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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Find Medical Providers in My Area?

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Question: How can I determine which Covered CA health provider plans will accept the particular medical group and doctor that I want? I also have difficulty because of the restrictions on the area in which I live. Will a PPO plan help resolve this issue?

Answer: You will have to do an online search of providers - doctors and hospitals - at the website of each carrier you are considering. I have provided a list of links to some carrier provider directories below. If you are uncomfortable using the internet, you should contact a Certified Agent to help you locate the best plan including your provider preferences. In 2016, all counties in California will offer a choice of at least 3 different Covered California carriers: Blue Shield and Anthem Blue Cross PPO plans (no more EPO) are available in every county statewide. New this year, United Healthcare will offer a third PPO choice in even the most rural counties.


My husband was just diagnosed with cancer and needs a hematology oncologist to develop a treatment plan. I called BlueShield and there are NO hematology oncologist providers available under our Platinum PPO IN THE ENTIRE LOS ANGELES AREA, so they just picked the first doctor they found alphabetically, (Alcantar, Juan) and will try to negotiate coverage with him. Can’t we pick our own doctor and do the same?

I ended up so frustrated the other day that Anthem started calling doctors for me to get me an appointment. They found out exactly what I had been going through.

What started all of it was needing an Urgent Care. Well, lo and behold, Hoag has taken over most Urgent Care facilities near me (in Orange County) and they no longer take Anthem. So, the ONLY Urgent Care in OC on the Anthem Bronze plan is one in Santa Ana called Advanced Urgent Care (but signage is Clinica Medica). There was over a 4 hour wait (per receptionist when I called). The next closest one is in Beverly Hills! I ended up having to suck it up because I wasted over 2 hours trying to find some place to go (and getting wrong information repeatedly). By the time i decided to just go pay cash somewhere I had to leave to pick up my children.

Having young children means frequent trips to Urgent Care. There is no way I can continue with Anthem with their lack of providers in my area.


What is even more frustrating is that doctors and facilities are in network but not in the online directory . Even reps don’t know. They use the online directory. I have had four different answers to the same question from four different reps : not in network, in network as skilled nursing home, it should ok if you travel 100 miles to a facility when the doctor has facility five miles away, no such Doctor.

I was even told once to see a doctor who died four years ago

Don’t Trust and Double Verify.

Be aware that for Anthem the provider list is horribly inaccurate. I have had numerous doctors refuse my insurance even though they are on the provider list. Even yesterday I called directly to Anthem to find a provider (for an emergency) and when I got there the doctor refused my plan.

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