Billing & Insurance
Insurance
We are contracted providers for both HMO and PPO health plans. If your health insurance is an HMO plan, it must be affiliated with Sharp Community Medical Group.
Co-pays are due at the time of visit.
As contracted providers with insurance plans, we have agreed to accept certain payment amounts for most services that we provide, such as physicals, well child checks, sick visits, vaccines, vision and hearing tests, etc. Each insurance policy is unique, though, even within the same health plan. Some carriers will not pay for certain services or will limit the number of well checks per year. We cannot know specifically what will be covered by your plan nor can we verify this at the time of the visit. We encourage you to discuss your benefits with your carrier and to verify coverage prior to your visit. Please rest assured that our practice is guided by what is medically necessary for you and your children, as well as by guidelines from the American Academy of Family Medicine.
Newborns must be added to your insurance plan within the first 30 days after birth for hospital charges to be paid by your insurance.
You are ultimately responsible for all charges incurred regardless of insurance payment
If we are not contracted with your insurance, we can still provide medical care to you and your family as out-of-network providers. This means that we do not have negotiated rates for our services with your carrier. We strongly advise you to contact your insurance carrier to determine your plan’s out-of-network benefits. As with all out-of-network providers, there will be a difference between our charges and the amount that your insurance pays.
Billing
Co-payments are due and payable at the time of your visit.
At the end of each business day we submit all charges to your insurance company for payment. Once we have received payment from your insurance our billing company will send out a statement notifying you of any remaining balance.
It is imperative that you keep us updated to any changes with your insurance. Insurance companies will deny payment if information is not submitted within a certain time frame. Please notify us at check-in if your coverage has changed or if you have any new information such as a name change or have recently moved.
If you have questions regarding a bill, please contact our billing office at 858-598-5654.
Form Fees
Our providers are happy to complete medical forms on your behalf. Most of these forms are completed after hours because our providers are busy treating patients here in the office. Because these forms require our physicians’ time there are required fees to be paid prior to completion. Unfortunately, these form fees are not covered by insurance. Please note, forms typically get completed between 3-5 business days. Once your form has been completed, our office staff will contact you.
- DMV Placard: $15
- FMLA (Family Medical Leave Act): $15
- EDD (Medical Disability Form) $35.00
- SDG&E Form: $15
- Jury Duty Forms / Letters: $35
- Driving Physicals: $35
- Patient Assistance Program Letters (ex: Pharmaceutical Programs): $15
- Military Transfer Exception Forms $35
- Sports/ Camp/ School Forms $15
*Please note we do not have these form in our office.
