A nationally renowned 266-bed hospital, Saint John's Health Center is a complex and vibrant hospital that has been serving the Santa Monica and Westside Los Angeles communities since 1942. F: 949-364-1318, Mission Hospital Imaging Tab will move on to the next part of the site rather than go through menu items. The Plan does not have a contract with all providers or facilities. Santa Rosa, CA 95405, Mon. We probably would not pay for that treatment. questions. Memorial Day - Monday, May 29 networks throughout the state. Mission Viejo, CA 92691. Sun., Dec. 24: 8 a.m. - 5 p.m. Certain Covered Services, such as most preventive care, are covered without a Deductible. Labor Day - Monday, September 4 Your physician may send in this statement and any supporting documents any time (24/7). to its medical groups, Heritage supports six distinct affiliated physician 4300 Rose Drive Thurs., Nov. 23: 9 a.m. - 1:00 p.m. There are four types of Network Pharmacies: Out-of-Network Provider means an Outpatient Surgical Facility, Home Health Provider, Hospital, Qualified Practitioner, Qualified Treatment Facility, Skilled Nursing Facility, or Pharmacy that does not have a written agreement with Providence Health Plan to participate as a health care Provider for this Plan. 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. This information will only be used to contact you regarding your message. Healdsburg, CA 95448 Orange, CA 92868 New Year's Eve/Day Sending us the form does not guarantee payment. Saturday, Sept. 5: 9 a.m. - 5 p.m. Contact Us | Providence Oregon Foundations Contact Us We want to hear from you. http://www.insurance.oregon.gov/consumer/consumer.html. Learn more St. Vincent Medical Foundation Willamette Falls Medical Foundation . Prescription drugs must be purchased at one of our network pharmacies. See below for information about what services require prior authorization and how to submit a request should you need to do so. If you have coverage under two or more health insurance plans, Providence will coordinate with the other plan(s) to determine which plan will pay for your Services. Mon - Sun: CLOSED for improvements until Fall 2021, 2501 E. Chapman Ave., Suite 101 their availability this week. 18310 Highway 18, Usually, Providers file claims with us on your behalf. If they are not met, a denial letter is sent to the member and the provider explaining why the service is not covered and how to appeal the claim denial. Mail Order: A Network Pharmacy that allows up to a 90-day supply of maintenance prescriptions and specializes in direct delivery to your home. 27231 La Paz Rd., Suite A Memorial Day - Monday, June 29 Mon., Jan. 1: 9 a.m. - 6 p.m. 1450 Medical Center Dr., If Providence denies your claim, the EOB will contain an explanation of the denial. We may not pay for the extra day. Left and right arrows move across top level links and expand / close menus in sub levels. Combined, they provide residents access Contact Us. For standard requests, Providence Health Plan will notify your provider or you of its decision within 72 hours after receipt of the request. Eureka, CA 95501 In Santa Monica California, Providence Saint Johns Medical Foundation has 222 members working at 33 different practice locations. Offer a medical therapeutic value at least equal to the Covered Service that would otherwise be performed or given. Thanksgiving Sun., Dec. 24: 8 a.m. - 5 p.m. Members will be responsible for applicable Copayments, Coinsurances, and Deductibles. Labor Day - Monday, September 4 Once a final determination is made, you will be sent a written explanation of our decision. 2700 Dolbeer St. For expedited requests, Providence Health Plan will notify your provider or you of its decision within 24 hours after receipt of the request. All hospital and birthing center admissions for maternity/delivery services, Inpatient rehabilitation facility admissions, Inpatient mental health and/or chemical dependency services, Procedures, surgeries, treatments which may be considered investigational. Windsor Urgent Care Locations. 2212 E. Fourth St., Get paid faster and reduce paper waste. If it is your nonprofit, add a problem overview. 4th of July - Tuesday, July 4 clinics in Sonoma, Mendocino and Lake Countries will be closed on Wednesday, IN AN INCREASINGLY UNCERTAIN WORLD, WE ARE COMMITTED TO HIGH-QUALITY, COMPASSIONATE CARE FOR EVERYONE -REGARDLESS OF COVERAGE OR ABILITY TO PAY. in clinical quality. Providence will notify you if an approved ongoing course of treatment is reduced or ended because of a medical cost management decision. Note: Due to high volume, please call before departure to verify our hours You or the out-of-network provider must call us at 800-638-0449 to obtain prior authorization. Holiday Hours: 8 a.m. - 5 pm. Is this your nonprofit? Learn about benefits. Use this form for non-urgent, non-medical questions or comments. Providence Health Plan offers commercial group, individual health coverage and ASO services.Providence Health Assurance is an HMO, HMOPOS and HMO SNP with Medicare and Oregon Health Plan contracts. Orange, CA 92868 Box 3375 Portland, OR 97208 Email 503-203-0788 We would not pay for that visit. In an emergency situation, go directly to a hospital emergency room. Rohnert Park, CA 94928. Providence Saint John's Health Center Hospitals and Health Care Los Angeles, California PA Health & Wellness . We allow 15 calendar days for you or your Provider to submit the additional information. If the information is not received within 15 calendar days, the request will be denied. T: (657) 500-0229 Santa Rosa, CA 95405, Mon. Note: Due to high volume, please call before departure to verify our hours We'll use your location to find clinics, hospitals and doctors closest to you. Click here to resend it.). A determination that relates to benefit coverage and Medical Necessity is obtained no more than 30 days prior to the date of the Service; or. Sun., Dec. 31: 8 a.m. - 5 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. If your physician recommends you take medication(s) not offered through Providences Prescription drug Formulary, he or she may request Providence make an exception to its Prescription Drug Formulary. Fullerton, CA 92835 You can find Providence Health Plans nationwide pharmacy network using our pharmacy directory. Providence St. John's Health Center in Santa Monica, CA is rated high performing in 4 adult specialties and 14 procedures and conditions. CompassionDignity JusticeExcellenceIntegrity, Providence National Foundation4400 NE Halsey Street, Suite 599Portland, OR 97213Tax ID 94-3078543, Senior Director, Corporate and Foundation Relations, Investing in Providence's Nursing Workforce, Work2BeWell: Improving Teen Mental Health, Mental Health & Well-Being Innovation Challenge, Community Health Foundation - Southern Oregon, Hospice and Home Care Foundation Snohomish, Notice of Nondiscrimination and Accessibility Rights. Thurs., Nov. 23: 8 a.m. - 12 p.m. They are visionaries, innovators, and leaders whose generosity has developed a small community hospital into a world-class health center. Prior Authorization review will determine if the proposed Service is eligible as a Covered Service or if an individual is a Member at the time of the proposed Service. By Nancy Brands Ward Almost everyone experiences problems with digestive health at some point. Labor Day - Monday, September 4 Santa Rosa Urgent Care or If an Out-of-Network Provider charges more than your plan allows, that Provider may bill you directly for the additional amount. Expedited determinations will be made within 24 hours of receipt. Laguna Beach, CA 92651 Providence Foundations of Oregon P.O. We may use or share your information with others to help manage your health care. (442) 936-3626, St. Joseph Hospital, Orange Participating Pharmacies may not charge you more than your Copayment of Coinsurance, except when Deductible and/or coverage limitations apply. Customer Service Assistance : (800) 627-8106 Patient Billing Assistance : (855) 221-8046 Self Help: High Desert | Northern California | Orange County | South Orange County Email: [email protected] 1801 Lind Ave SW . 4th of July - Tuesday, July 4 IN SERVICE TO OUR MISSION, PROVIDENCE PARTNERS WITH COMMUNITY-BASED ORGANIZATIONS TO IDENTIFY URGENT HEALTH NEEDS AND ENVIRONMENTAL FACTORS THAT ARE IMPACTING THE WELL-BEING OF OUR COMMUNITIES. Virtual Appointment | Email Us | Map It Call 911 if you have a life-threatening emergency. . Newport Beach, CA 92663 SAINT JOHN'S PHYSICIAN PARTNERS (SJPP) HAS BEEN SERVING THE SANTA MONICA AND WESTSIDE LOS ANGELES COUNTY COMMUNITIES SINCE 2018, AND HAS QUICKLY ESTABLISHED A REPUTATION FOR PERSONALIZED, HIGH-QUALITY, COORDINATED CARE.TODAY, SJPP IS A 1206(L) MEDICAL FOUNDATION WITH 195 HIGHLY ENGAGED AND SATISFIED PROVIDERS INCLUDING 151 PHYSICIANS, 21 NURSE PRACTITIONERS, AND 15 PHYSICIAN ASSISTANTS. SANTA MONICA (Feb. 2, 2023) - Living the Providence tradition of outreach to the under-served, Providence Saint John's Health Center and the Saint John's Health Center Foundation recently provided grants totaling more than $2 million to 33 programs across the Westside. Heritage medical /PRNewswire/ -- Providence Health & Services announced today a new affiliation with Pacific Neuroscience Institute, a multispecialty group of more than 30. Sun., Dec. 31: 9 a.m. - 6 p.m. (949) 499-1311, CHOC Childrens In-network providers will request any necessary prior authorization on your behalf. 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. A nationally renowned 266-bed hospital, Saint Johns Health Center is a complex and vibrant hospital that has been serving the Santa Monica and Westside Los Angeles communities since 1942. Sun: 9 a.m. - 2 p.m. (Last walk-in patient at 1:30 p.m.), 1621 W. Imola Ave., Visit HealthCare.gov to determine if you are eligible for the Advance Premium Tax Credit. A policyholder shall be age 18 or older. T: Claim your profile for free. Wed., Nov. 27 - 8 a.m.- 5 p.m. Please note hours and availability of our urgent cares may be impacted. Christmas Eve/Day For needs outside of our hours, please visit our nearby Main: 310-829-8424. . The information contained in this website is only for general information purposes. Day or night, use our advanced scheduling tool to view available times Hesperia, CA 92345, 26800 Crown Valley Pkwy., Suite 150 For more information about the Pacific Neuroscience Symposium, contact us at 310-582-7640. wherever you are. Sun., Dec. 24: 9 a.m. - 6 p.m. Coverage is subject to the medical cost management protocols established by Providence to make sure Covered Services are cost effective and meet our standards of quality. Copayments or Coinsurance specified as not applicable toward the Deductible in the Benefit Summary. Providence Saint Johns Medical Foundation. Sun., Dec. 24: 8 a.m. - 5 p.m. Mon - Sat: 8 a.m. - 8 p.m.; Sun: 9 a.m. - 5 p.m. Holiday Hours: 8 a.m. - 5 pm. Innovative research directly impacts health center patients with rare immediacy. Sun., Dec. 31: 8 a.m. - 5 p.m. Tuesday, Sept. 7: 8 a.m. - 8 p.m. Holiday Hours: Santa Ana, 92705 Mission Viejo, CA 92691 If you choose a brand-name drug when a generic-equivalent is available, any difference in cost for Prescription Drug Covered Services will not apply to your Calendar Year Deductibles and Out-of-Pocket Maximums. Laguna Niguel, CA 92677. Yorba Linda, CA 92886 This organization has no recorded board members. Durable medical equipment, including but not limited to: Certain infused prescription drugs administered in a hospital-based infusion center, Member ID number and plan number (refer to your member ID card), Provider name, address and telephone number, Date of admission or date services are to begin, Mail it to: Providence Health Plan, Appeals and Grievances Department, PO Box 4158, Portland, Oregon 97208-4158. 2141 Harbor Blvd., Suite 18000 Read the latest news from Providence Health Plan, Read the latest news from Providence Health Plan Learn more about our commitment to achieving True Health, together. Thank you for your interest in Providence. Clinical trials give patients access to leading-edge treatments and procedureswhile facilitating research discoveries. 925 Corporate Center Pkwy., Suite A Distinguished by its patient care programs, it is also the anchor for two outstanding partners, the Saint Johns Cancer Institute and the Pacific Neuroscience Institute. 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. WE ACT TO PROVIDE SHORT-TERM SOLUTIONS AND ENVISION LONG-TERM RESULTS BY WISELY INVESTING IN OUR COMMUNITIES TO HELP BUILD A MORE EQUITABLE AND SUSTAINABLE FUTURE. Providence Saint John's Health Center 2121 Santa Monica Blvd. Expedited coverage determinations will be made if waiting the standard timeframe will cause serious harm to your health. A request for payment that you or your health care Provider submits to Providence when you get drugs, medical devices, or receive Covered Services. The following information is provided to help you access care under your health insurance plan. We recommend you please call to confirm our hours before your departure. Mon., Jan. 1: 8 a.m. - 5 p.m. 17043 Main St., Your physician will need to make a statement supporting why this request is necessary, and the Providence Pharmacy team will review and respond to your request within three business days, unless the pharmacy team requires additional information from your physician before making a determination. If your premium is not received by the last day of the month, you will enter a grace period which begins retroactively on the first of the month. You may submit a request to reconsider that decision at least 24 hours before the course of treatment is scheduled to end. Please use this form for non-urgent, non-medical questions or comments. 1 Hoag Dr. Providence Saint John's Health Center Thanksgiving 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. We are ready to help with any question you may have. A retroactive denial may result in Providence asking you or your Provider to refund the Claim payment. Christmas Eve / Christmas Day (949) 364-1400, Mission Hospital, Laguna Beach If you fail to obtain a Prior Authorization when it is required, any claims for the services that require Prior Authorization may be denied. 27700 Medical Center Rd. T: (707) 861-6380, Hoag Memorial Hospital Presbyterian Sun., Dec. 31: 8 a.m. - 5 p.m. SAINT JOHN'S PHYSICIAN PROVIDERS PROVIDES THE LATEST IN PRIMARY CARE ACCESS AND HIGH-QUALITY SPECIALTY CARE WITH A STRONG COMMITMENT TO ITS CORE SERVICE LINES: PRIMARY CARE (INTERNAL MEDICINE, FAMILY PRACTICE, PEDIATRICS, OB/GYN) CARDIOVASCULAR SERVICES, ONCOLOGY, ORTHOPEDICS, AND NEUROSCIENCES. Our clinical team of experts will review the prior authorization request to ensure it meets current evidence-based coverage guidelines. Although a treatment was prescribed or performed by a Provider, it does not necessarily mean that it is Medically Necessary under our guidelines. (949) 764-4624, Mission Hospital, Mission Viejo That amount is in addition to any Deductible, Copayment, or Coinsurance for which you may be responsible, and does not count towards your Out-of-Pocket Maximum. Santa Rosa Urgent Care or Laguna Niguel, CA 92677. TO ACHIEVE OUR VISION OF HEALTH FOR A BETTER WORLD, OUR PROVIDENCE FAMILY OF ORGANIZATIONS FOCUSED ON FOUR COMMUNITY INITIATIVES IN 2020:1 FOUNDATIONS OF HEALTH;2 REMOVING BARRIERS TO CARE;3 COMMUNITY RESILIENCE; AND4 INNOVATING FOR THE FUTURE.WE CHOSE THESE FOCUS AREAS BECAUSE THEY ARE ALL FOUNDATIONAL TO HEALTH AND WELL-BEING, REPRESENTING IDENTIFIED NEEDS THAT ARE INTEGRAL TO IMPROVING QUALITY OF LIFE.PROGRAM SERVICE ACCOMPLISHMENTSPROVIDENCE SAINT JOHN'S MEDICAL FOUNDATION D.B.A. We will send an Explanation of Benefits (or EOB, see below) to you that will explain how your Claim was processed. With MyChart you can message your care team, schedule Hesperia, CA 92345, 26800 Crown Valley Pkwy., Suite 150 Open Daily, 8 a.m. - 8 p.m. If Providence needs additional information to process the request, we will notify you and your Provider within two business days of receipt, and you or your provider will have 15 days to submit the additional information. Project Ronin's groundbreaking software system aims to revolutionize cancer care, improve outcomes. See your Individual Plan Contract for more information on external review. Day, Thanksgiving, Christmas, New Year's Day. Under no circumstances (with the exception of Emergency and Urgent Care) will we cover Services received from an Out-of-Network Provider/Facility unless we have Prior Authorized the Out-of-Network Provider/Facility and the Services received. The following costs do not apply towards your Deductible: The Oregon Health Insurance Marketplace, where people can shop for plans and receive tax credits, including Advance Premium Tax Credits, to help pay for their Premiums and Covered Services. Mission Viejo, CA 92691. 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, about GuideStar Pro. organizations, including the Orange County Medical Association for Physicians and availability. Claims involving concurrent care decisions. Mon., Jan. 1: 8 a.m. - 5 p.m. 15855 Pomona Rincon Rd, Officers, directors, trustees, and key employees, Analyze a variety of pre-calculated financial metrics, Access beautifully interactive analysis and comparison tools, Compare nonprofit financials to similar organizations, Revenue and expense data for the current fiscal year, CEO, Board Chair, and Board of Directors information, *with the ability to download the data for 2020, 2019, 2018. Labor Day - Monday, September 4 27700 Medical Center Rd., 5th Floor Memorial Day - Monday, May 29 Open seven days a week, daily: 8 a.m. - 8 p.m. 12550 Hesperia Rd., Suite 100 For expedited requests, Providence will notify your Provider or you of its decision within 24 hours after receipt of the request. Payments for most Services are made directly to Providers. T: Providence Physician Enterprise (PE) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Chief Executive, Providence Saint Johns Health Center & Saint Johns Cancer Institute, Notice of Nondiscrimination and Accessibility Rights. Christmas Eve / Christmas Day Learn more about our mission, vision and values. Sun., Dec. 24: 8 a.m. - 5 p.m. Sun., Dec. 31: 8 a.m. - 5 p.m. In addition to its medical groups, Heritage supports six distinct affiliated physician networks throughout the state. Holiday Hours: 8 a.m. - 5 pm. Tuesday, Sept. 7: 8 a.m. - 8 p.m. Services or supplies your medical care Provider needs to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine. 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. Christmas Eve / Christmas Day Assistance Outside of Providence Health Plan. For example, we might talk to your Provider to suggest a disease management program that may improve your health. Services not covered because Prior Authorization was not obtained; Services in excess of any maximum benefit limit; Fees in excess of the Usual, Customary and Reasonable (UCR) charges; and. Out-of-network providers may not, in which case you will need to submit any needed requests for prior authorization. 4th of July - Tuesday, July 4 Day, Thanksgiving, Christmas, New Year's Day. Want to see how you can enhance your nonprofit research and unlock more insights? T: Martin Luther King Jr. Day - Monday, January 16 Providence St. Vincent Medical Foundation supports health and wellness in our community, patient care for those who are vulnerable and the latest medical research. Premium is due on the first day of the month. The monthly rates set by us and approved by the Director as consideration for benefits offered under this Contract. : CLOSED Programs and results. You can obtain Marketplace plans by going to HealthCare.gov. If any information listed below conflicts with your Contract, your Contract is the governing document. Multiple Locations Providence will not pay for Claims received more than 365 days after the date of Service. 1100 W. Stewart Dr. Santa Rosa, CA 95405, , 1162 Montgomery Dr., 2nd Floor Premium rates are subject to change at the beginning of each Plan Year. Note: Due to high volume, please call before departure to verify our hours Making a partial Premium payment is considered a failure to pay the Premium. Prior Authorized determinations are not a guarantee of benefit payment unless: A physician, Womens Health Care Provider, nurse practitioner, naturopath, clinical social worker, physician assistant, psychologist, dentist, or other practitioner who is professionally licensed by the appropriate governmental agency to diagnose or treat an injury or illness and who provides Covered Services within the scope of that license. Holiday Hours: Holiday Hours: 8 a.m. - 5 pm. Sun., Dec. 31: 8 a.m. - 5 p.m. Services that are not considered Medically Necessary will not be covered. 18310 Highway 18, We will notify you again within 45 days if additional time is needed. If you have questions about any of the information listed below, please call customer service at 503-574-7500 or 800-878-4445. With 52 hospitals, over 1,000 physician clinics, senior services, supportive housing, and many other health and educational services, the health system and its partners employ more than 120,000 caregivers serving communities across seven statesAlaska, California, Montana, New Mexico, Oregon, Texas and Washingtonwith system offices in Renton, WA, and Irvine, CA. SANTA MONICA, Calif., Oct. 6, 2022 /PRNewswire/ -- Providence Saint John's Health Center has . Providence is a national, nonprofit Catholic health system comprising a diverse family of organizations and driven by a belief that health is a human right. 1000 Trancas St. Apple Valley, CA 92307, 400 North McDowell Blvd., Petaluma, CA 94954 (707) 525-5300. Prior authorization is not a guarantee of coverage. ( 657 ) 500-0229 Santa Rosa, CA 92868 New Year 's Day Providence not! Oregon Foundations contact us we want to see how you can obtain Marketplace Plans by going HealthCare.gov. 9 a.m. - 5 p.m, vision and values up to a supply... 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