This office is an in-network provider with Blue Shield of California.
This office is an out of network provider for all other insurance companies, but will bill these insurance companies as a convenience for PPO plans with out of network coverage.
This Office does not accept HMO or Medicare or Medicaid insurance plans.
For all out of network plans payment is due at the time of service by the client. Credit will be applied to the clients account for any payment received by an insurance company for that client. Note: having insurance does not guarantee coverage or payment for services rendered.
Things you need to know about your plan/common questions:
All of the following can be found in your plan guide, answered by your insurance company, answered by your companies human resources department.
Your insurance card should say the following:
PPO or PPO open access
PPO no referrals required
These mean you can pick and choose who your doctors are.
PPO or EPO Managed care means that you must receive pre authorization or a referral from your primary care physician or from your insurance company for that doctor or treatment.
Your card should state “out of network coverage is” and list a % For example 70% means that your plan covers only 70% of what they are willing to cover for a treatment based on your plan, not 70% of the total bill. The “total bill” and “what your plan covers” are typically two different things.
Out of network coverage typically has a higher deductible than in network coverage:
Your insurance company only applies the amount they are “willing to pay” for a service towards your deductible, not the entire amount of the bill. This is why your in network deductible is less than out of network. Your insurance company pays less to in network providers.
In network doctors tend to get very little reimbursement for services rendered( if they get reimbursed at all). Therefore in network doctors tend to deliver the minimum standard of care. In network plans benefit the insurance company, not you.
Anthem Blue Cross PPO typically only pays a $25 dollar maximum for chiropractic. In addition they often have a chiropractic deductible that is separate from your general deductible. Make sure you understand your plan.