There are 222 members in Santa Monica CA. Main: 310-829-8424. . Enrollment in Providence Health Assurance depends on contract renewal. If you qualify for a Premium tax credit based on your estimate, you can use any amount of the credit in advance to lower your Premium. Medical taxonomies which are covered by Providence Saint Johns Medical Foundation include Hospice and Palliative Medicine, Registered Nurse, Gynecology, Clinical Cardiac Electrophysiology, Clinical, Nuclear Radiology, Psychiatry, Audiologist-Hearing Aid Fitter, General Acute Care Hospital, Family and many more. wherever you are. (657) 888-7179, St. Jude Heritage Medical Group - Diamond Bar 27231 La Paz Rd., Suite A Eureka - Family Medicine - Harrison Suite K, Laguna Niguel - Mission Heritage Same Day, Mission Viejo - Obstetrics & Gynecology, Suite 545, Mission Viejo - Obstetrics & Gynecology, Suite 525, Napa - TACS (Trauma and Acute Care Surgery), Eureka - Plastic & Reconstructive Surgery, Mission Viejo - Transitional Medical Clinic, Mission Viejo - Lab - Mission Medical Plaza, Mission Viejo - Lab - Marguerite Medical Plaza, Victorville - St. Mary High Desert Imaging Center, Mission Viejo - Center for Health Promotion, Humboldt County - Radiology & Imaging Services, Sonoma County - Radiology & Imaging Services, Rohnert Park - Urgent Care - Temporarily Closed, Foothill Ranch Obstetrics and Gynecology, Apple Valley - Providence AdvantAge Health Center, Tustin - Providence AdvantAge Health Center. An EOB explains how Providence processed your Claim, and will assist you in paying the appropriate member responsibility to your Provider. Office:310-829-8625 HealthCare4PPL.com does not provide medical advice, diagnosis or treatment. Healdsburg, CA 95448 clinics in Sonoma, Mendocino and Lake Countries will be closed on Wednesday, Services provided by out-of-network providers. If you have a Marketplace plan and receive a tax credit that helps you pay your Premium (Advance Premium Tax Credit), and do not pay your Premium within 10 days of the due date in any given month, you will be sent a Notice of Delinquency. Napa, CA 94558 (714) 871-3280, CHOC Childrens Below is a short list of commonly requested services that require a prior authorization. Labor Day - Monday, September 4 Eureka, CA 95501 If Providence needs additional information to complete its review, it will notify the requesting provider or you within 24 hours after the request is received. If you pay your Premiums in full before the date specified in the notice of delinquency, your coverage will remain in force and Providence will pay all eligible Pended Claims according to the terms of your coverage. Innovative research directly impacts health center patients with rare immediacy. Providence will then notify you of its reconsideration decision within 24 hours after your request is received. It is a general medical and surgical facility. F: 949-364-1318, Mission Hospital Imaging Santa Rosa, CA 95405, , 1162 Montgomery Dr., 2nd Floor A post-service review may be performed after a service has taken place that required a prior authorization and no authorization is on file or if a claim is received with a billing code that does not allow the plan to identify what services were provided. Whether you're a new or existing patient, We may also require that a Member receive further evaluation from a Qualified Practitioner of our choosing. online with a few easy clicks! Memorial Day - Monday, May 29 Call 911 if you have a life-threatening emergency. A list of covered prescription drugs can be found in the Prescription Drug Formulary. Christmas Eve/Day Mon., Dec. 25: 9 a.m. - 1:00 p.m. You can find the Prescription Drug Formulary here. If it is your nonprofit, add geographic service areas to create a map on your profile. If we need additional information to complete the processing of your Claim, the notice of delay will state the additional information needed, and you (or your provider) will have 45 days to submit the additional information. We will not share or publish this information. You're the heart of our members' health care. 4th of July - Tuesday, July 4 Providence will notify your Provider or you of its decision within 72 hours after the Prior Authorization request is received. Napa, CA 94559, Close at 5 p.m. on Christmas Eve and New Years Eve, Closed major holidays, open on MLK and Presidents Day, 5630 E. Santa Ana Canyon Rd., Suite 100, Sun., Dec. 31: 8 a.m. - 5 p.m. Anaheim, CA 92807. Mon., Jan. 1: 9 a.m. - 6 p.m. 1450 Medical Center Dr., You or the out-of-network provider must call us at 800-638-0449 to obtain prior authorization. in 1994 and includes eight medical groups throughout California. Specialty: A Network Pharmacy that allows up to a 30-day supply of specialty and self-administered prescriptions. The information contained in this website is only for general information purposes. We will send an Explanation of Benefits (or EOB, see below) to you that will explain how your Claim was processed. Our medical directors and special committees of Network Providers determine which services are Medically Necessary. This organization is required to file an IRS Form 990 or 990-EZ. If you have made a payment in advance and then cancelled your insurance, or have made an accidental double-payment, please contact your membership representative (888-816-1300) to request a refund. Laguna Niguel, CA 92677. . Download hospital map & directions. Non-discrimination and Communication Assistance |. Thurs., Nov. 23: 8 a.m. - 12 p.m. AS EXPRESSIONS OF GOD'S HEALING LOVE, WITNESSED THROUGH THE MINISTRY OF JESUS, WE ARE STEADFAST IN SERVING ALL, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE. Mail your claim and supporting document(s) to the address below: Alternatively, you may send the information by fax to, Have your knowledge and agreement while receiving the Service, Be prescribed and approved by your Provider; and. groups and affiliated physicians have received top honors from various Prescription drug formulary exception process. You may purchase up to a 90-day supply of each maintenance drug at one time using a Participating mail service or preferred retail Pharmacy. If your message is received All Covered Services are subject to the Deductible, Copayments or Coinsurance and benefit maximums listed in your Benefit Summary. Manage Health Online, Mammogram Screening 27700 Medical Center Rd. New Year's Eve/Day Mon., Jan. 1: 8 a.m. - 5 p.m. 15855 Pomona Rincon Rd, 26800 Crown Valley Pkwy., Suite 280 FOUNDED BY THE SISTERS OF CHARITY OF LEAVENWORTH, WHO IN 2014 PASSED ITS SPONSORSHIP TO PROVIDENCE HEALTH & SERVICES, PROVIDENCE SAINT JOHN'S IS ROOTED IN THE CATHOLIC HEALTH CARE TRADITION, WHICH IS DEVOTED TO PROVIDING LEADING-EDGE MEDICINE WITH UNWAVERING COMPASSION AND PERSONALIZED CARE. Payment of all Claims will be made within the time limits required by Oregon law. An EOB is not a bill. Services that are not considered Medically Necessary will not be covered. In addition Prior authorization requests may be accessed by clicking on the following links: For questions or assistance with the prior authorization request process, please call customer service at 800-878-4445. Offer a medical therapeutic value at least equal to the Covered Service that would otherwise be performed or given. Mon Sat: 9 a.m. 9 p.m.; Sun: 9 a.m. 5 p.m. 1 Hoag Dr. 4300 Rose Drive If timely repayment is not made, we have the right, in addition to any other lawful means of recovery, to deduct the value of the excess benefit from any future benefit that otherwise would have been available to the affected Member(s) from us under any Contract. Apple Valley, CA 92307, : CLOSED to get more GuideStar Nonprofit Profile data today! You can make this request by either calling customer service or by writing the medical management team. 18310 Highway 18, Administrative Office & Research Center: 2200 Santa Monica Blvd. New Year's Eve/Day Santa Monica, CA 90404 Driving directions Download hospital map & directions Main Hospital Phone: 310-829-5511 Ombudsperson For questions or concerns related to Providence Saint John's Development Agreement with the City of Santa Monica, please contact: Christmas Eve/Day Providence has the right, upon demand, to recover from a recipient the value of any benefit or Claim payment that exceeded the benefits available under your Contract. Santa Monica, CA 90404: Cancer Clinic: Providence Saint John's Health Center 2121 Santa Monica Blvd. Mon., Dec. 25: 8 a.m. - 12 p.m. Open Daily, 8 a.m. - 8 p.m. Pacific Brain Health Center 1301 20th St. Santa Monica, CA 90404 Phone: 310-582-7641 Fax: 310-315-4069 Eureka, CA 95501 and availability. 27700 Medical Center Rd., 5th Floor If an Out-of-Network Provider charges more than your plan allows, that Provider may bill you directly for the additional amount. 4th of July - Tuesday, July 4 If your appeal involves (a) medically necessary treatment, (b) experimental investigational treatment, (c) an active course of treatment for purposes of continuity of care, (d) whether a course of treatment is delivered in an appropriate setting at an appropriate level of care, or (e) an exception to a prescription drug formulary, you may waive your right to internal appeal and request an external review by an Independent Review Organization. During the first month of the grace period, your prescription drug claims will be covered according to your prescription drug benefits. Irvine, CA 92618 For example, we might talk to your Provider to suggest a disease management program that may improve your health. Martin Luther King Jr. Day - Monday, January 16 Providence Saint Johns Medical Foundation. For services that involve urgent medical conditions: Providence will notify your provider or you of its decision within 72 hours after the prior authorization request is received. Memorial Day - Monday, June 29 networks throughout the state. WE HELP PEOPLE AND COMMUNITIES BENEFIT FROM THE BEST HEALTH CARE MODEL FOR THE FUTURE - TODAY.TOGETHER, OUR 120,000 CAREGIVERS (ALL EMPLOYEES) SERVE IN 51 HOSPITALS, 1,085 CLINICS AND A COMPREHENSIVE RANGE OF SERVICES ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON. 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