Frequently Asked Questions (FAQs)
Clear Answers to Common Questions
Please scroll through the questions below to find the answers you’re looking for. If you’re still unsure about a specific topic, contact us directly by calling 888-8-CANOPY or by completing this simple form.
Who Is Canopy Health?
Owned by physicians and hospitals, Canopy Health is a community of caregivers championing health. Our focus is on improving health, advocating for the entire Bay Area, and supporting individuals in a way that is empathetic and respectful. Our large network of physicians and other providers offer consistently high-quality care with clear, foreseeable costs.
Canopy Health is owned by UCSF Health, John Muir Health, Muir Medical Group IPA, Hill Physicians Medical Group, and Meritage Medical Network. We have received a restricted Knox-Keene license from the Department of Managed Health Care (DMHC), which allows us to accept responsibility for the full medical costs and quality management of health plan enrollees.
Why Canopy Health?
Together, the entire Canopy Health alliance strives to provide the best care at the right time in the right setting to benefit all our shared patients and community.
Canopy Health works with our participating organizations to optimize service and improve access at every level through prompt, empathetic, and responsive human interaction as well as advanced technology and sound administrative policies. Our participating organizations have committed to moderating prices, and we pass those savings on to our members through lower premiums.
Which Healthcare Providers Are Part of Canopy Health?
Canopy Health is comprised of nearly 5,000 Bay Area physicians, and growing.
Medical Groups (IPAs)
- Hill Physicians Medical Group
- John Muir Physician Network
- Meritage Medical Network
- Santa Clara County IPA (SCCIPA)
- Meritage Medical Network
- John Muir Medical Group
- Dignity Health (St. Mary’s, Saint Francis, Sequoia)
- Alameda Health System
- Marin General Hospital
- San Ramon Regional Medical Center
- Regional Medical Center
- Good Samaritan Hospital
- Sonoma Valley Hospital
- UCSF Benioff Children’s Hospital
- Washington Hospital Healthcare System
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We also contract with hundreds of other medical providers. Our healthcare alliance of physicians, hospitals, and other healthcare professionals is always expanding.
What Bay Area Counties Does Canopy Health Cover?
Primary care physicians throughout our service area may refer patients to other Canopy Health physicians located throughout eight counties in the Bay Area, including:
- Contra Costa
- San Francisco
- San Mateo
- Santa Clara
Find a Doctor close to where you live, work, and play.
How Can I Access Canopy Health?
Canopy Health contracts with several prominent health plans to deliver high-quality, consumer-focused, and price-competitive insurance products for employers and their employees in the San Francisco Bay Area.
To access the Canopy Health network, simply opt-in to one of the employer-sponsored HMO plans below and choose a primary care physician from our extensive list of doctors:
- UnitedHealthcare: SignatureValue Advantage HMO
- Health Net: SmartCare HMO
- Western Health Advantage: all HMO plans
What Is the Alliance Referral Program?
Choosing between a PPO and an HMO comes with tradeoffs for the member. PPOs give members the greatest choice in choosing their doctors, but that choice comes at a higher price. HMOs can have a better price point, but the member may feel constrained by having all their care typically restricted to one medical group. At Canopy Health, we’re trying to create a hybrid model – to give our members a PPO-sized network at an HMO price.
Members must select a primary care physician from one of our three Medical Group partners (Hill Physicians Medical Group, Meritage Medical Network, John Muir Physician Network, and SCCIPA), but instead of being locked into that medical group for all their care, that primary care physician is now able to refer their patient to any specialist across the Canopy Health network, regardless of medical group. Thus, giving our members the feel of a PPO at an HMO price.
Do Canopy Health Patients Need a Referral to See a Specialist?
Yes. Canopy Health values the judgment and expertise of personal primary care physicians (PCP), as well as their relationships with their patients. At Canopy Health, physicians have the entire Canopy Health alliance of specialists and facilities at their disposal and can decide (along with their patients) when and where to refer them for specialty care.
Does Canopy Health Manage Authorizations and Claims for Medical Services?
Canopy Health believes the best care is local. Each patient who is part of Canopy Health chooses a PCP and medical group. That PCP and group best understand the patient, and they can recommend the best local resources for high-quality and compassionate care. At the same time, each medical group is committed to working together through Canopy Health’s larger network to allow access to the best options for our members’ unique needs.
Canopy Health’s medical group partners (Hill Physicians Medical Group, Meritage Medical Network, John Muir Physician Network, and SCCIPA) support the traditional functions for their patients, including care management, referral and authorization processes, and contracting and claims management. Reimbursement for Canopy Health physicians and outpatient diagnostic providers will continue to come through their local medical group or Independent Physicians Association (IPA).
The healthcare industry has seen immense consolidation over the past few years. The Bay Area has an extremely consolidated provider landscape, with a few big players accounting for a large percentage of market share. Canopy Health wants to give Bay Area residents another choice. Instead of consolidating, we aim to work together with our partners to expand access and choice for our members across the Bay Area.