Keeping current doctors depends on which doctors employers and employees are trying to keep. Each California medical insurance company has contracts with specific groups of doctors and hospitals. The contracted medical providers are “in-network” for a specific medical plan. The network varies depending on whether it is a PPO (Preferred Provider Organization) plan, HMO (Health Maintenance Organization) or an EPO (Exclusive Provider Organization). PPO plans will pay for services from non-contracted doctors or “out-of-network” providers. HMOs and EPOs won’t pay for medical services from out-of-network providers.
Further complicating matters is the fact that each insurance company offers different medical provider networks within each plan type. For example, Anthem Blue Cross offers the Prudent Buyer PPO network which is the largest and offers the most doctors and hospitals. Anthem also offers the Select PPO network which has fewer medical providers. Blue Shield of California offers their full network PPO and the Tandem (smaller) PPO network. UnitedHealth Care (UHC) offers Select Plus PPO (largest network) and the smaller Core PPO network.