoAdultAdult AutologousPediatricAutologous6
Introduction /IntroducciónNorthern California (continued)Transplant type CenterStem CellUCSF – San FranciscoPatient typeAdultPediatricAutologousAllogeneic Related and UnrelatedHeart*California Pacific Medical Center – San FranciscoAdultLucile Packard Children’s HospitalPediatricStanford University Hospital – Palo AltoAdultSutter Medical Center – SacramentoAdultUCSF – San FranciscoAdultPediatricHeart-Lung*KidneyLucile Packard Children’s HospitalPediatricStanford University Hospital – Palo AltoAdultUCSF – San FranciscoAdultCalifornia Pacific Medical Center – San FranciscoAdultLucile Packard Children’s HospitalPediatricStanford University Hospital – Palo AltoAdultSutter Medical Center – SacramentoAdultUC Davis – SacramentoAdult Cadaveric and AdultUCSF – San FranciscoAdultPediatricKidney-Pancreas California Pacific Medical Center – San FranciscoLiverAdultLucile Packard Children’s HospitalPediatricStanford University Hospital – Palo AltoAdultUCSF – San FranciscoAdultCalifornia Pacific Medical Center – San FranciscoAdultLucile Packard Children’s HospitalPediatricStanford University Hospital – Palo AltoAdultUCSF – San FranciscoAdultPediatricLungPancreasLucile Packard Children’s HospitalPediatricStanford University Hospital – Palo AltoAdultUCSF – San FranciscoAdultCalifornia Pacific Medical Center – San FranciscoAdultLucile Packard Children’s HospitalPediatricStanford University Hospital – Palo AltoAdultUCSF – San FranciscoAdult7
Southern CaliforniaTransplant type CenterStem CellCedars-Sinai Medical Center – Los AngelesPatient typeAdultAutologousAllogeneic Related and UnrChildren’s Hospital – Los AngelesPediatricAutologousAllogeneic Related and UnrChildren’s Hospital of Orange County – OrangePediatricAutologousAllogeneic Related and UnrRady Children’s Hospital – San DiegoAdultAutologousAllogeneic RelatedScripps Health – San DiegoAdultAutologousAllogeneic RelatedRonald Reagan UCLA Medical CenterAdultPediatricAutologousAllogeneic Related and UnrUC San Diego – San DiegoAdultAutologousAllogeneic RelatedHeart*Cedars-Sinai Medical Center – Los AngelesAdultChildren’s Hospital – Los AngelesPediatricLoma Linda University Medical Center – Loma LindaPediatricSharp Healthcare SystemAdultRonald Reagan UCLA Medical CenterAdultPediatricHeart-Lung*KidneyUSC – Los AngelesAdultChildren’s Hospital – Los AngelesPediatricUSC – Los AngelesAdultCedars-Sinai Medical Center – Los AngelesAdultLoma Linda University Medical Center – Loma LindaAdultRady Children’s Hospital – San DiegoPediatricPediatricSharp Memorial HospitalAdultSt. Joseph Hospital of OrangeAdultRonald Reagan UCLA Medical CenterAdultPediatricUC San Diego – San DiegoAdultUSC – Los AngelesAdultKidney-Pancreas Loma Linda University Medical Center – Loma LindaAdultPediatric8
Introduction /IntroducciónSouthern California (continued)Transplant type CenterLiverPatient typeCedars-Sinai Medical Center – Los AngelesAdultChildren’s Hospital – Los AngelesPediatricLoma Linda University Medical Center – Loma LindaAdultPediatricRady Children’s HospitalPediatricScripps Health – San DiegoAdultRonald Reagan UCLA Medical CenterAdultPediatricUC San Diego – San DiegoLungPancreasAdultUSC – Los AngelesAdultChildren’s Hospital – Los AngelesPediatricRonald Reagan UCLA Medical CenterAdultUC San Diego – San DiegoAdultUSC – Los AngelesAdultLoma Linda University Medical Center – Loma LindaAdultPediatricRonald Reagan UCLA Medical CenterSmall BowelRonald Reagan UCLA Medical CenterAdultAdultPediatric*Heart-Lung: Transplant is individually negotiated by Letter of Agreement.9
Frequently AskedQuestionsWhat is a participating physician group?A participating physician group is a team ofphysicians from various specialties assistedby nurses, technicians and other health careprofessionals contracted with Health Net toperform services for Health Net members.You may notice that some of our physiciangroup listings include the words “MedicalGroup,” “PMG,” “Independent PhysiciansAssociation” or “IPA” in the physicianname. Typically, in the physician groupsthat include the term medical group orPMG, most of the primary care physicianshave their offices at one principal location.In an IPA, the primary care physicianstypically practice at different locations.What is an affiliate office and howdoes it affect my selection of a primarycare physician?Affiliate office locations often have limitedphysician availability and different officehours. It’s also possible that your doctoroffers office hours in more than one location.Affiliates will often refer patients to theprimary location of a physician group forlaboratory and urgent care services.How is a referral specialist different from aprimary care physician?Your primary care physician is your mainmedical provider. He or she is the doctor whoiibl fdi till f10medical care and authorizing all specialtreatment or hospitalization. As a memof Health Net, you must obtain a referrfrom your primary care physician to seespecialist. Referral specialists are not avfor selection as your primary care physiWhat’s the difference between emergencare and urgent care?Emergency care is for a sudden, seriousand unexpected illness, injury or conditincluding severe pain that a reasonablewith an average knowledge of health anmedicine would believe requires immedmedical attention. Health Net covers careceived from any licensed provider ortreatment center anywhere in the worldemergency situation.Urgent care is provided for medicalconditions that require treatment withiseveral days but are not consideredimmediately life threatening. These mayinclude sprains and fractures, a suddenhigh fever or pneumonia, or a flare-upchronic condition such as asthma. Situarequiring urgent care are covered whenreceived from the member’s primary caphysician and physician group while ingroup’s service area, and from any licenprovider or treatment center while outof the area. All non-emergency care mube provided by or through the memberprimary care physician and physician gWhat is an outpatient surgical facilityAn outpatient surgical facility is a settinother than a medical or dental office, wmain function is performing surgical
Introduction /Introducciónbe licensed as an outpatient clinic accordingto state and local laws and must meetall requirements of an outpatient clinicproviding surgical services. The patient isadmitted to and discharged from the facilitywithin the same working day. Overnight staysare not permitted.Am I allowed to change to a new doctor onceI enroll?You may switch to another primary carephysician in the same physician group at anytime and for any reason by calling Health Netat 1-800-539-4072 or by going online towww.healthnet.com/uc. If you want to selecta new primary care physician affiliated with adifferent group, you can make the change ona monthly basis. If you choose a new doctorand physician group before the 15th of themonth, you can begin seeing the new doctoranytime after the 1st of the next month. Ifyou choose a new doctor after the 15th, you’llneed to wait as long as six weeks (the firstof the month after one full month has goneby after making the change) before you canbegin seeing the new doctor.How can I obtain information on doctorswho are in the Health Net network?Information is available in our directories,on our website, or by calling the Health NetCustomer Contact Center. You can learnwhether your doctor is board certified,where he or she attended medical schooland performed the residency, the officeaddress and phone number, whether yourdoctor participates in a Health Net HMO orHealth Net Blue & Gold HMO, the hospital(s)at which your doctor practices, and whichlanguages (in addition to English) that yourdoctor may speak.Where can I find specialist listings?Use the ProviderSearch function onHealth Net’s website at www.healthnet.com/uc,call Member Services at the toll-free numberlisted on your Health Net ID card, or askyour Health Net contracted physician orphysician group.Additional Health NetInformationAbout your Health Net ID cardAfter you enroll in Health Net, you willreceive a Health Net ID card. This card iswhat you need to receive all of your careas a Health Net member. Because it’s soimportant, it’s a good idea to keep yourHealth Net ID card with you at all times.If you lose your ID card, call our CustomerContact Center or order a new one online.Go to www.healthnet.com/uc.HospitalizationYour primary care physician or referralspecialist may find it necessary to referyou to a hospital for further care, oneither an inpatient or outpatient basis.You will usually be hospitalized whereyour physician has admitting privileges.(See your primary care physician’s grouplisting in this directory for a list of hospitalswhere he or she has admitting privileges.)11
Note: Your primary care physician orauthorized referral specialist must firstbe contacted for initial treatment andconsultation before you receive any careor treatment through a hospital. Yourprimary care physician or authorizedreferral specialist will be responsible fordetermining the most appropriate siteand location for your additional care.Admission to, and treatment rendered by,any hospital listed in this directory must beauthorized by your selected primary carephysician or authorized referral specialist.12
Ronald Reagan UCLA Medical Center 757 Westwood Pl. Los Angeles CA 90095 University of California, Los Angeles (UCLA) Medical Center 757 Westwood Pl. Los Angeles CA 90095 University of Southern California (USC) 1500 San Pablo St. Los Angeles CA 90033-5313 (323) 442-8500 USC University Physicians 1500 San Pablo St. Los Angeles CA 90033-5313
Para afiliados a Health Net Seniority Plus (HMO)*, Health Net Healthy Heart (HMO), Health Net Ruby Select (HMO), Health Net Gold Select (HMO), Health Net Jade (HMO SNP) y Health Net Seniority Plus (Employer HMO). Su examen de la vista de rutina está cubierto como un beneficio médico básico a través de su plan médico.
My Avatar - Financial Eligibility Guide . 10 Baycare Medical Group 44 HMO Insurance 11 BC Freedom Blue MDC HMO 42 HMO Insurance (MDC) 12 Benefit and Risk Management Services 45 HMO Insurance 13 Benesight 46 HMO Insurance 14 Blue Cross of CA 4 HMO Insurance (MDC) 15 Blue Shield Federal Emp Program 47 HMO Insurance
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Medical-Only HMO, Keystone 65 Select Medical-Only HMO, and Keystone 65 Select Rx HMO have networks of doctors, hospitals, pharmacies, and other providers. Keystone 65 Basic Rx HMO, Keystone 65 Liberty Medical-Only HMO, Keystone 65 Select Medical-Only HMO, and Keystone 65 Select Rx HMO: If you use providers that are not in
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Medical-Only HMO and Keystone 65 Preferred Rx HMO cover and what you pay. Keystone 65 Preferred Medical-Only HMO and Keystone 65 Preferred Rx HMO are Medicare Advantage HMO (Health Maintenance Organization) plans. With an HMO plan, members choose a family doctor, called a primary c
