Mission Hospital - Mission Viejo & Laguna Beach, California
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Accepted Health Plans

Mission Hospital is a preferred provider for most major insurance plans for both inpatient and outpatient services.

Please make a selection from the links below to learn more about that type of health insurance plan:

Behavioral Health

The following is a list of managed behavioral health plans accepted by Mission Hospital:

  • APS
  • Cigna Behavioral Health
  • Magellan
  • Managed Health Network (MHN)
  • United Behavioral Health Plan
  • US Behavioral Health Plan
  • ValueOptions

Exclusive Provider Organization

An Exclusive Provider Organization (EPO) is usually made up of a group of physicians, one or a small number of hospitals, and other healthcare providers who contract either with an insurer or directly with an employer to provide services for enrollees/employees. The arrangement is similar to a PPO; however, enrollees must receive their health services from only the designated exclusive providers in order for any portion of the care to be covered by the insurance carrier.

Please contact your health plan to determine if Mission Hospital is a participating provider.

Government Sponsored Plans

Government sponsored plans are usually available to active duty members of the military, qualified family members, non-Medicare eligible retirees and their family members and survivors of uniformed services.

The following is a list of Government Sponsored plans accepted by Mission Hospital:

  • TriCare (CHAMPUS)

Health Maintenance Organization (HMO) and Point-Of-Service (POS) Health Plans

HMO and POS Plans provide patients with a list of contracted physicians and require that the patient choose a Primary Care Physician (PCP) at the time of enrollment. The PCP generally will coordinate the patient's entire healthcare.

To be able to receive services at Mission Hospital, your PCP must be part of one of the physician groups listed below. To ensure that you may receive services at Mission Hospital, you must make sure that both the physician group and the health plan are contracted with Mission Hospital.

Physician groups at Mission Hospital are:

  • Mission Hospital Affiliated Physicians
  • Mission Internal Medical Group (formerly, Mission Heritage Medical Group)
  • Monarch Healthcare

Additionally, the following medical groups are affiliated with the St. Joseph Heritage Healthcare and members can receive care through any of the St. Joseph Health Hospitals, including Mission Hospital (as designated by your primary care physician):

  • High Desert Primary Care & Premier Healthcare IPA
  • St Joseph Heritage Medical Group
  • St Joseph Hospital Affiliated Physicians
  • St Jude Heritage Medical Group
  • St Jude Affiliated Physicians
  • St Mary Specialty Clinic

HMO/POS plans accepted at Mission Hospital are:

  • Aetna HMO/POS
  • Anthem Blue Cross HMO/POS
  • Blue Shield HMO/POS
  • Blue Shield Net Value HMO
  • Blue Shield Save Net HMO
  • Blue Shield Local Access Plus HMO
  • Cigna HMO/POS
  • HealthNet HMO/POS
  • United Healthcare HMO/POS

Indemnity Plans

Indemnity Plans are traditional insurance programs where a patient may seek services from any provider of their choice, and the person is responsible for a deductible and co- insurance. These plans generally cover only medically necessary services.

Mission Hospital accepts all indemnity insurance plans.

Medi-Cal Managed Care Plans

The Medi-Cal Managed Care Division (MMCD) provides high quality, accessible, and cost-effective health care through managed care delivery systems.

MMCD contracts for health care services through established networks of organized systems of care, which emphasize primary and preventive care. Managed care plans are a cost-effective use of health care resources that improve health care access and assure quality of care.

To be able to receive services at Mission Hospital through a Medi-Cal Managed Care program, your PCP must be part of one of the following networks:

  • CalOptima – Community Care Network (CCN)
  • CHOC Health Alliance
  • CalOptima Direct

Medicare

Medicare is complex, and requires thorough understanding of the program. To assist, Mission Hospital provides an extensive list of resources, which can be accessed by calling (949) 364-1770.

Preferred Provider Organizations

Preferred Provider Organization (PPO) Plans make arrangements with physicians, hospitals and other caregivers to provide services at a discounted payment. Under a PPO, when a patient receives services from a contracted provider, the cost will be less than if a non-contracted provider renders the services. When selecting contracted providers, there is not a restriction to remain within a specific physician group.

The PPO plans accepted at Mission Hospital are:

  • Aetna PPO
  • Affiliated Health Funds
  • Beech Street PPO
  • Anthem Blue Cross PPO
  • Blue Shield of California PPO
  • Cigna PPO
  • Community Care Network (CCN) PPO
  • Coventry PPO (Formerly First Health)
  • HealthNet PPO
  • Interplan Corp
  • MulitPlan PPO
  • Orange County Foundation PPO
  • Private HealthCare Systems (PHCS) PPO
  • Three Rivers Provider Network (TRPN) PPO
  • United Healthcare PPO
  • USA Managed Care Organization

The Senior PPO plans accepted at Mission Hospital are:

  • Aetna Senior PPO
  • Anthem Medicare Preferred Standard PPO (formerly Blue Cross Freedom Blue PPO)

Senior Managed Care Plans

Senior HMO Plans, known as Medicare Advantage (MA), are an option for people eligible for both Medicare Part A and B benefits. To enroll in a MA plan, a person must sign over his or her Medicare benefits to the selected MA plan. It is important to understand that the MA plan is an HMO, and therefore the same processes described under the HMO must be adhered to in order to receive benefit coverage.

To be able to receive services at Mission Hospital your Primary Care Physician must be part of one of the physician groups listed below. To ensure that you may receive services at Mission Hospital, you must make sure that both the physician group and the health plan are contracted with Mission Hospital.

The Senior HMO plans accepted at Mission Hospital are:

  • AARP Medicare Complete Secure Horizons
  • Aetna Senior
  • Anthem Blue Cross Senior
  • Blue Shield 65 Plus/65 Plus Choice
  • CalOptima OneCare (through Monarch Healthcare)
  • HealthNet Senior
  • SCAN
  • United Healthcare Medicare Solutions