Reflecting our commitment to providing the best possible access to our services for our community, Community Hospital enjoys strong and long-lasting relationships with numerous insurance plans.
Aspire Health Plan
Aspire Health Advantage (HMO) and Aspire Health Advantage Plus (HMO) were designed with Monterey County beneficiaries in mind. Locally owned and managed, Aspire provides coordinated care, linking you, your doctors, and your hospital through a single Medicare plan.
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Anthem Blue Cross
Our agreement with Blue Cross — effective Jan. 1, 2011 — gives Community Hospital tier-one, preferred status with employers that offer a tiered system of health insurance coverage and continues our longstanding, in-network status for all other Anthem Blue Cross plans offered locally.
Employers currently offering a tiered benefit structure and receiving Community Hospital’s tier-one, preferred status are CalPERS (California Public Employees' Retirement System), and MPC (Monterey Peninsula College).
What does tier-one status mean at Community Hospital versus other lower-tier hospitals?
- You will pay the lowest out-of-pocket costs available through your Anthem Blue Cross plan.
- You will have the lowest level of co-pays and co-insurances.
- You will pay the lowest possible deductibles.
- You will have access, at the lowest possible costs, to all Community Hospital-based doctors for whom the hospital bills — for example, radiologists, radiation oncologists, pathologists, and Emergency department physicians, among others.
Our agreement with Blue Shield — effective Jan. 1, 2011 — now includes the hospital-based doctors for whom Community Hospital bills — for example, the specialties of radiology, radiation oncology, pathology, psychiatry, and emergency medicine, among others. All will be considered in-network providers on all Blue Shield plans. That means lower out-of-pocket costs for our patients for these doctors' services.
In addition, we are an in-network provider of the Blue Shield Life and Health insurance plan.
A Message to Blue Shield and Blue Cross Federal Employee Program Subscribers
Effective Jan. 1, 2011, Community Hospital of the Monterey Peninsula is a preferred provider under Blue Shield of California PPO plans. Under Community Hospital’s signed agreement with Blue Shield, coverage includes the hospital-based physicians for whom Community Hospital bills — specifically, the specialties of radiology, radiation oncology, pathology, psychiatry, and emergency medicine. Those specialties are now considered in-network providers on all Blue Shield plans.
As a result, Blue Shield members have lower out-of-pocket expenses for these doctors’ services.
APS Healthcare (behavioral health)
Aspire Health Plan
Community Health Plan (CHP)
Magellan Health Services
Managed Health Network (MHN)
Pacific Health Alliance (PHA)
U.S. Behavioral Health (United Behavioral Health/PacifiCare Behavioral Health)
Covered California (California’s health insurance exchange)
Two health plans are offered in Monterey County through the Covered California insurance exchange: Anthem Blue Cross and Health Net. Community Hospital is a participating provide with both of these health plans.
To find out whether and how fully a procedure is covered, please contact your insurer directly.
In September 2010, we received notice from Aetna that they intended to cancel our contract with them. Despite considerable effort on our part to reach an agreement similar to those we signed with Anthem Blue Cross and Blue Shield, in the end that didn't work for Aetna. We realize that Aetna's decision to terminate has been very painful and disruptive to our community, and we wish that the same positive outcome achieved for Blue Cross and Blue Shield patients had been possible for those with Aetna.
So, since January 1, 2011, Aetna has not considered Community Hospital of the Monterey Peninsula an in-network provider — except for emergency services only. For those with Aetna insurance, that means Aetna does not cover services at Community Hospital in the way it did in the past and its members have higher out-of-pocket costs to use Community Hospital and the hospital-based doctors for whom Community Hospital bills. Some self-insured employers will still offer plans where Community Hospital is covered at in-network rates, so check with your employer’s HR department.
This change also meant that, as of January 1, 2011, if a community-based doctor only has privileges at Community Hospital, that doctor's services are no longer be paid in the same way. That resulted in higher out-of-pocket expenses for those patients with Aetna.