A National Cancer Institute-designated Comprehensive Cancer Center

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Medical Insurance Overview

City of Hope National Medical Center - Duarte (Main Campus)
City of Hope contracts with most major Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) for hospital services. In addition, City of Hope is a participating provider in government programs such as Medicare, MediCal and Tricare/Champus.
 
Insurance coverage will vary depending upon your insurance company, your plan and the state in which you live. Please 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.
 
Frequently Asked Questions
 
 
Managed Care Inquiries
 
  • If you have additional questions, you may either email us at sdesbiens@coh.org or contact the Managed Care Department at 626-256-HOPE (4673), ext. 86850.
  • Please note that we are unable to answer questions about your specific benefits or medical coverage. For those inquiries, use the phone number on your insurance card or in your benefits book to call your managed care organization or insurance company directly.
 
Billing Inquiries
 
  • For questions about a bill from City of Hope National Medical Center (to cover hospital/technical services), please call Patient Financial Services at 800-270-HOPE (4673).
  • For questions about a bill from the City of Hope Medical Foundation (to cover physician/professional services), please call the Medical Foundation at 626-775-3200.
 
 
City of Hope National Medical Center (which provides hospital services at the Duarte location) and City of Hope Medical Foundation (which bills for physician services) are participating in certain plans through the Affordable Care Act and the California health benefit exchange called Covered California.
 
For questions about our community practice sites' medical insurance coverage, please call 626-775-3200.
 

 
 

Is My Insurance Accepted at City of Hope (Duarte)?

For questions related to your specific coverage, please contact your insurance provider directly. You can find that phone number on your insurance card or in your benefits book. You can also call City of Hope New Patient Services at 800-826-HOPE (4673).

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.
 
The following is a list of insurance companies which cover care at City of Hope National Medical Center (Duarte campus) and City of Hope Physicians (Medical Foundation). City of Hope National Medical Center contracts for hospital/technical services only. City of Hope Medical Foundation contracts for physician services rendered at City of Hope National Medical Center and in our community practice sites. You can also find out what, if any, co-payments and deductibles will be your responsibility.
 
PLEASE NOTE:
 
  • Although we strive to keep this information current, it is subject to change without notice
  • HMO Plans: In order to receive care at City of Hope at the Duarte location or with a City of Hope physician as an HMO plan member, you will need written authorization, which gives you permission to be treated, from your insurance company/medical group before each planned admission and each type of outpatient treatment, e.g. chemotherapy, ambulatory surgery, or diagnostic service.
  • If you wish to receive treatment at a City of Hope location or with a City of Hope physician but your insurance plan does not cover care at City of Hope, contact your insurance company and ask about obtaining authorization to receive treatment here.
     
City of Hope National Medical Center - Duarte
Contracted insurance companies for coverage
of hospital and technical services at Duarte.

 
City of Hope Physicians (Medical Foundation)
Contracted insurance companies for physician services at  Duarte and Community Practice Sites.
 
Anthem Covered California EPO
Anthem Covered California PPO
Benefit Panel Services PPO
Benefit Panel Services (Multiplan) PPO
Blue Distinction Center for Transplant BMT
Envisioncare Triage-Advocates, Inc.
Great West Health Plan
LA Care Health Plan
LA Foundation for Medical Care PPO
LifeTrac Transplant Network BMT
Anthem Covered California EPO
Anthem Covered California PPO
Three Rivers Provider Network
TRICARE Federal Services
 
Covered California
 
City of Hope National Medical Center (which provides hospital services at the Duarte location) and City of Hope Medical Foundation (which bills for physician services) are participating in certain plans through the Affordable Care Act and the California health benefit exchange called Covered California. The information below applies to new individual and family plans purchased within or outside of Covered California to be effective on or after Jan. 1, 2014. Only the Anthem Blue Cross EPO and PPO plans are in-network for both hospital and physician services.
 
Anthem Blue Cross
 
  • Medical Center (Duarte): in-network for EPO and PPO plans
  • Foundation: in-network for EPO and PPO plans
  • Medical Center (Duarte) and Foundation are considered in-network for blood and marrow transplant services.
 
Blue Shield of California
 
  • Medical Center (Duarte): out of network for EPO and PPO. (Note: PPO patients may still access City of Hope, but will have a greater out-of-pocket expense. Please contact Blue Shield of California for more information. There are no out-of-network benefits for the EPO plan.)
  • Foundation: out of network for EPO and PPO. (Note: PPO patients may still have access to Foundation, but will have a greater out-of-pocket expense.  Please contact Blue Shield of California for more information. There are no out-of-network benefits for the EPO plan.)
  • Medical Center (Duarte) and Foundation are considered in-network for blood and marrow transplant services.


To learn more about the exchange, visit www.coveredca.com or call 888-975-1142.

For questions related to your specific coverage, please contact your insurance provider directly.

If you have additional questions, you may call 800-826-HOPE (4673).
 

Community Practices

City of Hope Medical Foundation contracts for physician services rendered at City of Hope community practice sites.
 
PLEASE NOTE:
 
  • Although we strive to keep this information current, it is subject to change without notice
  • HMO Plans: In order to receive care at a City of Hope community practice location or with a City of Hope physician as an HMO plan member, you will need written authorization, which gives you permission to be treated, from your insurance company/medical group.
  • If you wish to receive treatment at a City of Hope location or with a City of Hope physician but your insurance plan does not cover care at City of Hope, contact your insurance company and ask about obtaining authorization to receive treatment.
 
For questions regarding our community practice sites' medical insurance coverage, please call 626-775-3200.
 
;

Glossary of Terms

Ambulatory Care
Health care services that do not require hospitalization of a patient, such as those delivered at a physician’s office, clinic, medical center or outpatient facility.
 
Authorization
An authorization is the approval of care, such as for a hospitalization. Authorizations can be granted by health plans, hospitals or medical groups, depending on who is financially responsible for the health services to be rendered.
 
Clinical Trials
Scientifically controlled research studies involving people. Such studies are used to determine the effectiveness of a new treatment or pharmaceutical, or to compare standard medications or procedures with others that may be equal or better.
 
Coinsurance
Portion of covered health care costs for which the covered person has a financial responsibility, usually according to a fixed percentage. Often coinsurance applies after meeting a deductible requirement.
 
Coordination of Benefits
Provision that applies when a person is covered by more than one insurance plan. Coordination of benefits requires that payment of benefits be coordinated by all plans in order to eliminate over-insurance or duplication of benefits.
 
Co-Payment
Cost-sharing arrangement in which the insured person pays a specified share of the charge for a specified service, such as $10 for an office visit. The insured person is usually responsible for payment at the time the health care is rendered.
 
Deductible
Amount of eligible expense an insured person must pay from his/her own pocket before the insurance company will pay for eligible benefits.
 
HMO (Health Maintenance Organization)
A healthcare service plan that requires its subscribers or members, except in a medical emergency, to use the services of designated physicians, hospitals or other providers of medical care.
 
IPA (Independent Practice Association)
A group of physicians that contracts for services with insurance plans.
 
Knox-Keene Act
This legislation provides protection to patients through a variety of requirements imposed on HMOs in California. Requirements cover services and characteristics such as marketing, financial, administrative, access and quality assurance.
 
MediCal
California’s version of Medicaid, this federal health insurance program is administered and operated individually by participating state and territorial governments. It provides medical benefits to eligible low-income and disabled persons needing health care. The federal and state governments share the program costs.
 
MediCal Managed Care
MediCal benefits for which the eligible person must choose a Primary Care Physician who manages all care provided to the eligible person via treatment or referrals for treatment by specialists. Patients who do not follow the prescribed guidelines are responsible for all charges associated with that episode of care and are not covered by the state MediCal program.
 
Medicare
Federally administered health insurance program that covers the cost of hospitalization, medical care and some related services for eligible persons. Medicare has two parts: PART “A” covers inpatient services, nursing home care, home health care, and hospice care; PART “B” covers outpatient services, physician services, medical equipment and supplies. Medicare covers those individuals 65 years or older and younger disabled people and dialysis patients.
 
Medi-Medi
Refers to those individuals who are dually eligible for Medicare and MediCal programs.
 
Non-Covered Services
Those services not covered by benefits policy.
 
Out-of-Network
Any insured person who receives care from a provider not holding a contract with the insured person’s insurance company is receiving services out-of-network. When a patient receives care out-of-network, he or she may be financially responsible for the care provided to them.
 
PCP (Primary Care Physician)
Physician whose practice is devoted to internal medicine, family/general practice or pediatrics.
 
POS (Point of Service)
Option offered by a health plan allowing the covered person to choose to receive a service from a participating or non-participating provider, with different benefit levels associated with the use of each.
 
PPO (Preferred Provider Organization)
An arrangement whereby a third-party payer contracts with a group of medical care providers who furnish services at lower-than-usual fees and in return guarantees a certain volume of patients.
 
Payor or Payer
A health plan, medical group, hospital, employer, individual or other entity that is financially responsible for payment of health care services.
 
Premium
The amount paid to an insurance carrier or health plan for providing insurance coverage under a contract.
 
Provider
In this document, provider refers to physician, hospital, nurse, pharmacy or any individual or group of individuals that provides a health care service.
 
*Most of the terms and definitions herein were taken from the Aventis Managed Healthcare: A Reference Guide.
 

Medical Insurance

Medical Insurance Overview

City of Hope National Medical Center - Duarte (Main Campus)
City of Hope contracts with most major Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) for hospital services. In addition, City of Hope is a participating provider in government programs such as Medicare, MediCal and Tricare/Champus.
 
Insurance coverage will vary depending upon your insurance company, your plan and the state in which you live. Please 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.
 
Frequently Asked Questions
 
 
Managed Care Inquiries
 
  • If you have additional questions, you may either email us at sdesbiens@coh.org or contact the Managed Care Department at 626-256-HOPE (4673), ext. 86850.
  • Please note that we are unable to answer questions about your specific benefits or medical coverage. For those inquiries, use the phone number on your insurance card or in your benefits book to call your managed care organization or insurance company directly.
 
Billing Inquiries
 
  • For questions about a bill from City of Hope National Medical Center (to cover hospital/technical services), please call Patient Financial Services at 800-270-HOPE (4673).
  • For questions about a bill from the City of Hope Medical Foundation (to cover physician/professional services), please call the Medical Foundation at 626-775-3200.
 
 
City of Hope National Medical Center (which provides hospital services at the Duarte location) and City of Hope Medical Foundation (which bills for physician services) are participating in certain plans through the Affordable Care Act and the California health benefit exchange called Covered California.
 
For questions about our community practice sites' medical insurance coverage, please call 626-775-3200.
 

 
 

Is My Insurance Accepted?

Is My Insurance Accepted at City of Hope (Duarte)?

For questions related to your specific coverage, please contact your insurance provider directly. You can find that phone number on your insurance card or in your benefits book. You can also call City of Hope New Patient Services at 800-826-HOPE (4673).

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.
 
The following is a list of insurance companies which cover care at City of Hope National Medical Center (Duarte campus) and City of Hope Physicians (Medical Foundation). City of Hope National Medical Center contracts for hospital/technical services only. City of Hope Medical Foundation contracts for physician services rendered at City of Hope National Medical Center and in our community practice sites. You can also find out what, if any, co-payments and deductibles will be your responsibility.
 
PLEASE NOTE:
 
  • Although we strive to keep this information current, it is subject to change without notice
  • HMO Plans: In order to receive care at City of Hope at the Duarte location or with a City of Hope physician as an HMO plan member, you will need written authorization, which gives you permission to be treated, from your insurance company/medical group before each planned admission and each type of outpatient treatment, e.g. chemotherapy, ambulatory surgery, or diagnostic service.
  • If you wish to receive treatment at a City of Hope location or with a City of Hope physician but your insurance plan does not cover care at City of Hope, contact your insurance company and ask about obtaining authorization to receive treatment here.
     
City of Hope National Medical Center - Duarte
Contracted insurance companies for coverage
of hospital and technical services at Duarte.

 
City of Hope Physicians (Medical Foundation)
Contracted insurance companies for physician services at  Duarte and Community Practice Sites.
 
Anthem Covered California EPO
Anthem Covered California PPO
Benefit Panel Services PPO
Benefit Panel Services (Multiplan) PPO
Blue Distinction Center for Transplant BMT
Envisioncare Triage-Advocates, Inc.
Great West Health Plan
LA Care Health Plan
LA Foundation for Medical Care PPO
LifeTrac Transplant Network BMT
Anthem Covered California EPO
Anthem Covered California PPO
Three Rivers Provider Network
TRICARE Federal Services
 
Covered California
 
City of Hope National Medical Center (which provides hospital services at the Duarte location) and City of Hope Medical Foundation (which bills for physician services) are participating in certain plans through the Affordable Care Act and the California health benefit exchange called Covered California. The information below applies to new individual and family plans purchased within or outside of Covered California to be effective on or after Jan. 1, 2014. Only the Anthem Blue Cross EPO and PPO plans are in-network for both hospital and physician services.
 
Anthem Blue Cross
 
  • Medical Center (Duarte): in-network for EPO and PPO plans
  • Foundation: in-network for EPO and PPO plans
  • Medical Center (Duarte) and Foundation are considered in-network for blood and marrow transplant services.
 
Blue Shield of California
 
  • Medical Center (Duarte): out of network for EPO and PPO. (Note: PPO patients may still access City of Hope, but will have a greater out-of-pocket expense. Please contact Blue Shield of California for more information. There are no out-of-network benefits for the EPO plan.)
  • Foundation: out of network for EPO and PPO. (Note: PPO patients may still have access to Foundation, but will have a greater out-of-pocket expense.  Please contact Blue Shield of California for more information. There are no out-of-network benefits for the EPO plan.)
  • Medical Center (Duarte) and Foundation are considered in-network for blood and marrow transplant services.


To learn more about the exchange, visit www.coveredca.com or call 888-975-1142.

For questions related to your specific coverage, please contact your insurance provider directly.

If you have additional questions, you may call 800-826-HOPE (4673).
 

Community Practices

Community Practices

City of Hope Medical Foundation contracts for physician services rendered at City of Hope community practice sites.
 
PLEASE NOTE:
 
  • Although we strive to keep this information current, it is subject to change without notice
  • HMO Plans: In order to receive care at a City of Hope community practice location or with a City of Hope physician as an HMO plan member, you will need written authorization, which gives you permission to be treated, from your insurance company/medical group.
  • If you wish to receive treatment at a City of Hope location or with a City of Hope physician but your insurance plan does not cover care at City of Hope, contact your insurance company and ask about obtaining authorization to receive treatment.
 
For questions regarding our community practice sites' medical insurance coverage, please call 626-775-3200.
 
;

Glossary of Terms

Glossary of Terms

Ambulatory Care
Health care services that do not require hospitalization of a patient, such as those delivered at a physician’s office, clinic, medical center or outpatient facility.
 
Authorization
An authorization is the approval of care, such as for a hospitalization. Authorizations can be granted by health plans, hospitals or medical groups, depending on who is financially responsible for the health services to be rendered.
 
Clinical Trials
Scientifically controlled research studies involving people. Such studies are used to determine the effectiveness of a new treatment or pharmaceutical, or to compare standard medications or procedures with others that may be equal or better.
 
Coinsurance
Portion of covered health care costs for which the covered person has a financial responsibility, usually according to a fixed percentage. Often coinsurance applies after meeting a deductible requirement.
 
Coordination of Benefits
Provision that applies when a person is covered by more than one insurance plan. Coordination of benefits requires that payment of benefits be coordinated by all plans in order to eliminate over-insurance or duplication of benefits.
 
Co-Payment
Cost-sharing arrangement in which the insured person pays a specified share of the charge for a specified service, such as $10 for an office visit. The insured person is usually responsible for payment at the time the health care is rendered.
 
Deductible
Amount of eligible expense an insured person must pay from his/her own pocket before the insurance company will pay for eligible benefits.
 
HMO (Health Maintenance Organization)
A healthcare service plan that requires its subscribers or members, except in a medical emergency, to use the services of designated physicians, hospitals or other providers of medical care.
 
IPA (Independent Practice Association)
A group of physicians that contracts for services with insurance plans.
 
Knox-Keene Act
This legislation provides protection to patients through a variety of requirements imposed on HMOs in California. Requirements cover services and characteristics such as marketing, financial, administrative, access and quality assurance.
 
MediCal
California’s version of Medicaid, this federal health insurance program is administered and operated individually by participating state and territorial governments. It provides medical benefits to eligible low-income and disabled persons needing health care. The federal and state governments share the program costs.
 
MediCal Managed Care
MediCal benefits for which the eligible person must choose a Primary Care Physician who manages all care provided to the eligible person via treatment or referrals for treatment by specialists. Patients who do not follow the prescribed guidelines are responsible for all charges associated with that episode of care and are not covered by the state MediCal program.
 
Medicare
Federally administered health insurance program that covers the cost of hospitalization, medical care and some related services for eligible persons. Medicare has two parts: PART “A” covers inpatient services, nursing home care, home health care, and hospice care; PART “B” covers outpatient services, physician services, medical equipment and supplies. Medicare covers those individuals 65 years or older and younger disabled people and dialysis patients.
 
Medi-Medi
Refers to those individuals who are dually eligible for Medicare and MediCal programs.
 
Non-Covered Services
Those services not covered by benefits policy.
 
Out-of-Network
Any insured person who receives care from a provider not holding a contract with the insured person’s insurance company is receiving services out-of-network. When a patient receives care out-of-network, he or she may be financially responsible for the care provided to them.
 
PCP (Primary Care Physician)
Physician whose practice is devoted to internal medicine, family/general practice or pediatrics.
 
POS (Point of Service)
Option offered by a health plan allowing the covered person to choose to receive a service from a participating or non-participating provider, with different benefit levels associated with the use of each.
 
PPO (Preferred Provider Organization)
An arrangement whereby a third-party payer contracts with a group of medical care providers who furnish services at lower-than-usual fees and in return guarantees a certain volume of patients.
 
Payor or Payer
A health plan, medical group, hospital, employer, individual or other entity that is financially responsible for payment of health care services.
 
Premium
The amount paid to an insurance carrier or health plan for providing insurance coverage under a contract.
 
Provider
In this document, provider refers to physician, hospital, nurse, pharmacy or any individual or group of individuals that provides a health care service.
 
*Most of the terms and definitions herein were taken from the Aventis Managed Healthcare: A Reference Guide.
 
Patient Care Overview
City of Hope sees patients at all points in their care, from diagnosis, to treatment, through survivorship.
City of Hope combines compassionate care with the best and most innovative science. Our 100+ acre campus is designed to meet the full range of needs of our patients and families. This guide is designed to help you take advantage of all that is offered at City of Hope - Duarte.
Your insurance company/medical group will tell you if you need any authorizations. You can also find out what, if any, co-payments and deductibles will be your responsibility.
Information on how to obtain your City of Hope medical records.
 
Interpreter Services
City of Hope offers free interpretation for patients and caregivers whose first language is not English. Please call 626-256-HOPE (4673), ext. 62282, to reach the Clinical Social Work office.
Tips, tools and resources to help you and your family cope with the issues that arise during and after cancer treatment.


NEWS & UPDATES
  • It was 2009 when a City of Hope patient in her 40s learned that the cancer she had been fighting for several years had metastasized to her lungs. Her medical team ran genetic tests on the tumor, but none of the drug therapies available at the time targeted the known mutations in the tumor cells. […]
  • Acute myeloid leukemia (AML) is characterized by a rapidly-developing cancer in the myeloid line of blood cells, which is responsible for producing red blood cells, platelets and several types of white blood cells called granulocytes. Because AML grows rapidly, it can quickly crowd out normal blood cells, leadi...
  • Rachel Divine is a yoga therapist and patient leader for the Sheri & Les Biller Patient and Family Resource Center. She’s also a former City of Hope patient. When someone you know has cancer, even the word “cancer” can make you feel nervous, sleepless, depressed or more. But, as a yoga teacher for 15 ...
  •   Diagnosed with type 1 diabetes when she was 9 years old, Gina Marchini accepted the fact that she would need insulin the rest of her life. Every day, she injected herself with the lifesaving hormone. She also carefully controlled her diet and monitored the rise and fall of her blood glucose with military...
  • The defeat of cancer will require a team effort. Nowhere is this more necessary (or apparent) than in efforts to combat two of the most deadly forms of the disease  – pancreatic cancer and triple-negative breast cancer. It’s the approach City of Hope is taking with its newly launched multidisciplinary teams, br...
  • It’s a reasonable question: Why is the National Cancer Institute funding a study on preventing heart failure? The answer is reasonable as well: Rates of heart failure are drastically high among childhood cancer survivors — 15 times higher than among people the same age who were never treated for cancer. T...
  • Many teenagers take a break from academics during the summer, but not the eight high school students enrolled in the California Institute for Regenerative Medicine (CIRM) Creativity Awards program at City of Hope. They took the opportunity to obtain as much hands-on research experience as possible, learning fro...
  • About one in eight women will develop breast cancer at some point in her life. In fact, breast cancer is the most common cancer in American women, behind skin cancer. Although women can’t change some risk factors, such as genetics and the natural aging process, there are certain things they can do to lower thei...
  • As genetic testing becomes more sophisticated, doctors and their patients are finding that such tests can lead to the discovery of previously unknown cancer risks. In his practice at City of Hope, Thomas Slavin, M.D., an assistant clinical professor in the Division of Clinical Cancer Genetics, sees the full spe...
  • And the winners are … everyone in the San Gabriel Valley. The recipients of City of Hope’s first-ever Healthy Living grants have been announced, and the future is looking healthier already. In selecting San Gabriel Valley organizations to receive the grants, City of Hope’s Community Benefits Advisory Council ch...
  • Barry Leshowitz is a former City of Hope patient and a family advisor for the Sheri & Les Biller Patient and Family Resource Center. It’s been almost seven years since I checked into a local hospital in Phoenix for a hip replacement, only to be informed by the surgeon that he had canceled the surgery....
  • When it comes to science, the best graduate schools don’t just train scientists, they prepare their students for a lifetime of learning, accomplishment and positive impact on society. At City of Hope, the Irell & Manella Graduate School of Biological Sciences goes one step further – by preparing students to...
  • Cancer affects not just the cancer patient, but everyone around him or her, even after treatment is complete. The challenges can include the fear of cancer recurrence, coping with cancer’s economic impact and the struggle to achieve work-life balance post-treatment. Family members and loved ones of cancer patie...
  •   Bladder cancer facts: Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder. 2015 estimates: 74,000 new cases of bladder cancer diagnosed 16,000 deaths from bladder cancer (about 11,510 in men and 4,490 in women) Risk factors for bladder cancer: Smoking: Smokers...
  • Women with ovarian cancer have questions about the most promising treatment options, revolutionary research avenues, survivorship and, of course, the potential impact on their personal lives. Now, together in one place, are experts who can provide answers. On Saturday, Sept. 12, the 2015 Ovarian Cancer Survivor...