City of Hope contracts with most major Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) for hospital services. For a list of plans with which City of Hope contacts, view "Is My Insurance Accepted?"
In addition, City of Hope is a participating provider in government programs such as Medicare and MediCal.
City of Hope and the City of Hope Medical Foundation are distinct, separate entities, and the two do not share common ownership interests. City of Hope is a California, non-profit public benefit corporation. The City of Hope Medical Foundation employs physicians who treat patients at the medical center. As separate entities, City of Hope contracts for hospital/technical services only. City of Hope Medical Foundation contracts for professional services only.
Because they are separate entities, City of Hope contracts for hospital/technical services only. City of Hope Medical Foundation contracts for professional/physicians' services only. If you are insured by an HMO, and wish to receive treatment or services at City of Hope, you must obtain an authorization from your health plan and/or medical group for both hospital services and physicians services. City of Hope will assist you in obtaining the appropriate authorizations for all services provided at the medical center. For any applicable co-payments, deductibles, or non-covered services, you may receive a bill from City of Hope and/or the City of Hope Medical Foundation.
Insurance coverage will vary depending upon your insurance company, your plan and the state in which you live. We recommend that you speak with a representative from your insurance company to ensure that your treatment is covered. Your insurance company can also tell you about any applicable co-payments or deductibles for which you will be responsible. You may also contact City of Hope Financial Support Services at 626-256-HOPE, ext. 62715, for assistance. Because individual or group benefits vary, City of Hope cannot answer questions regarding your specific benefit coverage.
NOTE: If you belong to an HMO, your insurance will not pay for your health care unless you have an authorization. A written authorization, which gives you permission to be treated, must be obtained from your insurance company/medical group before each planned admission and each type of outpatient treatment, e.g. chemotherapy, ambulatory surgery, or diagnostic service.
Obtain an HMO Provider Directory booklet from your insurance company and search for a PCP in your area that is also listed with the City of Hope Medical Foundation. See "Is My Insurance Included?"
Not necessarily. Authorizations are granted based on various criteria, one of them being contractual relationships, but other more significant factors play a key role in this process. Typically, your medical group's Utilization Management/Case Management Departments, in conjunction with the PCP's Medical Director, make decisions regarding authorizations.
Yes, City of Hope will bill your insurance company for your hospital services. However, you are financially responsible for any part of your medical bill that is not covered by your insurance. This includes your co-payments, deductibles and any non-covered services.
Yes, the City of Hope Medical Foundation will bill your insurance company for your physician services. (The bill for physicians' services will be separate from the one sent to you by the medical center for hospital services.) However, you are financially responsible for any part of your medical bill that is not covered by your insurance. This includes your co-payments, deductibles and any non-covered services.
Contact your insurance company and ask about obtaining authorization to receive treatment at City of Hope. Every medical situation - and every insurance plan - is different, and there is no guarantee that coverage can be secured. But it is reasonable to make this request, and to ask your insurance company to review the matter with City of Hope directly.
City of Hope can still provide treatment even if your plan will not authorize the treatment, or you do not have insurance. In these instances, a deposit is required prior to commencement of treatment. Contact New Patient Services at 1-800-826-HOPE (4673) for more information.
Please refer to the back of your insurance card and call the applicable Customer Service or Member Services Department and inquire about your appeal rights. You may also refer to the California Department of Managed Health Care at www.dmhc.ca.gov
or 1-888-HMO-2219 for further assistance.
If the bill in question was sent from City of Hope, please call Patient Business Services at 1-800-270-HOPE (4673).
However, if the bill was sent from the City of Hope Medical Foundation (to cover physicians' professional services), please contact the Medical Foundation at 626-775-3200.