CalCPA ProtectPlus

Participating Hospital is a hospital which has a claims administrator’s Participating Agreement in effect with the claims administrator, as appropriate, at the time services are rendered. Participating hospitals agree to accept the negotiated rate as payment in full for covered services. Participating hospitals agree to participate in procedures established to review the utilization of hospital services. Hospital services determined to be unnecessary, according to these utilization review procedures, are not covered by the plan. A list of participating hospitals is available upon request from the plan administrator, as appropriate.

Hospital Facilities:

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Anthem Blue Cross is currently in active negotiations with Children’s Hospital of Central California, located in Madera county.  Anthem’s contract with this provider is currently scheduled to terminate as of 6/8/09,  if an agreement is not made with  this facility. 

Should this occur, alternative facilities that members can use in this area include Fresno Heart Hospital, St. Agnes Medical Center or Community Medical Center of Fresno.