Frequently Asked Questions

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 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 will offer consistently high-quality care with clear, foreseeable costs.

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. Canopy Health is owned by UCSF Health, John Muir Health, Muir Medical Group IPA, Hill Physicians Medical Group, and Meritage Medical Network.
 

Why Canopy Health?

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.

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.
 

Which Healthcare Providers Are Part of Canopy Health?

 
Canopy Health is comprised of 4,000-plus Bay Area physicians from a growing list of partner hospitals and affiliate networks, including:
 

We also contract with hundreds of other medical providers to provide a complete set of healthcare services to our patients. And our care team of physicians, hospitals, and other healthcare providers is always expanding.

 

Is Canopy Health an Insurance Company or a Health Plan?

Neither! Canopy Health is an alliance of physicians and hospitals that contracts with insurance companies to offer health plans in which high-quality healthcare is provided by our vast network of physicians and facilities. Employers, individuals, and other purchasers may select Canopy Health from among a series of alternative health plan products offered by insurance companies.

What Kinds of Health Plans Does Canopy Health Offer?

Canopy Health contracts with several prominent health plans to deliver high-quality, consumer-focused, and price-competitive insurance products for employers, individuals, and other purchasers in the San Francisco Bay Area.

We are currently working on finalizing our health plan offerings. Check back soon for the details.

Is Canopy Health an HMO?

Canopy Health is not an HMO, but our initial licensure is through the Department of Managed Health Care (DMHC) to contract with HMOs. Unlike other HMO products, however, Canopy Health is owned and governed by local practicing physicians and hospitals. Like HMOs, though, we embrace a steadfast commitment to preventive health services, personal primary care physicians, and evidence-based care management plans and services.

At Canopy Health, our focus is on improving health, advocating for the entire Bay Area, and supporting individuals in a way this is both empathetic and respectful. In short, we are caregivers championing health.

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 Provide Their Members with Services Close to Where They Live and Work?

Yes! Primary care physicians throughout our service area may refer patients to other Canopy Health physicians located throughout seven counties within the Bay Area, including:

  • Alameda
  • Contra Costa
  • Marin
  • San Francisco
  • San Mateo
  • Solano
  • Sonoma

 

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, and John Muir Physician Network) 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). Hospitals and other outpatient facilities will be reimbursed for services by Canopy Health via our management partner, Conifer Health Solutions.