We have contracts with many insurance carriers. However, it is not possible for our office to know the covered benefits of your plan. Patients and their parents have the responsibility to understand their insurance benefits, coverage, co-payment responsibilities, processing regarding referrals and authorizations, and which laboratory, x-ray, and urgent care facilities are available to them on their plan.
If your insurance is a HMO, we are members of Brown and Toland Medical Group and Hill Physicians Medical Group. It is important that one of our doctors is listed on the patient’s card as the Primary Care Physician.
Below is a list of some of the insurance plans we are contracted with:
PLEASE NOTE: Within the Plans listed, the carriers are offering "Narrow Network" plans that we may not be considered in-network providers for. Please verify our Tax ID Number 47-1370520 with your insurer to confirm our participation status with your particular plan.
- Health Net HMO and PPO
- United Health Care (We are not part of UHC "Core" Plans)
- Aetna HMO and PPO
- Cigna HMO and PPO
- Blue Shield of California HMO and PPO
- Anthem Blue Cross HMO and PPO (We are not part of the Anthem "Select" Plans)
- COVERED CALIFORNIA: Through the State marketplace, we are providers under Blue Shield PPO, all tiers.
- Managed Care Medi-Cal plans through Children's First Medical Group. For Alameda county residents, accepted plans are Alameda Alliance. For Contra Costa County residents, accepted plan is Contra Costa Health Plan.
Newborn Health Insurance Coverage
Coverage is not automatic. The parents must add the baby to the insurance policy as soon as possible within the first 30 days of life in order for the baby to be covered on the policy. Newborn health insurance coverage is usually through the mother’s insurance and medical group for the first 30 days of life. We are members of Hill Physicians Medical Group and Brown and Toland Medical Group. If mom is not in either one of those medical groups, you will need to contact the carrier to see if mom and baby can be in different medical groups for the first 30 days. If you have an HMO insurance, check that one of our doctors is listed as the primary care physician on the card. If you are unable to present a card for the baby at the 2 month visit, you will be asked to pay in full until we have a card. Insurance carriers limit the amount of time we can retroactively bill. In order for you to be reimbursed any overpayment, you must provide us with a current insurance card within 30 days of the visit
Dual Insurance Coverage Information
Please inform the office if you have dual insurance coverage for your child. The general rule to determine primary and secondary insurance coverage is that the plan of the person with the earlier birthday (in the case of a dependent children with both parents having insurance) is usually considered primary, while the other plan becomes secondary; this is often referred to as the "birthday rule".
We asked that you take these steps if you have dual coverage to ensure proper billing:
- Check Policy Details: Review both health insurance policies to understand what is covered, any exclusions, and how benefits will be coordinated.
- Understand COB (Coordination Of Benefits) Rules: Ensure you know which insurance is primary and which is secondary.
- Notify Providers: Inform your healthcare provider that you have dual coverage, as they will need to submit claims to both insurers.
- Confirm Benefits: Call both insurance companies to confirm that they are aware of the dual coverage and understand how claims will be handled.
- Track Payments and Claims: After receiving care, check your Explanation of Benefits (EOB) statements from both insurers to ensure that both have paid correctly and that you are not overcharged.
Check to see if your primary care provider is in network
If you have any questions, please feel free to contact our business office at (510) 848-4782. Please contact your plan, in advance, to confirm that we are a provider of your insurance. If there is a change to your insurance, address or phone number, contact our business office as soon as possible, as this may affect claims submission & processing. Our billing staff is here to assist you. Please call (510) 848-4782 with any questions.