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Medical Provider Network

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Choosing a PCP and Medical Group within the Scripps Health Plan HMO in San Diego County

Each Scripps Health Plan HMO member is required to designate a PCP from the Scripps Health Plan HMO Network. A PCP can provide routine, basic care and help find the right specialist when needed. PCPs are typically physicians who practice in the areas of Internal Medicine, Family Practice, General Practice, Pediatrics and OB/GYN. An OB/GYN can only be selected as a PCP if the provider is contracted with SHP as a PCP. This can be verified by accessing the online provider directory or by contacting Customer Service. The PCP selected determines the Plan Medical Group (PMG) in which members may see specialists. Specialists cannot be selected as PCPs. Members may choose a different PCP and/or medical group for each family member. For example, the employee and spouse could elect a PCP with Scripps Coastal, and elect PCPs with Rady’s for their children.

PCPs have at least one Plan Medical Group affiliation, and some may have multiple affiliations to choose from. When electing a PCP, members should review the physician’s medical group affiliations to ensure they are gaining access to the correct medical group and specialty care. The medical group that the PCP is affiliated with is the medical group that all care must be accessed within.

You or your dependent may change PCPs or designated medical group at any time by calling our Customer Service Department toll free at 1-844-337-3700 or for the hearing and speech impaired TTY: 1-888-515-4065, Monday through Friday from 8 a.m. to 5 p.m. PST. PCP and/or medical group changes are effective the first of the month following the date of your requested change. Once your medical group change is effective, all previous authorizations for specialty care or procedures are no longer valid and must be transitioned to specialists affiliated with the new medical group, even if you remain with the same PCP. Additionally, changing your PCP or designated medical group during a course of treatment may interrupt the quality and continuity of your health care. For this reason, the effective date of your new PCP or designated medical group, when requested during a course of treatment, will be the first of the month following the date it is medically appropriate to transfer your care to your new PCP or designated medical group

You can also search for an HMO provider by visiting www.scrippshealthplan.com and choosing the ‘Find a Doctor’ option, you are able to check status of a provider by accessing the HMO provider directory which is updated twice a week.

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The availability of any particular provider cannot be guaranteed and provider network composition is subject to change. Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, clinic or call Scripps Health Plan at (844) 337-3700 to ensure that you can obtain the health care services that you need.

To request a printed copy of the Scripps Health Plan HMO provider directory, you may do one of the following:

  • Call us at 844-337-3700
  • Email us at customerservice@scrippshealth.org
  • Write to Scripps Health Plan, Attention: Member Services, P.O. Box 2749, La Jolla CA 92038.

To report any inaccuracies in the Scripps Health Plan HMO provider directory through the online search tool or printed copy, you may do one of the following:

  • Call us at 844-337-3700
  • Email us at SHPSAppealsAndGrievancesDG@scrippshealth.org
  • If you are a member, submit your concern through our online member form.
  • If you are a provider, submit your concern through our online provider form.

At Scripps Health Plan, we understand that health care matters can be complex and confusing sometimes even harder to understand if English isn’t your primary language.

We provide free interpreter and translation services for all of our members. If you need help talking to your doctor, understanding medical information or obtaining care, please call our Customer Service Department (844-337-3700 or TTY/TDD line 888-515-4065). We have representatives who have access to interpreter services in over 100 other languages who focus on quality of health care communication of medical relevant information.

Scripps Health Plan values and respects the dignity of each and every one of our members. If you have a qualifying disability, you may have the right to reasonable accommodations to access the care you need – this is your right under Section 504 of the American’s with Disabilities Act. If you need help getting the care you need because of your disability, or believe that you have been discriminated against, please contact our Customer Service team at 844-377-3700.