Hoag Care Coordination Services

Appointments can be scheduled online, through MyChart, or over the phone. You can book online and via MyChart for the following appointments: Screening Mammogram, Screening Breast Ultrasound, Dexa Bone Density, Plain X-rays, and various Ultrasounds (Pelvic, Abdominal, Renal, Scrotal, Head/Neck/Thyroid, and Obstetric). All other exams can be booked over the phone by calling (949) 764-5573 on Monday-Friday from 8am-5pm.

Hoag is contracted with Original Medicare Parts A & B, CalOptima Direct and Community Care Network, most major PPO and POS plans except for Healthnet Enhanced Care PPO (also known as Ambetter). Additionally, Hoag accepts HMO plans that designate Hoag Medical Group or Hoag Physician Partners as their IPA.

Most complex imaging exams such as CT scans, MRI, Fluoroscopy, and Nuclear Medicine, require pre-authorization from your insurance company. This requirement applies to HMO, CalOptima, and most PPO & POS plans. While Medicare does not require pre-authorization, it may require that an exam meets the medical necessity criteria, which we will verify on your behalf.

For HMO & CalOptima plans, the requesting physician must obtain authorization for your exam from your insurance company. Once the exam has reached the approval status, we can proceed with scheduling your appointment. For PPO & POS plans, Hoag will initiate the authorization with your insurance company after scheduling your appointment. This often involves collaborating with your requesting physician to provide the necessary documentation to demonstrate medical necessity. The process can take anywhere from 5-7 business days or longer depending on several factors such as speed of communication with your physician’s office, review time with your insurance company, and the potential for the request to be denied or require peer-to-peer review, which requires direct physician intervention with your insurance company.

Contact our cashier’s department and we will be happy to provide you with an estimated out-of-pocket cost for your scheduled appointment. If your exam requires authorization, and it is denied, or your insurance is out of network, we can provide you with a discounted cash price estimate.