+ When should I call to confirm if you take my insurance?

If your insurance card says:

• Kaiser Hills
• Physicians Network
• Medi-cal
• Medicaid
• San Francisco Health Plan
• Western Growers Insurance
• TriCare East
• Worker’s Compensation Claims

+ What is a premium?

A premium is the amount of money you pay on a regular basis-once a month, four times a year, twice a year or once a year-to your insurance company to keep your health plan active. You can’t apply what you pay for your premium toward your deductible.

+ What is a deductible?

A deductible is the amount of out-of-pocket expenses you have to pay each year before your health plan kicks in and starts paying for services.

+ What is a coinsurance level?

A coinsurance level is the percentage of money you have to pay out of your own pocket for covered services. It’s the portion of the bill not paid by your health plan after the deductibles have been reached.

+ What is an out-of-pocket limit?

An out-of-pocket limit is the total amount of money (not counting your premiums) you have to pay each year for your covered medical services. Your deductible and coinsurance payments for covered services count toward your out-of-pocket limit.

+ What's the Difference Between an HMO, EPO, and PPO?

• HMO - An HMO, or Health Maintenance Organization, is a type of health plan that offers a local network of doctors and hospitals for you to choose from. It usually has lower monthly premiums than a PPO or an EPO health plan. An HMO may be right for you if you’re comfortable choosing a primary care provider (PCP) to coordinate your health care and are willing to pay a higher deductible to get a lower monthly health insurance premium.

• EPO - An EPO, or Exclusive Provider Organization, is a type of health plan that offers a local network of doctors and hospitals for you to choose from. An EPO is usually more pocket-friendly than a PPO plan. However, if you choose to get care outside of your plan’s network, it usually will not be covered (except in an emergency). If you’re looking for lower monthly premiums and are willing to pay a higher deductible when you need health care, you may want to consider an EPO plan.

• PPO - A PPO, or Preferred Provider Organization, is a type of health plan that offers a larger network so you have more doctors and hospitals to choose from. Your out-of-pocket costs are usually higher with a PPO than with an HMO or EPO plan. If you're willing to pay a higher monthly premium to get more choice and flexibility in choosing your physician and health care options, you may want to choose a PPO health plan.

+ Help! I was referred to you by an urgent care/my Primary Care Physician, but it seems like you don’t take my insurance plan?

No worries! Please give us a call at 415-390-6511 and we would be more than happy to help you out. We also offer very competitive self-pay rates if needed.

+ Do I need a referral from my Primary Care Physician (PCP) to see an orthopedic specialist?

• NO, if you have a PPO or EPO plan
• YES, if you have an HMO plan.
• YES, If you have:
  • Aetna Elect Choice Plan - please call 415-390-6511 for more information
  • Aetna Select Plan - please call 415-390-6511 for more information
  • Aetna Open Access Select - please call 415-390-6511 for more information

+ I was referred to you by the Emergency Room (ER) of a hospital, or another Urgent Care Clinic, and I have an HMO plan. Do I still need to contact my Primary Care Physician (PCP) for a referral?

• NO, if you have a PPO or EPO plan
• YES. If you have an HMO plan, you must obtain a referral from your Primary Care Physician that you designated with your health insurance plan to see an orthopedic specialist.
• YES. If your insurance plan requires PCP referrals (such as Aetna Elect Choice, Aetna Select, and Aetna Open Access Select).
• If you are unsure whether a PCP referral is required by your health insurance plan, please call the Member Services Phone Number typically located on the back of your insurance card.

+ If I don't have insurance, can you see me?

• YES. Our self-pay rates are $270 for an office visit and $80 for an X-ray exam of 1 body part. Additional procedures and ortho equipment may add additional cost. If your appointment is with one of our surgeons, this price may not apply and charges may be higher. Call us at (415) 390-6511 for a quote.