HMO plans

We are members of both Brown and Toland Physicians and Hill Physicians for HMO plans. It is important that if you are a member of one of these HMO plans and receive care in our office, that one of the doctors in our group is listed as your Primary Care Physician (PCP).

Non-HMO plans

Below is a list of some of the non-HMO insurance Plans & Networks we participate in:

*Covered California – The only plans under the State marketplace we are contracted with are the Blue Shield plans.

** We are not contracted with Medi-Cal

There are numerous other plans our physicians are contracted with. Please contact the plan you are considering and give them our Tax ID # (80-0752962) to confirm if your Primary Care Physician is a contracted provider with that plan.

It is very important that you notify your insurance company of your newborn within the first 30 days of life.

At every office visit, be prepared to show your current insurance card and make a co-payment if your plan requires so. If your child is sent with a childcare provider, please make sure that that person is prepared to make the co-payment.

Please notify our office any time there is a change in insurance coverage. You can do so by filling out our Change of Insurance form and submitting it to our billing office with a copy of the new insurance card, both front, and back. You can submit this form via our website. Failure to do so results in unnecessary billings to insurance companies only to find out that the policy has lapsed. Incorrect or out-of-date information will delay your claim and you may be held responsible to full payment of the claim.

Please notify our office of any Change of Address as soon as possible.

We must emphasize we cannot accept responsibility for collecting or negotiating insurance claims.

Authorizations & Referrals

HMO Members

Patients who are part of HMO plans such as Brown and Toland Physicians or Hill Physicians are required to get a referral from your Primary Care Physician (PCP) in order for you to see a Specialist (i.e. allergist, pulmonologist, orthopedist, etc.) that is in your HMO Network. If you feel there is a need to see a Specialist, please contact your PCP and if necessary a referral will be generated.

Prior Authorizations are required for certain procedures, durable medical equipment, to see a doctor that is “out-of-network” and other services as well. Prior Authorizations can be requested by your PCP. Our office sends a request for the service or equipment to your HMO with any supporting documentation of why we are requesting the service or equipment to be authorized. The HMO reviews the information and makes a decision to approve or deny the request based upon various factors. To see if a procedure or equipment needs to be authorized, you should contact your HMO.

Non-HMO’s

Most PPO plans and other non-HMO care plans do not require referrals or authorizations to be generated from your PCP. However, it is impossible for our office to know what each plans policies are and what the covered benefits of each plan are. Please contact your insurance company if you are unclear on what your policy requires.

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