Is Providence Your Primary Care Provider? Your Insurance May No Longer Cover Any Trips to Redwood Urgent Care - Lost Coast Outpost

What the report says

Lost Coast Outpost reports that Providence made a recent policy change affecting some Humboldt County patients who use Redwood Urgent Care, a local clinic that is not contracted with Providence. According to the report, Redwood Urgent Care was notified on Wednesday, July 15, that patients receiving primary care through an HMO with a Providence Medical Group clinic in its network must obtain approval from the HMO or Providence’s insurance carrier before visits to Redwood Urgent Care will be covered.

The article says the change applies to about 1,800 Humboldt County members treated through Western Health Advantage, based on information from Providence Medical Group & Clinical Network Regional Chief Executive Bob Just provided through a spokesperson. Patients who go to an urgent care provider that is in Providence’s network do not need that prior authorization, but the Outpost notes Redwood Urgent Care is the only urgent care clinic of its kind in Humboldt County; OpenDoor described its own service as a same-day appointment clinic rather than the same type of facility.

Just characterized the change as largely administrative and said Providence has a financial responsibility to manage costs for HMO members by keeping care in-network when possible. He told the Outpost patients can access same-day primary care on weekdays and telehealth daily from 8 a.m. to 8 p.m.; if urgent care is needed when those options are unavailable, authorization would typically be approved if submitted.

If authorization is not obtained, affected patients may face out-of-pocket costs or use Providence’s emergency room at St. Joseph Hospital, which is generally more expensive than urgent care. The Outpost also issued a correction stating Providence employees on the company health plan are not affected.