Finding a Doctor Who Accepts Covered California Health Plans

Posted: June 12, 2015

by Esmeralda Mercado

Earlier this year, many people enrolled on a Covered California health plan just to comply with the mandate and avoid the tax penalty. Check mark! Since then, however, another issue has arisen. A good number of people have been shocked to learn that their doctors who previously accepted their health plan were no longer accepting it if the plan was purchased through Covered California. 

How do I find a health plan that covers my doctor?

A better question may be: What insurance does my doctor accept? Go straight to the source, your doctor and ask for the department or the person who handles the insurance billing. Your #1 question to them is, “Do you take Covered California health insurance?” If they do, then ask which insurance company/ies they are contracted with and whether they accept the HMO, PPO or EPO that you are either enrolled on or considering through Covered California. At the beginning many doctors were confused and so conflicting information was provided from the carriers and doctors. However, due to the educational outreach that many carriers such as Anthem Blue Cross and others are making, coinciding information is improving.

If your doctor does not honor your Covered California health plan, you have two options: 

See your doctor anyway but be aware that you’ll be paying full price for the doctor’s visit.

Switch to a doctor that accepts Covered California health plans. If you need to find a doctor, see the healthcare provider links below from the four top insurance companies that offer Covered California plans:

• Anthem Blue Cross 
• Blue Shield
• Health Net
• Kaiser Permanente 

Note: If you are enrolled with Kaiser Permanente, which is an HMO, there should be no question on whether or not your doctor will accept your Kaiser Permanente health insurance because Kaiser Permanente doctors do not differentiate between coverage purchased inside or outside the Health Insurance Exchange.  

Important: Even if you find a doctor you like on one of the provider links above, be sure to call the doctor to make sure they are still part of the network.

Generally, the Affordable Care Act does not allow for plan changes unless you have a qualifying life event, such as a loss of coverage or relocation to California, etc. For most people, the next opportunity to switch plans is during the next open enrollment. For more information, click Covered California insurance quotes or contact Health for California Insurance Center at (877)-752-4737.