Mon., Dec. 25: 9 a.m. - 1:00 p.m. 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 are seeing a non-participating provider, you should contact that providers office and arrange for the necessary records to be forwarded to us for review. to get more GuideStar Nonprofit Profile data today! Santa Rosa Urgent Care or Sign in. Providence will let your Provider or you know if the Prior Authorization request is granted within two business days after it is received. Whether it's live chat, sending us a message or calling our customer Shield Concierge: Phone: (855) 599-2657 . October 30. Learn more and Register Now! Providence will notify you if an approved ongoing course of treatment is reduced or ended because of a medical cost management decision. You are essential to the health and well-being of our Member community. THE PROVIDENCE FAMILY INCLUDES:-PROVIDENCE ACROSS SEVEN WESTERN STATES-COVENANT HEALTH IN WEST TEXAS-PROVIDENCE FACEY MEDICAL FOUNDATION IN LOS ANGELES, CA-HOAG MEMORIAL HOSPITAL PRESBYTERIAN IN ORANGE COUNTY, CA-KADLEC IN SOUTHEAST WASHINGTON-PACIFIC MEDICAL CENTERS IN SEATTLE, WA-SWEDISH HEALTH SERVICES IN SEATTLE, WA2020 - AN UNPRECEDENTED YEAROVER THE PAST YEAR, OUR COMMUNITIES HAVE FACED EXTRAORDINARY CHALLENGES. Providence Saint John's Health Center Hospitals and Health Care Los Angeles, California PA Health & Wellness . If any information listed below conflicts with your Contract, your Contract is the governing document. Due to high volume, please call before departure to verify our hours and Hours may vary during seasonal times. Mon., Jan. 1: 9 a.m. - 6 p.m. 1450 Medical Center Dr., 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: Saint John's Physician Partners combines highly-experienced primary care physicians working in partnership with our world-renowned specialists, all delivering the most personalized patient experiences in a community setting. Providence St. John's Health Center in Santa Monica, CA is rated high performing in 4 adult specialties and 14 procedures and conditions. (Please note last patient check in is at 7:30 p.m.) 3300 Renner Dr. Claims involving concurrent care decisions. 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. In Santa Monica California, Providence Saint Johns Medical Foundation has 222 members working at 33 different practice locations. HealthCare4PPL.com does not provide medical advice, diagnosis or treatment. 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. Your Coinsurance for a Covered Service is shown in the Benefit Summary, and is a percentage of the charges for the Covered Service. 27700 Medical Center Rd., 5th Floor As expressions of Gods healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable. Please verify with your providers office to confirm Thurs., Nov. 23: 8 a.m. - 12 p.m. 925 Corporate Center Pkwy., Suite A These prescriptions require special delivery, handling, administration and monitoring by your pharmacist. 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. Orange, CA 92868 Our providers are here, virtually and in-person, to address your medical needs. If you end up on hold the next time you call, use our in-queue callback option. view your physician's open schedule up to three months out and book Mon., Jan 17 - CLOSED. Your physician may send in this statement and any supporting documents any time (24/7). What we aim to . I have about 7 years of experience working as a Registered Nurse (RN) in acute care setting. Register now. THESE EFFORTS SEEK TO MITIGATE IMMEDIATE CHALLENGES WHILE FINDING SOLUTIONS TO DEEP-ROOTED PROBLEMS, IMPROVE ACCESS TO HEALTH CARE, AND ADVANCE INNOVATIVE CARE MODELS TO MEET THE EVOLVING NEEDS OF OUR COMMUNITIES.CARING FOR OUR COMMUNITIES HAS NEVER BEEN MORE IMPORTANT. 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. We will send an Explanation of Benefits (or EOB, see below) to you that will explain how your Claim was processed. Napa, CA 94558 Mission Viejo, CA 92691. Your Plan only pays for Covered Services received from approved, Prior Authorized Out-of-Network Providers at rates allowed under your plan. You go to a hospital emergency room to have stitches removed, rather than wait for an appointment in your doctors office. Messages should not contain personal health information. You may submit a request to reconsider that decision at least 24 hours before the course of treatment is scheduled to end. About Providence Medical Foundation Part of Providence, Providence Medical Foundation (Heritage) was founded in 1994 and includes eight medical groups throughout California. Offer a medical therapeutic value at least equal to the Covered Service that would otherwise be performed or given. The following Out-of-Pocket costs do not apply toward your Out-of-Pocket Maximum: A claim that requires further information or Premium payment before it can be fully processed and paid to the health care Provider. For expedited requests, Providence Health Plan will notify your provider or you of its decision within 24 hours after receipt of the request. 18310 Highway 18, Community Health Needs Assessments and Improvement Plans, Notice of Nondiscrimination and Communication Assistance. A letter will be sent to you and your provider detailing the reason for the denial and explaining your appeal rights if you feel the denial was issued in error. Mon - Sun: CLOSED for improvements until Fall 2021, 2501 E. Chapman Ave., Suite 101 Holiday Hours: 8 a.m. - 5 pm. If this happens, you will need to pay full price for your prescription at the time of purchase. Box 3375 Portland, OR 97208 Email 503-203-0788 Attention: Medical Records If it is your nonprofit, add a problem overview. to its medical groups, Heritage supports six distinct affiliated physician 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. Contact us. Rapid Response team members: Dr. Jason Tarpley, Melanie Lynch, RN, John Michael Matilla, RN, Alex Ortega, RN, and Dr. Frances Fan. | Disclaimer | Notice of Privacy Practice | Non-discrimination & Communication Assistance To qualify for expedited review, the request must be based upon urgent circumstances. (657) 445-2854, Healdsburg Hospital Mission Viejo, CA 92691. Our right of recovery applies to any excess benefit, including, but not limited to, benefits obtained through fraud, error, or duplicate coverage relating to any Member. Open daily from 8 a.m. to 8 p.m. 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. Written by Nancy Sokoler Steiner When Grace Cherry, RN, was only 3 years old, she would take [], Motown founder and rock legend Berry Gordy embraces his own good health and reaches out to people in need. Orange, CA 92868 An inside look at how youre helping us save lives. Providence St. Vincent Medical Foundation supports health and wellness in our community, patient care for those who are vulnerable and the latest medical research. Up and Down arrows will open main level menus and toggle through sub tier links. Santa Monica, CA 90404 Fullerton, CA 92835. (657) 888-7179, St. Jude Heritage Medical Group - Diamond Bar When we take care of each other, we tighten the bonds that connect and strengthen us all. All Covered Services are subject to the Deductible, Copayments or Coinsurance and benefit maximums listed in your Benefit Summary. Is this your nonprofit? Let us help you find the plan that best fits your needs. Usually, Providers file claims with us on your behalf. Call 911 if you have a life-threatening emergency. 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. clinics in Sonoma, Mendocino and Lake Countries will be closed on Wednesday, 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 allow 15 calendar days for you or your Provider to submit the additional information. Sun: 9 a.m. - 5 p.m. A determination that relates to eligibility is obtained no more than five business days prior to the date of the Service. Contact Us. We'll use your location to find clinics, hospitals and doctors closest to you. We recommend you please call to confirm our hours before your departure. 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. Our clinic is walking distance from Pacific Neuroscience Institute, Providence Saint John's Health Center and Tower Saint John's Imaging. Disclaimer |Non-discrimination and Communication Assistance |Notice of Privacy Practice |Terms of Use & Privacy Policy, Providence Health Plan, 3601 SW Murray Blvd., Suite 10, Beaverton, Oregon 97005(if mailing, use only the post office box address listed above). Thanksgiving Want to see how you can enhance your nonprofit research and unlock more insights? This organization has no recorded board members. We Save Lives With the Help of Berry Gordy. Windsor Urgent Care Locations. All inpatient hospital admissions (not including emergency room care). If the Premium is not paid by the last day of the grace period specified in the notice, your coverage will be terminated with no further notice on the last day of the month through which Premium was paid. If you have questions about any of the information listed below, please call customer service at 503-574-7500 or 800-878-4445. Santa Monica, CA 90404. Programs and results. Thanksgiving 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. Providence Saint Johns Medical Foundation Renton, WA. Not all drugs are covered for more than a 30-day supply, including compounded medications, drugs obtained from specialty pharmacies, and limited distribution pharmaceuticals. T: Claim your profile for free. Mon - Sun: CLOSED for improvements until Fall 2021, 2501 E. Chapman Ave., Suite 101 925 Corporate Center Pkwy., Suite A Orange, CA 92868 4th of July - Tuesday, July 4 Build relationships with key people who manage and lead nonprofit organizations with GuideStar Pro. Thanksgiving 1000 Trancas St. Already have a GuideStar Account? Learn more about our mission, vision and values. Wed., Nov. 27 - 8 a.m.- 5 p.m. You can find your Contract here. 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. Preferred Retail: A Network Pharmacy that allows up to a 90-day supply of maintenance prescriptions and access to up to a 30-day supply of short-term prescriptions. Services that involve prescription drug formulary exceptions. We will make an exception if we receive documentation that you were legally incapacitated during that time. 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.