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. When purchasing a Prescription Drug, you may have to pay Coinsurance or make a Copayment. A Provider may be in-network for Providence members on a certain plan but Out-of-Network for other plans. (866) 481-2003, St Jude Heritage Medical Group 1801 Lind Ave SW . 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. Thank you for your interest in Providence. 2121 Santa Monica Blvd, Santa Monica, CA 90404, USA. 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. 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. Payment will be made to the Policyholder or, if deceased, to the Policyholders estate, unless payment to other parties is authorized in writing. 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 Fullerton, CA 92835 Listed as a benefit in the Benefit Summary and in your Contract; Not listed as an Exclusion in the Benefit Summary or in your Contract; and. Sign up for a free MyChart account to access your online health record Tuesday, Sept. 7: 8 a.m. - 8 p.m. For example, we might talk to your Provider to suggest a disease management program that may improve your health. Meet Our Doctors Services, Treatments & Conditions When we take care of each other, we tighten the bonds that connect and strengthen us all. See also Prescription Drugs. Open Daily, 8 a.m. - 8 p.m. Labor Day - Monday, September 4 Click the green "Help" or "Chat" button on the bottom There are 222 members in Santa Monica CA. If enrollment under this Contract consists solely of children under the age of 21, the adult person who applied for such coverage shall be deemed to be the Policyholder. 4th of July - Tuesday, July 4 Your Provider or you will then have 48 hours to submit the additional information. If Providence denies your claim, the EOB will contain an explanation of the denial. Napa, CA 94559, Close at 5 p.m. on Christmas Eve and New Years Eve, Closed major holidays, open on MLK and Presidents Day, 5630 E. Santa Ana Canyon Rd., Suite 100, Santa Ana, 92705 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. Sun: 9 a.m. - 5 p.m. We will work to reschedule all appointments and appreciate Closed on Saturday and Sunday. 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). That amount is in addition to any Deductible, Copayment, or Coinsurance for which you may be responsible, and does not count towards your Out-of-Pocket Maximum. 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. service center, our skilled team of caregivers is here for all your service-related Certain Covered Services, such as most preventive care, are covered without a Deductible. IN SERVICE TO OUR MISSION, PROVIDENCE PARTNERS WITH COMMUNITY-BASED ORGANIZATIONS TO IDENTIFY URGENT HEALTH NEEDS AND ENVIRONMENTAL FACTORS THAT ARE IMPACTING THE WELL-BEING OF OUR COMMUNITIES. Providence Saint John's Health Center 2121 Santa Monica Blvd. You can find the Prescription Drug Formulary here. Instant Care Advice. Once we receive the additional information, we will complete processing the Claim within 30 days. Apple Valley, CA 92307, 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. To request reimbursement, you will need to fill out and send Providence a Prescription Drug reimbursement request form. Tuesday, Sept. 7: 8 a.m. - 8 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. Providence Saint Johns Medical Foundation. Providence Saint John's Health Center and Saint John's Physician Partners Agreed to Pay $4.9 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Provided for in Clinical Research Studies | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services Home Fraud 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. 925 Corporate Center Pkwy., Suite A Sun., Dec. 24: 8 a.m. - 5 p.m. Project Ronin's groundbreaking software system aims to revolutionize cancer care, improve outcomes. Were here to give you the support and resources you need. This organization is required to file an IRS Form 990 or 990-EZ. We Save Lives With the Help of Berry Gordy. New Year's Eve/Day BUT EVEN DURING THE MOST DIFFICULT PUBLIC HEALTH CRISIS OF OUR TIME, COMMUNITIES HAVE ALSO SHOWN REMARKABLE STRENGTH AND RESOLVE. Is this your nonprofit? 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. Enrollment in Providence Health Assurance depends on contract renewal. Premium is due on the first day of the month. 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. Office:310-829-8625 Thurs., Nov. 23: 8 a.m. - 12:00 p.m. Petaluma, CA 94954 HealthCare4PPL.com does not provide medical advice, diagnosis or treatment. Making a partial Premium payment is considered a failure to pay the Premium. Hours may vary during seasonal times. Providence will notify your Provider or you of its decision within 72 hours after the Prior Authorization request is received. 8 a.m. - 8 p.m, 7 days a week If you do not pay the Premium within 10 days after the due date, we will mail you a Notice of Delinquency. Access everything you need to sell our plans. 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. We Save Lives With Help From the Borsteins. A request to us by you or a Provider regarding a proposed Service, for which our prior approval is required. Christmas Eve/Day We probably would not pay for that treatment. This information will only be used to contact you regarding your message. Thanksgiving Upon Member or Provider request, the Plan will coordinate with Members, Providers, and the dispensing pharmacy to synchronize maintenance medication refills so Members can pick up maintenance medications on the same date. Santa Rosa Urgent Care or Due to the events of the Kincade fire, many of our primary care and specialty Let us help you find the plan that best fits your needs. (Please note last patient check in is at 7:30 p.m.) Holiday Hours: 8 a.m. - 5 pm. 18310 Highway 18, about GuideStar Pro. Thanksgiving If this happens, you will need to pay full price for your prescription at the time of purchase. If your Provider bills you directly, and you pay for Services covered by your plan, we will reimburse you if you send us your claims information in writing. A pharmacy that has signed a contractual agreement with Providence Health Plan to provide medications and other Services at special rates. Programs and results. (707) 445-8121, St. Joseph Hospital, Eureka Innovative research directly impacts health center patients with rare immediacy. New Year's Eve/Day Mission Viejo, CA 92691. Saint John's has a well-earned reputation for clinical excellence and award-winning care in a compassionate and tranquil healing environment. 2212 E. Fourth St. 1000 Trancas St. We're here for you Explore support for plan members and Medicare beneficiaries during this unprecedented time. We believe that the health of a community rests in the hearts, hands, and minds of its people. For standard requests, Providence Health Plan will notify your provider or you of its decision within 72 hours after receipt of the request. Typically, Providence individual plans do not pay for Services performed by Out-of-Network Providers. Windsor, CA 95492. Compassion, Dignity, Justice, Excellence, Integrity. Mon., Dec. 25: 8 a.m. - 12:00 p.m. Rohnert Park, CA 94928. Providence will complete its review and notify your 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. 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. Contact Us 2121 Santa Monica Blvd. Want more information about cancer treatment at Saint John's Cancer Institute? A determination that relates to benefit coverage and Medical Necessity is obtained no more than 30 days prior to the date of the Service; or. Once a final determination is made, you will be sent a written explanation of our decision. 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. New Year's Eve/Day Sending us the form does not guarantee payment. Medical taxonomies which are covered by group's doctors and health care providers in the city include Allopathic & Osteopathic Physicians/Otolaryngology, Psychiatry & Neurology/Neurology, Allopathic & Osteopathic Physicians/Internal Medicine, Allopathic & Osteopathic Physicians/Obstetrics & Gynecology, Internal Medicine/Cardiovascular Disease, Allopathic & Osteopathic Physicians/Family Medicine, Student, Health Care/Student in an Organized Health Care Education/Training Program, Otolaryngology/Facial Plastic Surgery, Internal Medicine/Rheumatology, Nurse Practitioner/Primary Care and more. : CLOSED (909) 612-9776, St. Jude Heritage Medical Group - Orange Mission Viejo, CA 92691 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. Providence will then notify you of its reconsideration decision within 24 hours after your request is received. Prior authorization for services that involve urgent medical conditions. organizations, including the Orange County Medical Association for Physicians To obtain prescriptions by mail, your physician or Provider can call in or electronically send the prescription, or you can mail your prescription along with your Providence Member ID number to one of our Network mail-order Pharmacies. Labor Day Schedule The site navigation utilizes arrow, enter, escape, and space bar key commands. New Year's Eve/Day Martin Luther King Jr. Day - Monday, January 16 New Year's Eve/Day We will provide a written response within the time frames specified in your Individual Plan Contract. We recommend you consult your provider when interpreting the detailed prior authorization list. 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. : CLOSED If you have misplaced or do not have your Member ID Card with you, please ask your pharmacist to call us. You can find your Contract here. Santa Rosa, CA 95405, Mon. Providence Medicare Advantage Plan is an HMO, HMO-POS and HMO D-SNP with Medicare and Oregon Health Plan contracts under contract ID H9047. wherever you are. Mission Viejo Urgent Care. Open seven days a week, daily: 8 a.m. - 8 p.m. 12550 Hesperia Rd., Suite 100 By Nancy Brands Ward Almost everyone experiences problems with digestive health at some point. Assistance Outside of Providence Health Plan. 27700 Medical Center Rd., 5th Floor For expedited requests, Providence will notify your Provider or you of its decision within 24 hours after receipt of the request. Wed., Nov. 27 - 8 a.m.- 5 p.m. Your Deductible is the dollar amount shown in the Benefit Summary that you are responsible to pay every Calendar Year for Covered Services before benefits are provided by us. Mon - Sat: 8 a.m. - 8 p.m.; Sun: 9 a.m. - 5 p.m. Holiday Hours: 8 a.m. - 5 pm. Our providers are here, virtually and in-person, to address your medical needs. Copyright 2023 Providence Health Plan, Providence Plan Partners, and Providence Health Assurance. The claim within 30 days here to give you the support and resources need. Save Lives with the Help of Berry Gordy request reimbursement, you will need to fill out and send a... Contain an explanation of our decision cancer treatment at Saint John & # x27 ; s has well-earned... Its reconsideration decision within 72 hours after the prior authorization request is received Provider may be for! Providence Plan Partners, and space bar key commands we probably would not pay that! 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