October 1, 2015 Search Criteria: Plan name: Blue Shield of California PPO Specialties: All Physicians and Specialists Medical Groups: County: Butte Prepared For: City of Oroville PPO Participants 1735 Montgomery St., Oroville, CA, 95965 Prepared By: Liz Ehrenstrom Phone #: (530) 538-2407 Visit us at blueshieldca.com 1 An Independent Member of the Blue Shield Association INTRODUCTION This regional directory lists the physicians and healthcare facilities in the Blue Shield of California PPO network and the Blue Shield Life Provider Network. All of the providers in this directory have agreed to accept our payment, plus any applicable coinsurance or co payments for which you may be responsible, as payment-in-full for the covered services described in your plan's Evidence of Coverage or Certificate of Insurance. Making quality part of the equation We have made quality measures an essential part of how we categorize hospitals. We use quality data compiled from two leading independent performance initiatives: the Leapfrog Group survey, which focuses on hospital quality and safety practices, and the hospital performance ratings used by the California Hospital Assessment and Reporting Taskforce (CHART). The Leapfrog Group is an initiative driven by organizations that buy health care who are working to initiate breakthrough improvements in healthcare safety, quality and affordability. The Leapfrog Group's growing consortium of major companies and other large private and public healthcare purchasers provide health benefits to more than 37 million Americans in all 50 states. The Leapfrog Group survey is a voluntary program in which hospitals report on the quality and safety practices they have implemented. CHART was established in 2004 to develop a statewide hospital performance reporting system built around multi- stakeholder collaboration including health plans, hospitals, and employer groups. It produces a standardized California hospital quality report card and supports hospital quality improvement efforts through standardized quality reporting and the ongoing introduction of new quality measures. CHART is a voluntary project in which hospitals are rated on over 70 performance indicators, including patient satisfaction measures and specific conditions such as heart disease, surgical infection prevention, and pneumonia. When you look at a hospital's listing in this directory, you'll be able to see whether that facility participates in the Leapfrog Group and CHART programs. You'll also see codes that can help you determine the hospital's relative cost. Please note that the cost of a hospital's care does not necessarily determine its quality of care. We determine a hospital's relative cost by comparing patient care costs for certain illnesses and procedures at all network hospitals in that geographic area. The number of dollar signs associated with a hospital will indicate how expensive that hospital is, in general, compared with other similar hospitals in the network. One dollar sign ($) indicates the lowest cost, and four dollar signs ($$$$) indicate the highest cost. $ - Lowest cost hospital $$ - Lower cost hospital $$$ - Higher cost hospital $$$$ - Highest cost hospital You may want to discuss this information with your doctor when making decisions about hospital care. We will continue to work closely with hospitals on quality measures to provide you with valuable information and enable you to make informed decisions about your care. If you have any questions about any of our hospitals, call the Customer Service number shown on your Blue Shield of California or Blue Shield of California Life &Health Insurance Company (Blue Shield Life) member ID card. 2 Urgent care providers To lower your healthcare costs, you should use the urgent care providers listed in this directory rather than hospital emergency rooms, when appropriate. The physicians and medical groups in this urgent care provider listing are private offices that offer extended hours of operation, including weekends, and do not require patients to make appointments in advance. Seek care from urgent care providers when you are unable to make an appointment with your regular physician, or you need urgent care - not emergency care - after regular physician office hours, on weekends or at other times when your regular physician is not readily available. Whenever possible, check first with your regular physician before contacting an urgent care provider. Whenever possible, avoid using urgent care in place of your regular physician. In cases when your medical condition clearly requires emergency care, call 911 or go to the closest emergency facility. Ambulatory surgery centers In addition to network hospitals, we have contracted with ambulatory surgery centers (ASC) for outpatient surgery. When you need outpatient surgery, it can pay to consider an ambulatory surgery center. Outpatient surgery procedures can cost more than twice as much at a hospital than at an ASC. Depending on your health plan, the difference can add up to a lot in out-of-pocket savings for you. You should use these ambulatory surgery centers when appropriate. Subacute care facilities We also contract with subacute care facilities, which are not listed in this directory. These facilities provide skilled nursing or rehabilitative care in a hospital or skilled nursing facility to patients who require nursing; physical, occupational or speech therapy, or a coordinated program of multiple therapies. Patients are referred to subacute care facilities by their physician. Therefore, you should discuss your options for subacute care with your physician. If you'd like a directory of network subacute care facilities or need more information about using these facilities, please call the toll-free Customer Service number shown on your Blue Shield of California or Blue Shield Life ID card. Blue Shield Life members Blue Shield Life plan members should use providers in the Blue Shield Life Provider Network to obtain the lowest out-of- pocket costs for care. You can tell whether you are a Blue Shield Life member by looking at your member ID card. Please note that not every individual physician listed under a Blue Shield Life physician group is a Blue Shield Life physician, so you should check a physician's network status carefully before accessing care. Providers who do not participate in the Blue Shield Life Provider Network are denoted by an asterisk (*) throughout this directory. You can also check whether your provider participates in the Blue Shield Life network by going to the Find a Provider section of blueshieldca.com or by calling the Customer Service number on your Blue Shield Life ID card. You may still choose to see a provider who is not in the Blue Shield Life Provider Network, but your costs will be higher. You will pay a higher coinsurance amount and be responsible for any amounts above the allowable amount. Blue Shield Life plan members should make every effort to use Blue Shield Life Provider Network hospitals for non- emergency care, to avoid out-of-pocket expenses beyond the deductibles and copayments specified in your Certificate of Insurance. It is important for you to discuss the importance of using Blue Shield Life Provider Network hospitals with your physician to avoid the higher out-of-pocket expenses of being treated in a non-Blue Shield Life Provider Network hospital. In this directory, all urgent care providers are in the Blue Shield Life Provider Network. 3 Non-network providers Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective physician, medical group, clinic, or call our Customer Service representatives to ensure that you can obtain the healthcare services that you need. Family planning services Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning, contraceptive services, including emergency contraception, sterilization, including tubal ligation at the time of labor and delivery, infertility treatments, or abortion. You should obtain more information before you enroll. Call your prospective physician, medical group, clinic, or call our Customer Service representatives to ensure that you can obtain the healthcare services that you need. For the most up-to-date information Because of periodic changes in our provider networks, you should confirm each provider's network status prior to receiving services. You should also verify that your physician is a network physician at the location where you wish to receive care. You can do so by calling the provider directly or by calling Customer Service. The fastest way to get most up-to-date information on network physicians, hospitals, medical groups and Independent Practice Associations is to visit our Web site, blueshieldca.com, and click on the Find a Provider link. This information is updated twice a week. You can use Find a Provider to locate network doctors, hospitals and other healthcare professionals, and to create and print your own provider directory using your home computer and printer. The fastest way to get most up-to-date information on network physicians, hospitals, medical groups and Independent Practice Associations is to visit our Web site, blueshieldca.com, and click on the Find a Provider link. This information is updated twice a week. You can use Find a Provider to locate network doctors, hospitals and other healthcare professionals, and to create and print your own provider directory using your home computer and printer. This printed directory is updated annually. You may request an updated list of network providers in your geographic area by calling the Customer Service telephone number on your Blue Shield of California or Blue Shield Life member ID card.