For a complete list of services and treatments that require a prior authorization click here. Holiday Hours: Martin Luther King Jr. Day - Monday, January 16 Thurs., Nov. 23: 8 a.m. - 12 p.m. 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. to its medical groups, Heritage supports six distinct affiliated physician Mission Viejo/Laguna Beach For standard requests, Providence Health Plan will notify your provider or you of its decision within 72 hours after receipt of the request. Martin Luther King Jr. Day - Monday, January 16 Thurs., Nov. 23: 8 a.m. - 12 p.m. create an account to view Form(s) 990 for 2020, 2019 and 2019. Windsor, CA 95492, St. Mary Medical Center Providence Saint Johns Medical Foundation is a Medical Group that has 60 practice medical offices located in 1 state 12 cities in the USA. Get paid faster and reduce paper waste. We reserve the right to make substitutions for Covered Services; these substituted Services must: * If you fail to obtain a Prior Authorization when it is required, any claims for the services that require Prior Authorization may be denied. Sun., Dec. 31: 8 a.m. - 5 p.m. Sign up for a free MyChart account to access your online health record 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. We're here to supply you with the support you need to provide for our members. Mon., Dec. 25: 8 a.m. - 12:00 p.m. Click here to resend it.). 4th of July - Tuesday, July 4 Your request for external review must be made to Providence Health Plan in writing within 180 days of the date on the Explanation of Benefits, or that decision will become final. Santa Rosa, CA 95405, , 1162 Montgomery Dr., 2nd Floor These prescriptions require special delivery, handling, administration and monitoring by your pharmacist. Multiple locations (707) 525-5300, St. Joseph Hospital, Eureka Download hospital map & directions. BUT EVEN DURING THE MOST DIFFICULT PUBLIC HEALTH CRISIS OF OUR TIME, COMMUNITIES HAVE ALSO SHOWN REMARKABLE STRENGTH AND RESOLVE. All inpatient, residential, day, intensive outpatient, or partial hospitalization treatment Services, and other select outpatient Services must be Prior Authorized. Thanksgiving (Please note last patient check in is at 7:30 p.m.) 18300 CA-18 Log in to access your myProvidence account. Please note hours and availability of our urgent cares may be impacted. 1514 S. Valley Vista Dr. We will work to reschedule all appointments and appreciate Providence Saint John's Health Center 2121 Santa Monica Blvd. to more than 2,000 providers in virtually every specialty. The Prescription Drug Benefit provides coverage for prescription drugs which are Medically Necessary for the treatment of a covered illness or injury and which are dispensed by a Network Pharmacy pursuant to a prescription ordered by a Provider for use on an outpatient basis, subject to your Plans benefits, limitations, and exclusions. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers. Christmas Eve / Christmas Day 1165 Montgomery Dr. (866) 481-2003, St Jude Heritage Medical Group Providence Saint John's Health Center 2121 Santa Monica Blvd. 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. Thanksgiving Build relationships with key people who manage and lead nonprofit organizations with GuideStar Pro. 1201 W. La Veta Ave. Mon., Dec. 25: 8 a.m. - 12 p.m. 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. You can avoid retroactive denial by making timely Premium payments, and by informing your customer service representative (800-878-4445) if you have more than one insurance company that Providence needs to coordinate with for payment. 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: We are ready to help with any question you may have. NEARLY EVERY CORE SERVICE LINE AT PROVIDENCE SAINT JOHN'S PHYSICIAN PARTNERS PARTICIPATES IN RESEARCH OR CLINICAL TRIALS.SJPP WAS BORN FROM THE PHYSICIANS ON STAFF AT PROVIDENCE SAINT JOHN'S HEALTH CENTER. (714) 871-3280, CHOC Childrens We may not pay for the extra day. Mon - Fri: 8 a.m. - 7:30 p.m. If you do not pay the Premium within 10 days after the due date, we will mail you a Notice of Delinquency. about GuideStar Pro. 2121 Santa Monica Blvd. Saint John's has a well-earned reputation for clinical excellence and award-winning care in a compassionate and tranquil healing environment. Sun., Dec. 31: 8 a.m. - 5 p.m. Providence will then notify you of its reconsideration decision within 24 hours after your request is received. Your Provider suggests a treatment using a machine that has not been approved for use in the United States. Santa Monica, CA 90404 . Santa Ana, CA 92705, Thurs., Nov. 23: 8 a.m. - 12:00 p.m. 4th of July - Tuesday, July 4 Mon Sat: 9 a.m. 9 p.m.; Sun: 9 a.m. 5 p.m. Check your inbox or spam folder to confirm your subscription. We believe you are entitled to comprehensive medical care within the standards of good medical practice. Thanksgiving 707-431-6300, Petaluma Valley Hospital Sun., Dec. 24: 8 a.m. - 5 p.m. Within two business days of the receipt of the additional information, Providence will complete its review and notify you and your Provider of its decision. and availability. Virtual Appointment | Email Us | Map It 4th of July - Tuesday, July 4 Tuesday, Sept. 7: 8 a.m. - 8 p.m. Providence will only pay for Medically Necessary Covered Services. 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. Providence Saint Johns Medical Foundation Renton, WA. Want to see how you can enhance your nonprofit research and unlock more insights? If you are in a situation where benefits need to be coordinated, please contact your customer service representative at800-878-4445 to ensure your Claims are paid appropriately. Open seven days a week, daily: 8 a.m. - 8 p.m. 12550 Hesperia Rd., Suite 100 Mon., Dec. 25: 9 a.m. - 1:00 p.m. 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. Mon - Sat: 8 a.m. - 8 p.m. The site navigation utilizes arrow, enter, escape, and space bar key commands. THE PROVIDERS RESPONSIBLE FOR THESE ACHIEVEMENTS NOW MAKE UP THE SJPP MEDICAL FOUNDATION.THROUGH THE DEDICATION AND COLLABORATIVE EFFORTS OF THE COMMUNITY, FRIENDS, PATRONS, PHYSICIANS, NURSES, STAFF AND VOLUNTEERS, PROVIDENCE SAINT JOHN'S ALONG WITH SJPP CONTINUES ITS WORLD-CLASS TRADITION ESTABLISHED MORE THAN 70 YEARS AGO BY PROVIDING BREAKTHROUGH MEDICINE IN AN ENVIRONMENT OF INSPIRED HEALING.YEAR AFTER YEAR, PROVIDENCE SAINT JOHN'S HEALTH CENTER ALONG WITH ITS STAFF, PHYSICIANS AND NURSES ARE RECOGNIZED BY THE NATION'S LEADING HEALTHCARE RATING ORGANIZATIONS, THE MEDICAL COMMUNITY AND THE MEDIA FOR CLINICAL EXCELLENCE AND EXCEPTIONAL PATIENT CARE. Copyright 2023 Providence Health Plan, Providence Plan Partners, and Providence Health Assurance. If you have misplaced or do not have your Member ID Card with you, please ask your pharmacist to call us. and availability. A health care related procedure, surgery, consultation, advice, diagnosis, referrals, treatment, supply, medication, prescription drug, device or technology that is provided to a Member by a Qualified Practitioner. Premium is due on the first day of the month. To qualify for expedited review, the request must be based upon urgent circumstances. Fortuna, CA 95540 Open daily from 8 a.m. to 8 p.m. To qualify for expedited review, the request must be based upon exigent circumstances. Explore our directory for contact information for our Centers of Excellence, surgeons, doctors and caregivers. Let us help you find the plan that best fits you or your family's needs. What are the organization's current programs, how do they measure success, Orange, CA 92869. For services that do not involve urgent medical conditions, Providence will notify you or your provider of its decision within two business days after the prior authorization request is received. Deductible amounts are payable to your Qualified Practitioner after we have processed your Claim. We will notify you again within 45 days if additional time is needed. Providence St. Vincent Medical Foundation supports health and wellness in our community, patient care for those who are vulnerable and the latest medical research. Providence will notify your Provider or you of its decision within 72 hours after the Prior Authorization request is received. Copayments or Coinsurance specified as not applicable toward the Deductible in the Benefit Summary. Main: 310-829-8424. . Fullerton, CA 92835. Whether it's live chat, sending us a message or calling our customer All inpatient hospital admissions (not including emergency room care). If an Out-of-Network Provider charges more than your plan allows, that Provider may bill you directly for the additional amount. An EOB is not a bill. When purchasing a Prescription Drug, you may have to pay Coinsurance or make a Copayment. Typically, Providence individual plans do not pay for Services performed by Out-of-Network Providers. Combined, they provide residents access Payment will be made to the Policyholder or, if deceased, to the Policyholders estate, unless payment to other parties is authorized in writing. You're the heart of our members' health care. Santa Rosa, CA 95405 Our clinic is walking distance from Pacific Neuroscience Institute, Providence Saint John's Health Center and Tower Saint John's Imaging. Retail: A Network Pharmacy that allows up to a 30-day supply of short-term and maintenance prescriptions. Providence Saint Joseph Medical Center; Providence Saint John's Health Center; . Learn more about our mission, vision and values. 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. Chino Hills, CA 91709. Mission Viejo, CA 92691 of Excellence and the Integrated Healthcare Association with distinction to get more GuideStar Nonprofit Profile data today! Register now. Mission Viejo, CA 92691 Mon Sat: 9 a.m. 9 p.m.; Sun: 9 a.m. 5 p.m. Providence Saint Johns Health Center New Year's Eve/Day The information mainly comes from Centers for Medicare & Medicaid Services (CMS) published data, and while we endeavour to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information, products, services, user generated contents or related graphics or advertisings contained on the website for any purposes. 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. - Sat. All Covered Services are subject to the Deductible, Copayments or Coinsurance and benefit maximums listed in your Benefit Summary. Note: Due to high volume, please call before departure to verify our hours Christmas Eve/Day (657) 888-7179, St. Jude Heritage Medical Group - Diamond Bar If you end up on hold the next time you call, use our in-queue callback option. Once a final determination is made, you will be sent a written explanation of our decision. Our clinical team of experts will review the prior authorization request to ensure it meets current evidence-based coverage guidelines. The agreement between you and Providence that defines the obligations of both parties to maintain health insurance coverage. Memorial Day - Monday, June 29 You must file your appeal with Providence Health Plan in writing and within 180 days of the date on the Explanation of Benefits, or that decision will become final. Eureka, CA 95501 Payment of all Claims will be made within the time limits required by Oregon law. You will receive an explanation of benefits (EOB) from Providence after we have processed your Claim. There are 222 members in Santa Monica CA. If Providence needs additional information to complete its review, it will notify your Provider or you within 24 hours after the request is received. T: 949-282-1675 You may request a reconsideration of that decision by submitting an oral or written request at least 24 hours before the course of treatment is scheduled to end. Please use our convenient HIPAA-compliant online process to request your medical records from any US healthcare provider (including Providence Saint John's Health Center), and we will provide you with your medical records on your behalf quickly and securely. (Last patient accepted at 7:30 p.m.) 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. Healdsburg, CA 95448 Providence will notify you if an approved ongoing course of treatment is reduced or ended because of a medical cost management decision. Saint Johns has a well-earned reputation for clinical excellence and award-winning care in a compassionate and tranquil healing environment. 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. If you pay all outstanding premiums before the date specified in the notice of delinquency, Providence will reinstate your coverage and reprocess your prescription drug claims applying the applicable cost-share. If Providence denies your claim, the EOB will contain an explanation of the denial. Mon - Sat: 8 a.m. - 8 p.m. Closed: Martin Luther King Jr. Day, Easter, Memorial Day, Independence Day, Labor Deductibles, Copayments or Coinsurance for a Covered Service if indicated in any Benefit Summary as not applicable to the Out-of-Pocket Maximum. Closed: Martin Luther King Jr. Day, Easter, Memorial Day, Independence Day, Labor However, Claims for the second and third month of the grace period are pended. right to live chat with our service center. Certain Covered Services, such as most preventive care, are covered without a Deductible. Thurs., Nov. 23: 8 a.m. - 12:00 p.m. Claims involving concurrent care decisions. Sun., Dec. 24: 8 a.m. - 5 p.m. 18310 Highway 18, Rapid Response team members: Dr. Jason Tarpley, Melanie Lynch, RN, John Michael Matilla, RN, Alex Ortega, RN, and Dr. Frances Fan. 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. Let us help you find the plan that best fits your needs. Mon., Dec. 25: 8 a.m. - 12:00 p.m. . nor does Blue Shield make any recommendations, representations, claims, or guarantees regarding the practitioners, their availability, fees, services, or products. Sun., Dec. 24: 8 a.m. - 5 p.m. Labor Day - Monday, September 4 If additional information is needed to process the request, Providence will notify you and your provider. Mon., Jan. 1: 8 a.m. - 5 p.m. 6580 Hembree Ln., Suite 270 Memorial Day - Monday, June 29 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 recommend you consult your provider when interpreting the detailed prior authorization list. See also Prescription Drugs. See your Individual Plan Contract for more information on external review. Copayment means the fixed dollar amount that you are responsible for paying to a health care Provider when you receive certain Covered Services, as shown in the Benefit Summary. Martin Luther King Jr. Day - Monday, January 16 We will send an Explanation of Benefits (or EOB, see below) to you that will explain how your Claim was processed. Christmas Eve / Christmas Day If it is your nonprofit, add a problem overview. Help us get you more of the nonprofit information you need, including: An email has been sent to the address you provided. We probably would not pay for that treatment. We recommend you please call to confirm our hours before your departure. New Year's Eve/Day Want to see how you can enhance your nonprofit research and unlock more insights? Providence will complete its review and notify the requesting provider or you of its decision by the earlier of (a) 48 hours after the additional information is received or, (b) if no additional information is provided, 48 hours after the additional information was due. Prescription drugs must be purchased at one of our network pharmacies. New Year's Eve/Day If your formulary exception request is denied, you have the right to appeal internally or externally. Christmas Eve/Day 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. You can find Providence Health Plans nationwide pharmacy network using our pharmacy directory. Out-of-network providers may not, in which case you will need to submit any needed requests for prior authorization. We Save Lives With the Help of Berry Gordy. You are essential to the health and well-being of our Member community. Providence Health Plan Participating Pharmacies are those pharmacies that maintain all applicable certifications and licenses necessary under state and federal law of the United States and have a contractual agreement with us to provide Prescription Drug Benefits. Santa Rosa, CA 95405, , 1162 Montgomery Dr., 2nd Floor Providence Saint John's Health Center You can find your Contract here. APPROXIMATELY 250 CAREGIVERS (EMPLOYEES), DELIVERY ACCESSIBLE, COST-EFFECTIVE CARE IN 43 LOCATIONS THROUGHOUT LOS ANGELES COUNTY, WITH THE MAJORITY OF OUR SITES BEING BETWEEN PACIFIC PALISADES TO THE NORTH, BEVERLY HILLS TO THE EAST, AND TORRANCE TO THE SOUTH. IN 2020, WE INVESTED $1.7 BILLION IN COMMUNITY BENEFIT ACROSS SEVEN REGIONS, TO SUPPORT ORGANIZATIONS, PROGRAMS AND INITIATIVES THAT CREATE LASTING CHANGE AT THE COMMUNITY LEVEL. 27700 Medical Center Rd. Santa Monica, CA 90404: Cancer Clinic: Providence Saint John's Health Center 2121 Santa Monica Blvd. Mon., Jan. 1: 8 a.m. - 5 p.m. 15855 Pomona Rincon Rd, See the complete list of services that require prior authorization here. Christmas Eve/Day You may need to make multiple Copayments for a multi-use or unit-of-use container or package depending on the medication and the number of days supplied. 1801 Lind Ave SW . We'll use your location to find clinics, hospitals and doctors closest to you. A policyholder shall be age 18 or older. Support Hours: Mon - Fri: 7:30 a.m. - 5:30 p.m. However, benefits for Covered Services by an Out-of-Network Provider will be provided when we determine in advance, in writing, that the Out-of-Network Provider possesses unique skills which are required to adequately care for you and are not available from Network Providers. Associate Patient Services Specialist - International Heart Institute at Providence Medical Group Montana $2,000 Sign-On Bonus $2,000 sign-on bonus for eligible external hires that meet required . A tax credit you may be eligible for to lower your monthly health insurance payment (or Premium). Napa, CA 94558 For questions or concerns related to Providence Saint Johns Development Agreement with the City of Santa Monica, please contact: Christina Crawford, Manager Community Health Click the green "Help" or "Chat" button on the bottom Email:Christina Crawford. Your Coinsurance for a Covered Service is shown in the Benefit Summary, and is a percentage of the charges for the Covered Service. If you receive APTC, you are also eligible for an extended grace period (see Grace Period). A prior authorization is an approval you need to get from the health plan for some services or treatments before they occur. Sun., Dec. 31: 8 a.m. - 5 p.m. We reserve the right to deny payment for Services that are not Medically Necessary in accordance with our criteria. Hours may vary during seasonal times. For expedited requests, Providence will notify your Provider or you of its decision within 24 hours after receipt of the request. If you are hearing impaired and use a Teletype (TTY) Device, please call our TTY line at 711. Multiple Locations Prior authorization is not a guarantee of coverage. PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION 2121 SANTA MONICA BLVD SANTA MONICA, CA ZIP 90404 Phone: (310) 582-7312 Get Directions Mailing Address PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION 2020 SANTA MONICA BLVD STE 300 SANTA MONICA, CA ZIP 90404 Phone: (310) 582-7312 Location Map Authorized Official During the first month of the grace period, Providence will pay Claims for your Covered Services received during that time. 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