Billing & Insurance

On each arrival, please check in at the front desk and present your current insurance card and photo ID. If you are new to the practice, or if your insurance or demographic data has changed, you will be asked to fill out or update our registration paperwork.

This is your verification of the correct insurance and consent to bill them on your child’s behalf. If the insurance company or information that you designate is incorrect, you will be responsible for payment of the visit.

HMO plans

We are members of  Hill Physicians. 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).

Below is a list of some of the non-HMO (PPO, EPO, etc.) insurance plans we participate in:

• Aetna
• Blue Cross
• Blue Shield
• Cigna
• Coventry Health Network / First Health
• Great West
• HealthNet
• Multiplan (PHCS, Admar, Beech St.)
• PacifiCare
• Sutter Select / UMR- Limited employment sites. Under “Out-Of-Network” benefits.
• United Healthcare

There are numerous other plans our physicians are contracted with. Please contact the plan you are considering during enrollment to confirm if your Primary Care Physician is a contracted provider with that plan. If we are not contracted with your plan, ask your insurance carrier about considering “out of network” options as well.

It is very important that you notify your employee benefits or HR department and insurance company of your newborn within the first 30 days of life for enrollment on your health plan.

At every office visit, be prepared to show your current insurance card and make a co-payment if your plan requires so.

Please notify our office any time there is a change in insurance coverage and bring the new insurance card to your appointment. Incorrect or out-of-date information will delay your claim and you may be held responsible to full payment of the claim.

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

Covered California (also known as Exchange Plans or “Obamacare” Plans)

Covered California products offered in Alameda county starting from January 1, 2016:

Blue Shield IFP PPO (EXCLUSIVE): We are happy to announce that South East Bay Pediatric Medical Group is contracted with the Blue Shield plan offered through Covered California effective 2016. This will also be true for families that purchase their plans directly from Blue Shield.

Anthem Blue Cross PPO (Pathway X PPO): Our practice is considered out of network with this plan at this point in time. We would like our local families to know that we will see those covered under the Anthem Exchange plan, however there will be significant out of pocket expense as we are considered “Out Of Network.” Learn more about this coverage. If you obtain your health insurance through your employer (like most of our families), then this will not affect you and we are contracted as in-network with most employer issued Anthem Blue Cross health plans.

Kaiser: not accepted by our practice.

If you ever have any questions or are unsure whether we accept your insurance, please contact our office and speak to one of our receptionists.

Billing Office

Our new billing office can be reached at 844 399-8227, Monday – Friday between 7am – 4:30pm. For questions regarding visits before January 11, 2022 please contact our office directly.

We are contracted with numerous insurance plans. However there are many insurance plans and variations of plans that employers choose, therefore making it impossible for our office to know the covered benefits of your insurance plan. It is the responsibility of the patient or family to know and understand the policies and benefits of their insurance plan.

This includes:

• Co-payments
• Covered hospitals, labs & x-ray
• Prior Authorization & Referral procedures

If you have been affected by the recent changes between Anthem Blue Cross and Bay Valley Medical Group, we’d like you to know our doctors are contracted providers through Hill Physician’s Medical Group and WE ARE OPEN to new patients!