Question: I have a BS PPO family plan through Covered California. I have been told by UCLA Hospital & affiliated doctors that if you purchased BS PPO through CC then you are not in network. But if you purchased the same plan through an agency you are in network. When I asked the BS agent, prior to signing up at CC, about providers accepting BS PPO/CC I was told that if providers are in network with BS PPO then they're in network through CC. They said it was the same. Can you please explain this? The doctors offices are unaware and uninformed.
Answer: The provider networks of the health plans participating in Covered California, like Blue Shield, must match their off-exchange plans networks to their Covered California networks exactly. The are the same. However, the reverse is not true, these same carriers have other networks that do not match their Covered California networks. Examples of these are grandfathered individual plan legacy networks and group plan networks. So this statement "if providers are in network with BS PPO then they're in network through CC" is not accurate. Some doctors' offices are of the opinion that Covered California has it's own network and this is way not accurate.