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. We are also contracted with Medicare. Please note we are not providers of Medi-Cal, San Francisco Health Plan or any subsidiary of Medi-Cal state programs.
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.
If you have had your first obstetrics (prenatal) appointment by December 31, 2012, you may stay with our practice and deliver at CPMC, even if your due date is in August, 2013. You will incur no additional costs. We will facilitate the necessary paperwork for you to switch to Hill Physicians but stay with our practice and CPMC!
Annual examinations/other gynecological issues:
If you switch to Hill Physicians, we recommend two options:
1) See Dr. Elizabeth Moy, a Hill Physicians member, for your 2013 annual;
2) For a nominal fee (far less than a single month of the additional premium required to stay with Brown and Toland), you may still see your own doctor in the practice. All tests and images (sonograms, mammograms, blood work) will be sent to "in network" labs and imaging centers, so you would not bear any additional costs for any tests we might order.
We are hopeful that new contracts will be available in 2014 so that patients have more choices! Please feel free to contact Harriet at 415-379-9600 or email@example.com if you have questions or need assistance
We are proud to be members of the Brown and Toland Medical Group (BTMG), our independent physician affiliation.
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.
Because Brown and Toland Medical Group (BTMG) offers the advantage of both university and community physicians, we recommend that our patients switch affiliation to Brown and Toland. We are happy to assist you in finding a primary care doctor within BTMG. You may switch medical groups the first of day 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.
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.
We will be happy to provide you, upon written request copies of your file with Pacific Women’s OB/GYN Medical Group. A copy charge will be incurred and if your file must be retrieved from storage, you will be charged our costs for retrieval as well.
Due to escalating administrative costs, we must charge a $15.00 fee for completing each disability form. This fee includes postage.
State Disability Insurance:
If you are planning on filing with the state for your disability, it is recommended to go online to start your claim. Please visit www.edd.ca.gov, and click on “File for State Disability” located under File & Manage a Claim. From there, please select SDI Online Registration to begin your claim (Form DE2501). Once you have completed your portion, you will be given a receipt number. Please email this number to our Disability Coordinator, Emmy Garcia at firstname.lastname@example.org.
The state is no longer accepting ‘future’ dated claims. You will need to file your claim on the “start” date of your maternity leave, or you will have up to 49 days to file from your “start” date.
Also, while filing your claim, you will need to indicate your last day worked in addition your ‘start’ date. These two dates cannot be the same as you cannot be disabled and working. For example, if your last day of work is on a Thursday, you will list your start date as the following day, Friday. If you do put the same date for each, then your claim will be null and you will be required to file a brand new claim with appropriate dates.
If you have Employer Disability Forms, please email them to Vivian at email@example.com, or fax them directly to (415) 379-9823. Please be sure to indicate your last day of work, and the “start” date of your disability leave.