Accepted Health Plans

Mission Hospital is a preferred provider for most major insurance plans for both inpatient and outpatient services. Please make a selection from the links below to learn more about that type of health insurance plan.

Senior Managed Care Plans
HMO and POS Health Plans
Preferred Provider Organizations
Exclusive Provider Organization
Government Sponsored Plans
Indemnity Plans
Medicare
Medi-Cal Managed Care Plans
Behavioral Health

Senior Managed Care Plans

Senior HMO Plans, known as Medicare Advantage (MA), are an option for people eligible for both Medicare Part A and B benefits. To enroll in a MA plan, a person must sign over his or her Medicare benefits to the selected MA plan. It is important to understand that the MA plan is an HMO, and therefore the same processes described under the HMO must be adhered to in order to receive benefit coverage.

To be able to receive services at Mission Hospital your Primary Care Physician must be part of one of the physician groups listed below. To ensure that you may receive services at Mission Hospital, you must make sure that both the physician group and the health plan are contracted with Mission Hospital.

The Senior HMO plans accepted at Mission Hospital are:

• Secure Horizons through MonarchHealthcare
• SCAN through Monarch Healthcare

Health Maintenance Organization (HMO) And Point-Of-Service (POS) Health Plans

HMO and POS Plans provide patients with a list of contracted physicians and require that the patient choose a Primary Care Physician (PCP) at the time of enrollment. The PCP generally will coordinate the patient's entire healthcare.

To be able to receive services at Mission Hospital, your PCP must be part of one of the physician groups listed below. To ensure that you may receive services at Mission Hospital, you must make sure that both the physician group and the health plan are contracted with Mission Hospital.
Physician groups at Mission Hospital are:

• Mission Hospital Affiliated Physicians
• Monarch Healthcare
• Bristol Park Medical Group

HMO/POS plans accepted at Mission Hospital are:

• Aetna/US Healthcare HMO
• Aetna/US Healthcare Managed Choice POS
• Blue Cross California Care HMO
• Blue Cross California Care POS
• Blue Shield of California HMO
• Blue Shield of California Select Choice POS
• Cigna HMO
• Cigna POS
• Great West Healthcare POS (formerly One Health Plan)
• Health Net HMO
• Health Net POS
• Pacificare HMO
• Pacificare POS
• United Healthcare Select Plus POS

Preferred Provider Organizations

Preferred Provider Organization (PPO) Plans make arrangements with physicians, hospitals and other caregivers to provide services at a discounted payment. Under a PPO, when a patient receives services from a contracted provider, the cost will be less than if a non-contracted provider renders the services. When selecting contracted providers, there is not a restriction to remain within a specific physician group.

The PPO plans accepted at Mission Hospital are:

• Aetna PPO
• Affiliated Health Funds
• Beech Street
• Blue Cross Prudent Buyer
• Blue Shield of California PPO
• Cigna PPO (formerly Great West Healthcare PPO, previously One Health Plan PPO)
• Community Care Network (CCN)
• Corvel
• First Health PPO
• Health Net PPO
• Health Payors Organization
• InterPlan Corporation
• Managed Care Inc.
• Multiplan (includes formerly known plans Admar and Benefit Panel Services)
• Orange County Preferred Provider Organization
• Pacificare PPO
• PPO Next (formerly Preferred Health Network)
• Private HealthCare Systems PPO
• Three Rivers Provider Network
• United HealthCare Options PPO
• USA Managed Care Organization

The Senior PPO plans accepted at Mission Hospital are:

• Blue Cross Freedom Blue PPO

Exclusive Provider Organization

An Exclusive Provider Organization (EPO) is usually made up of a group of physicians, one or a small number of hospitals, and other healthcare providers who contract either with an insurer or directly with an employer to provide services for enrollees/employees. The arrangement is similar to a PPO; however, enrollees must receive their health services from only the designated exclusive providers in order for any portion of the care to be covered by the insurance carrier.

The following is a list of EPO plans accepted by Mission Hospital:

• Aetna Select Choice EPO
• First Health Network (EPO)
• Orange County Foundation for Medical Care EPO
• Private Healthcare Systems EPO

Government Sponsored Plans

Government sponsored plans are usually available to active duty members of the military, qualified family members, non-Medicare eligible retirees and their family members and survivors of uniformed services.

The following is a list of Government Sponsored plans accepted by Mission Hospital:

• TriCare (CHAMPUS)

Indemnity Plans

Indemnity Plans are traditional insurance programs where a patient may seek services from any provider of their choice, and the person is responsible for a deductible and co- insurance. These plans generally cover only medically necessary services.

Mission Hospital accepts all indemnity insurance plans.

Medicare

Medicare is complex, and requires thorough understanding of the program. To assist, Mission Hospital provides an extensive list of resources, which can be accessed by calling (949) 364-1770.

Medi-Cal Managed Care Plans

The Federal Government provides medical benefits for eligible low income and disabled persons needing healthcare. In Orange County, the California Government sponsored MediC-al program is a managed care program operated by Blue Cross Healthy Families.

To be able to receive services at Mission Hospital through a Medi-Cal Managed Care program, your PCP must be part of one of the following networks:

• United Care Medical Group
• CHOC Health Alliance
• Cal Optima Direct

Behavioral Health

The following is a list of managed behavioral health plans accepted by Mission Hospital:

• Aetna
• APS
• Blue Cross
• Blue Shield
• Champus
• Cigna Behavioral Health
• Health Net
• Managed Health Networks
• PacifiCare
• United Behavioral Health Service
• United Healthcare
• Value Options