Insurance & Payment
We are contracted with most major insurance companies under the PPO network and are ONLY contracted with Brown and Toland Medical Group under the HMO network.
To verify our participation with your specific insurance policy, please contact your insurance company directly and provide them with our Tax ID number 94-3063257.
If you intend to pay out of pocket, we accept cash, checks, MasterCard and Visa. Please be prepared to pay for your service at the time it is rendered.
We are proud to be members of the Brown and Toland Medical Group (BTMG), our independent physician affiliation.
Along with being a member of the Brown and Toland Medical Group, Dr. Elizabeth Moy is also a member of the Hill’s Physicians Group.
If you are currently a member of a different IPA (for example Marin IPA or Mills Peninsula IPA) AND have straight HMO insurance (not "point of service") your plan will not cover your visit. You will need to pay out of pocket for this visit. If you wish to see a physician and are of a different IPA you will need to switch medical groups to Brown and Toland. You can switch the first day of any month.
If we are participating providers in your PPO plan, our fees are paid in accordance with your pre-arranged benefit package (with deductibles, co-pays, etc.). Please be sure you know which laboratories and radiology units are also participating members so that we may refer you to the appropriate resources.
Because some health plans restrict our ability to provide you the type of care we value, the physicians of PWOG have declined "preferred provider" status with a few small PPO health plans.
If we are not participating providers in your plan (i.e. "out of network"), you may be asked to pay for physician services "up front". We will provide the necessary paperwork for you to seek reimbursement from your insurance. In almost all instances, your insurer still pays a large portion of physician fees. In some cases, your out of pocket costs actually drop! Either way, the patient's out of pocket costs are usually quite nominal. We expeditiously refund your initial payment as soon as insurance compensation is received.
Because we refer you to "in network" providers for lab work, radiology (ultrasound, bone densities, mammograms, etc), and hospitalization, your co-pays for these services are unaffected even though we are out of network.
- All routine, prenatal office visits are bundled with the delivery and billed after the baby is born. This is called Global Billing. Should you change insurance carriers in the middle of your pregnancy, we will bill your insurance for the visits you had and then bill your new insurance for your remaining prenatal visits with delivery. Any additional services outside of routine prenatal visits are billed separately and usually incur additional charges (i.e. ultrasounds, injections, prenatal testing).
- Global billing refers to the physician fees only and does not include the hospital’s fees for admission or delivery.
While we are participating providers of the Medicare plan, please note that Medicare does not pay for all your healthcare costs. You should be aware Medicare will not pay for Preventative Well-Woman visits, as it does not meet the definition of any Medicare benefits. Medicare covers the costs of your Pap smear once every 24 months.
If you have questions or need further clarification on insurance coverage our billing company at 415-972-4500 is happy to assist you.
- Medicare: Medicare is a Federal health benefit for all residents over the age of 65 and others with long term disabilities. Most patients have a supplemental policy coverage to offset their out-of-pocket responsibilities, but Medicare is always the primary policy. Medicare patients are subject to an annual deductible and co-insurance, like any PPO insurance plan.
- What does Medicare Pay For?
- While Medicare pays for many services, it does NOT pay for annual well-woman exams. Medicare differentiates between the annual wellness exam, a general physical performed by a PCP, and annual well-woman exam, as performed by a specialist or OBGYN physician. Medicare will pay for a pelvic exam and pap smear once every 24 months, but does not pay for the office visit itself.
- Problem-focused exams and treatment of diagnosed conditions are typically a covered benefit of Medicare.
- Pacific Women’s OB/GYN Medical Group recognizes that paying the annual well-woman exam can become a financial burden to patients, which is why we ask our Medicare patients to review an Advanced Beneficiary Notice (ABN) at the time of their annual well-woman visit. The ABN allows our Medicare patients to still receive their annual well-woman exam at a discounted rate.