How Do I Know if Scripps Is in My Health Plan?
Learn how to confirm Scripps providers are in-network
Learn how to confirm Scripps providers are in-network
Key Takeaways
- Know the exact health plan and network you're considering.
- Check that your Scripps doctors and care locations are in network.
- Verify coverage with your insurer before enrolling.
Choosing a health plan involves more than comparing premiums, deductibles and copays. It also determines which doctors, medical groups and hospitals you can access at the best in-network rate.
If you want to receive care at Scripps, checking whether your health plan includes your preferred Scripps doctors and facilities is an important step before you enroll.
“Open enrollment gives you an opportunity to look closely at your options and think about not only what your health plan costs, but where you want to receive your care,” says Anil Keswani, MD, corporate senior vice president and chief medical officer of ambulatory care and accountable care operations at Scripps Health.
“The plan you choose can affect whether you have access to the doctors, hospitals and convenient care options you trust,” Dr. Keswani says.
Scripps accepts most health insurance plans, including many HMO and PPO plans. However, health plan networks can vary, and participation can differ by physician, medical group, facility and specific plan.
Here’s how to find out whether the Scripps care you want is included in a health plan.
1. Start with the exact name of the health plan
Knowing the insurance company alone isn't enough.
An insurer may offer numerous HMO, PPO and other plans, each with a different provider network. Two people can have insurance from the same company but have access to different doctors and facilities.
When reviewing your options, write down the complete name of each plan you're considering. If your employer provides health insurance, you can usually find this information in your open enrollment materials or benefits portal.
If you already have insurance, check your insurance card or online member account.
2. Check the health plans accepted by Scripps
Visit the Understanding Health Insurance page to learn about health insurance and review the health plans accepted by Scripps.
Scripps accepts most insurance plans and provides information for people with employer-sponsored commercial insurance as well as Medicare and Covered California plans.
Keep in mind that the Scripps list is a helpful starting point, but health plan participation can change. You should still verify coverage directly with your insurance carrier before making a final decision.
3. Check your health plan's provider directory
Next, go to the insurance company's website and use its provider directory.
Search for specific Scripps doctors and facilities that are important to you. Depending on your health needs, that might include:
- Your current primary care physician
- Your child's pediatrician
- Specialists you already see
- A Scripps medical group
- A Scripps hospital you prefer
- Other Scripps facilities you use regularly
Be sure you're searching within the specific plan and network you're considering, rather than the insurer's entire provider directory.
“Don't assume that because an insurance company works with a health system that every plan it offers provides the same access,” says Dr. Keswani. “Take the time to check the specific plan you're considering and the physicians and facilities that matter to you.”
4. Call your insurance company to confirm
If you're unsure about anything you find online, call the health plan directly.
The member services or sales number should be available on the insurer's website, insurance card or enrollment materials.
Ask specific questions, such as:
- Is my Scripps primary care doctor in-network for this specific plan?
- Is my specialist in-network?
- Which Scripps medical group can I select?
- Are the Scripps hospitals I want to use in-network?
- Do I need to select a primary care physician when I enroll?
- Will I need referrals to see specialists?
- What will I pay if I receive care outside the network?
If you're comparing plans during open enrollment, have the exact plan name available when you call.
5. Check both your doctor and your preferred facility
This step is easy to overlook. Don't assume that confirming one Scripps provider means every Scripps physician or facility is included in your plan.
For example, if you already see a primary care physician and a specialist, verify both. If access to a particular hospital is important to you, confirm that as well.
This can be particularly important if you expect significant healthcare needs in the coming year, such as pregnancy, surgery, treatment for a chronic condition or ongoing specialty care.
“Think about the care you may need in the year ahead, as well as the needs that can be harder to anticipate,” says Dr. Keswani. “If you already have a physician you trust or know you'll need specialty care, make sure those providers are part of the network. It is also worth checking your options for urgent and emergency care before you enroll.”
6. Understand how HMO and PPO networks differ
The type of health plan you choose can affect how you access Scripps care.
With an HMO, you generally receive care within the plan's network and select a primary care physician who helps coordinate your care. Referrals may be required to see specialists.
A PPO generally gives you more flexibility in choosing doctors and specialists and may provide some coverage for out-of-network care. However, going outside the network usually costs more.
Neither plan type is automatically better. Consider your health needs, budget and how much flexibility you want when choosing providers.
7. Verify again before you enroll
Provider networks can change, so make a final check before submitting your enrollment selection.
If keeping a current Scripps doctor is especially important to you, verify the physician's participation with the health plan. You can also contact Scripps for help finding a physician who participates in your plan.
“Choosing a health plan is also choosing the care and support you'll be able to rely on,” says Dr. Keswani. “Take time to compare your options and choose a plan that gives you access to trusted doctors, facilities and services for routine, specialty and unexpected health needs.”
What if I already have a Scripps doctor?
Even if you aren't planning to change health plans, review your coverage during open enrollment.
Insurance benefits, costs and provider networks can change from year to year. Confirm that your Scripps physician and other providers you regularly see will remain in-network for the upcoming plan year.
If your employer is offering a new plan or you're considering switching plans, check before enrolling rather than assuming your current doctor will be covered.
What if I want to start receiving care at Scripps?
If you're considering Scripps, first identify which health plans are available to you that include Scripps. Then you can search for a primary care doctor based on location, specialty, availability and other preferences.
Scripps offers care for both expected and unexpected health needs, including primary and specialty care, nationally recognized hospitals, urgent care, walk-in care and emergency services throughout San Diego County, along with virtual care options.
Scripps referral specialists can also help you find a Scripps doctor who is in-network with your health plan. Call 1-800-SCRIPPS (800-727-4777), Monday through Friday, 7 am to 7 pm.
Take time to check before you choose
Health insurance can be complicated, but checking your provider network doesn't have to be.
Before enrolling:
- Get the exact name of the plan you're considering.
- Review the health insurance plans accepted by Scripps.
- Search the insurer's provider directory for your doctors and facilities.
- Confirm network participation directly with the insurance carrier.
- Check the doctors, specialists and hospitals that matter to you.
- Verify your choices one more time before you enroll.
Taking these steps now can help prevent surprises when you need care later.