Insurance FAQs for Patients

Which health plans are contracted with City of Hope National Medical Center and City of Hope Medical Foundation?

City of Hope National Medical Center and City of Hope Medical Foundation contract with most major health plans for hospital and physician services. For a list of contracted health plans, follow the link to "Is My Insurance Accepted?" In addition, City of Hope is a participating provider in government programs such as Medicare, MediCal and Tricare/Champus.

What is the difference between City of Hope National Medical Center and the City of Hope 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.

Why is the distinction between these two entities important to me?

Because they are separate entities, City of Hope National Medical Center 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 National Medical Center 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 National Medical Center and/or the City of Hope Medical Foundation.

Will insurance cover my care?

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.

How do I find a Primary Care Physician (PCP) that is contracted with both my insurance company and the City of Hope Medical Foundation?

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?"

If I enroll with a PCP that contracts with City of Hope Medical Foundation, does that guarantee that my treatment at City of Hope will be authorized?

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.

Will City of Hope bill my insurance for hospital services?

Yes, City of Hope National Medical Center 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.

Will the City of Hope Medical Foundation bill my insurance for physicians' 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.

Can I still receive treatment at City of Hope if my insurance plan is not accepted at City of Hope?

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.

My plan contracts with City of Hope, but has denied coverage for a particular medical stay or procedure. What can I do?

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.

Who can answer questions about my bill?

If the bill in question was sent from City of Hope National Medical Center, please call Patient Financial 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.