Billing Policies > Accepted Health Plans

St. Joseph Health System, Sonoma County 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

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.

The Senior HMO plans accepted at St. Joseph Health System are:

  • Health Net

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.

HMO/POS plans accepted at St. Joseph Health System are:

  • Aetna
  • Blue Cross
  • Blue Shield
  • Cigna
  • Health
  • Pacificare HMO

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 St. Joseph Health System are:

  • Aetna
  • BCE Energis
  • Benefit Risk Management Services (BRMS)
  • Blue Cross
  • Blue Shield
  • Cigna
  • First Health
  • Great-West Healthcare
  • Health Net
  • Interplan Corporation
  • MultiPlan
  • Pacific Foundation for Medical Care
  • Pacific Health Alliance
  • Pacificare
  • Private Healthcare Systems (PHCS)
  • United Healthcare
  • United Payors and United Providers (UP & UP)

The Senior PPO plans accepted at St. Joseph Health System 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 St. Joseph Health System:

  • Aetna Select Choice EPO
  • First Health Network (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 St. Joseph Health System:

  • TriCare (CHAMPUS)
  • TriWest

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.

St. Joseph Health System accepts all indemnity insurance plans.

Medicare

Medicare is complex, and requires thorough understanding of the program. For Medicare questions please call 1-800-MEDICARE (1-800-633-4227).

Medi-Cal Plans

The Federal Government provides medical benefits for eligible low income and disabled persons needing healthcare. In Sonoma County, the California Government sponsored Medi-Cal program must be part of one of the following networks:

  • Blue Cross Healthy Families EPO
  • County Medical Services Program (CMSP)
  • Partnership Health Plan