Best ways to check if your providers participate in the network for “off-exchange”, non-CoveredCA plans.

Posted by Phil Dougherty
November 30, 2015

Ensuring your “must have” providers are in your health plan’s network is not as easy as it should be. Some PPO carriers have gone to narrower networks (namely Anthem Blue Cross, Blue Shield and CIGNA) so it’s important to check provider participation. Although carriers each have a provider search tool on their website, search tools are not always easy to use or up-to-date.

Before finalizing your health insurance carrier and plan decision, you’ll want to take several steps to make sure your providers take your plan. Although the following suggestions are not fail proof, they can provide some peace of mind that your providers are likely “ in-network”.

  1. Use carrier provider search tools. See below for the search links and assistance in how to use them.
  2. If you find your provider on the carrier’s search tool (or even if you don’t) call the provider to check if they are in the network.
  3. When calling the provider, be sure to ask about the specific carrier, network and exchange of your proposed health plan. For example, Anthem Blue CrossPathwaydirect off-exchange is the carrier, network name and exchange, respectively.  You can further define it by saying the plan is not from CoveredCA and not through an employer-based group plan. Note: If a provider’s office tells you they take all PPO’s, that isn’t sufficient enough to verify they participate in your plan. If a provider says they don’t take CoveredCA plans that too isn’t sufficient enough.
  4. You can also check the provider’s website, which may have a current list of health plans accepted.
  5. Finally you can call  the carrier directly. Specify that you are looking for a provider in a direct off-exchange plan (not CoveredCA).

In summary, due diligence is key to reducing the chance you find out too late your “must have” provider is not in your plan’s network.

Phil Dougherty

Carrier Search Tool Web Links:
Blue Shield Individual PPO: Provider Search Tool
Blue Shield Video: How to Use the Provider Search Tool

HealthNet PPO: Provider Search Tool
HealthNet Instructions: Provider Search Tour

Anthem Blue Provider Search Tool (No instructions)

Western Health Advantage, which is a popular local HMO that utilizes the Meritage Provider Network in Marin   (No Video; this tool is pretty easy to use without help)