Protect Your Access to Hoag

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Attention Commercial HMO and Medicare Advantage Patients of Greater Newport Physicians (GNP)

Check Your Access to Hoag

Starting on January 1, 2023, access to elective services at Hoag facilities may be limited for commercial HMO and Medicare Advantage members assigned to a Greater Newport Physicians (GNP) primary care physician. Elective services subject to limitation include, but are not limited to, the following:

  1. Physical Therapy
  2. Maternity/Labor and Delivery*
  3. Diagnostic Testing
  4. Radiology/MRI/CT, PET scans
  5. Cardiac Rehab
  6. Mammography
  7. Wound Healing Center
  8. Radiation Therapy
  9. Hoag Urgent Care
  10. Elective inpatient and outpatient services at Hoag Hospital Irvine and Newport Beach*

* It is important to note that this change will not restrict or affect your access to emergency medical treatment at any Hoag hospital and you may also be entitled to receive continuity of care services for a limited period of time for certain elective inpatient and outpatient services, including Maternity Care, as determined by your medical group or health plan.

Hoag cares about the health and well-being of our patients.

To ensure your access to all of Hoag, choose a Primary Care Physician in Hoag Medical Group or Hoag Physician Partners.

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Frequently Asked Questions (FAQs): Contract Expiration – Greater Newport Physicians

Q: I have a PPO plan; do I need to be concerned?

A: No, PPO, Medicare PPO, and Medicare supplement insurance plans are not affected by this change. You still will access Hoag the way you always have.
 

Q: What services are impacted?

A: Starting on January 1, 2023, certain Hoag facilities will not be included in HMO and Medicare Advantage (MA) health plans with Greater Newport Physicians (GNP). Patients with a HMO or MA plan with a GNP primary care physician will no longer be able to access Hoag facilities and services including but not limited to the following:

  • Elective Inpatient and Outpatient Services at Hoag Hospital Irvine and Hoag Hospital Newport Beach*
  • Maternity/Labor and Delivery*
  • Radiology/MRI/CT, PET scans
  • Mammography
  • Radiation Therapy
  • Physical Therapy
  • Diagnostic Testing
  • Cardiac Rehab
  • Wound Healing Center
  • Hoag Urgent Care

*Some exceptions may apply. Please contact member services at 949-520-1423 or your health plan with questions.
 

Q. Can I still come to Hoag for my yearly mammogram?

A: Starting on January 1, 2023, certain Hoag facilities will not be included in HMO and MA health plans with GNP. Therefore, if you are assigned to a GNP primary care physician (PCP), your GNP PCP will most likely direct you to a GNP-contracted (i.e., non-Hoag) facility for your mammogram. If you have a HMO or MA plan and would like to have your mammogram at Hoag,
you will need to select a PCP from Hoag Medical Group or Hoag Physician Partners now or during open enrollment. Please see below instructions to “ensure access to Hoag.”

 

Q: I’m pregnant – may I still deliver at Hoag?

A: Starting on January 1, 2023, certain Hoag facilities will not be included in HMO and MA health plans with GNP. Some exceptions may apply, and members should check with their health plan and with their OB/GYN physician to confirm access.

 

Q. I am considering having a baby next year and would like to deliver at Hoag. My primary care physician (PCP) is with GNP, do I need to make a change?

A: The most effective way to plan for full access to services at Hoag, including the ability to deliver at Hoag, is to make a change from your GNP PCP to a Hoag Medical Group or Hoag Physician Partners PCP. However, if you prefer to keep your GNP PCP, you may be able to deliver at Hoag if all of the following conditions are satisfied: (1) your OB/GYN is contracted with GNP, (2) your OB/GYN has hospital privileges at Hoag, and (3) Hoag is in-network with your plan. We recommend contacting your health plan directly to confirm what is allowed under your benefit plan.

 

Q: Why is Hoag stopping my access to services at Hoag – I have had my GNP Primary Care Physician (PCP) for many years?

A: For now, and through the remainder of 2022, you can continue to have access to services at Hoag as you normally would.
However, due to a change in the contractual relationship between GNP and Hoag, effective January 1, 2023,
if you are assigned to a Greater Newport Physicians (GNP) primary care physician (PCP) your HMO or Medicare Advantage Plan
may restrict your access to certain Hoag facilities and services for elective services and procedures.
We want you to be informed about your options prior to the change taking place and in advance of Open Enrollment.
The most effective way to plan for full access to medical care and services at Hoag is to make sure you select a HMO or MA plan
that allows you to designate a PCP from Hoag Medical Group or Hoag Physician Partners as your PCP. If you have questions,
please contact Hoag member services at 949-520-1423 or your health plan.
 

Q: What if I have an emergency?

A: It is important to understand that this change in the contractual relationship between Hoag and GNP will not restrict or affect your access to emergency medical treatment at Hoag Hospital at any time. You can continue to access our emergency care services the same way you always have.
 

Q: I am currently undergoing treatment at Hoag (i.e., chemo, radiation therapy or other ongoing course of treatment). Can I continue my treatment?

A: You may be entitled to continue to receive your treatment at Hoag until completion if you qualify under your plan’s continuity of care guidelines. You should contact your health plan and medical group to inquire about your rights to continuity of care.
 

Q: I have a HMO plan with GNP – will I have a higher cost to switch my PCP to Hoag?

A: Benefits are determined by the health plan and are typically set each calendar year. There should be no increase in co-pay or premium if your present insurance plan provides access to Hoag. We recommend you confirm with your plan.
 

Q: I have a Medicare Advantage HMO Plan (Scan Health Plan, United Healthcare, Blue Shield) with GNP, does this affect me?

A: Yes, starting on January 1, 2023, if you are assigned to a Greater Newport Physicians (GNP) primary care physician (PCP) your HMO or Medicare Advantage Plan may restrict your access to certain Hoag facilities for elective procedures and services. It is important to understand that some exceptions may apply. For example, this change will not restrict or affect your access to emergency medical treatment at Hoag Hospital and you also may be entitled to receive continuity of care services for period of time for certain elective inpatient and outpatient services. Please contact Hoag member services at 949-520-1423 or your health plan with questions.

 

Q: I received a letter from GNP, and they said that Hoag is misleading patients about access to Hoag, and that I do not need to change my Primary Care Physician (PCP).

A: Managed care arrangements can be complicated, and we strive to keep our patients informed of any changes that may affect how they access care to empower patients to make the best health care decisions for themselves and their families.
There is a change effective January 1, 2023, which will impact patients with a GNP PCP.
Many patients have asked how they can ensure full access to Hoag facilities, for both elective outpatient and elective inpatient care.
The most effective way to ensure that you have full access to Hoag is to select a PCP from Hoag Medical Group or Hoag Physician Partners.
These PCP’s have direct access to all the services and facilities at Hoag, including 15 urgent care locations and nationally recognized specialist physicians located throughout Orange County. If you prefer to keep your GNP PCP, you will no longer be able to access outpatient services such as Radiology/MRI/CT, PET scans, Mammography, and Radiation Therapy. With
regard to other inpatient and outpatient services at Hoag, you may be able to access some elective services if all of the following conditions are satisfied: (1) your referring specialist is contracted with GNP, (2) your specialist has hospital privileges at Hoag, and (3) Hoag is in-network with your health plan. If you have additional questions, we recommend that you contact your health plan directly to confirm. We respect your health care decisions, and we are here to help answer any questions. For more information call 949-520-1423 , Monday – Friday from 9 a.m. – 5 p.m.
 

Q: How do I ensure access to Hoag now and in the future?

A: If you have a HMO or MA insurance plan, you have the right to choose the physician and the medical group that you would like to care for you and your family. Your insurance provider can easily assist with a change if that is your preference. Take the following steps to select Hoag Medical Group or Hoag Physician Partners Primary Care Physician to guarantee access to elective services at Hoag:

  • Call the customer service number on your current HMO insurance card, and request to change the Primary Care Physician and medical group.
  • Provide the name of the Hoag Medical Group or Hoag Physician Partners primary care physician that you have selected and let the insurance representative know the medical group is Hoag Medical Group or Hoag Physician Partners.
  • Once you receive your new insurance card, call the Hoag Medical Group or Hoag Physician Partners primary care office to request an appointment.

 

Q: Where can I go for more information?

A: We understand the questions and concerns this may create, and we want to help you understand what this means for you. Please call 949-520-1423 , Monday – Friday from 9 a.m. – 5 p.m. You may also contact the Department of Managed Health Care (DMHC) (toll free) at 888-466-2219.
 

Note: HMO members have the option to switch medical groups and PCP each month within their plan. Here is a list of plans and their member services phone numbers.

Commercial:

Aetna: (800) 872-3862 (Corporate Number)

Anthem Blue Cross: (800) 288-6921

Blue Shield: (800) 256-3650; (855) 836-9705 if signed through Covered CA

Cigna: (800) 244-6224

United Healthcare: (800) 624-8822

Senior:

AARP/United Healthcare (formerly Secure Horizons): (800) 950-9355

Blue Shield: (800) 776-4466

Scan: (800) 559-3500

Medicare Broker information: Hoag Customer Service (888) 803-3038

For HMO and Medicare Advantage plan participants:

  • Call Customer Service

    Call the customer service number on your current insurance card, and request to change the Primary Care Physician (PCP) and medical group.

  • Provide Name of Physician

    Provide the name of the Hoag Medical Group (HMG) or Hoag Physician Partners (HPP) primary care physician, and confirm with the insurance representative that the physician is a provider with Hoag Medical Group or Hoag Physician Partners.

  • Request Appointment

    Once you receive your new insurance card, call the physician’s office to request an appointment. The change will typically take effect within 30-45 days of the request.

It is important to know this change does not affect patients with a PPO plan.

Call the Customer Service number on the back of your health insurance card to request the change to your medical group and primary care physician.

For more information, email [email protected] or call 949-520-1423.

* Some exceptions may apply. Please contact Hoag Customer Service at 949-520-1423 with questions, or your health plan directly for confirmation.