Tuesday, March 25, 2014

Sutter Amador Hospital: Key Facts about Covered California -- Amador County

Key Facts about Covered California -- Amador County
March 2014
Individual and Family Product
Blue Shield of California
·         All Sutter Providers, including those in Amador County, are contracted with Blue Shield of California for the EPO or PPO Covered California products, although the Blue Shield PPO product is not offered to residents of Amador County.
·         Blue Shield is only licensed in certain ZIP codes in Amador County for their EPO product. (This was a business decision made by Blue Shield and approved by Covered California. This is not related to our contract with Blue Shield. We contracted with Blue Shield for all of their Covered California individual and family products).
o        Blue Shield has excluded the following Amador County ZIP codes: 95629, 95640, 95666, 95669, 95689
o        If you have questions or concerns about Blue Shield insurance plans, please call 1-800-541-6652 (Providers) or 1-888-256-3650 (Members).

Individual and Family Product
Anthem Blue Cross
·         Anthem Blue Cross is licensed in ZIP codes where Blue Shield is not.
·         Sutter Amador Hospital is contracted with Anthem Blue Cross PPO Pathway product; however, Sutter Medical Group doctors are not.
·         Anthem Blue Cross patients who reside in these ZIP codes (or the county) can choose independent physicians for their health needs and access Sutter Amador Hospital services.
·         If you have questions or concerns about Anthem Blue Cross Pathway, please call 1-855-333-5730 or visit www.anthem.com/ca.

SHOP Product (Small Business Health Options Program
·         This is a small group product for employers with 1-50 employees
·         Sutter participates in the Blue Shield PPO product for SHOP. There are no ZIP code exclusions for this product.
·         Sutter also participates in the Health Net PPO for the SHOP product. There are no ZIP code exclusions for this product.

If you need help with your existing health plan, please call, write or email:

Department of Managed Health Care
California Help Center
980 9th Street, Suite 500, Sacramento, CA 95814-2725
Covered California Service Center
P.O. Box 989725
West Sacramento, CA

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