Archived Q&A and Reviews

Pediatricians that take Anthem Pathway PPO

Feb 2015

I am a UCB doctoral student who purchased Anthem Blue Cross Pathway PPO insurance through Covered California website. We learned recently that our pediatrician at Bayside Medical Group does not take our insurance. We had been going to this doctor (who we loved) since our son was born last year. In an attempt to find another provider, all of the places I have called (Primary Pediatrics, Sutter East Bay Medical Foundation, etc.) all say they will not take this insurance. We were told that Anthem isn't paying well in this plan and that is why so many providers have dropped this insurance. Apparently, the similar Anthem PPO plans that are purchased through and employer are fine but the ones that are purchased by individuals are not. This is bad news for people like us who have been paying for insurance out of pocket (and this insurance is not cheap). I even called Anthem, who gave me a list, but many of the providers on the list still do not take this ''pathway'' PPO. Has anyone else had this trouble? Do you have recommendations for providers that take this insurance? Thanks for your help.

I'm sorry that you also have to deal with Anthem Pathways PPO. The network is terrible — our family lost access to 10 of our 11 doctors when we were forced to switch to it from another private Anthem plan. Like you, our beloved pediatrician of 7 years doesn't take it, but we've been happy with Berkeley Pediatrics on Walnut Street in North Berkeley. Our first visit to them led to an emergency hospital stay and several follow up appointments for one of my kids and they handled the whole thing very well.

A word of warning: we've found that many doctors are listed as in-network on Anthem's website, and when we've called to confirm, many doctors' offices erroneously say they're in network when they're actually not. My advice is to find someone in the doctor's billing office who is familiar with the Pathways PPO and ask them to confirm with Anthem that they're indeed in-network.

We have spent dozens of hours on the phone over the past year+ sorting this stuff out. Now my husband and I go to UCSF for almost all of our care. It's inconvenient, but they're in-network and trying to find in-network doctors in the East Bay is too much trouble. frustrated Anthem customer