Insurance Plans

Annotations:

• PPO Plans are Deductible based plans wherein the DED must be met unless blanketed by a copayment.Once DED is met Coinsurance kicks in. if OOP is ever met do not collect only cc auth

1. Anthem Blue Cross Blue Shield
   1. Blue Shield of Cali

      Annotations:

      • ** Covered California DED applies charge $160 
      1. United Health Care
         1. Aetna
            1. Cigna
               1. PHCS/ Multiplan
                  1. Tricare

                     Annotations:

                     • Tricare Standard and Prime are accepted. Tricare West, East and Tricare for life (medicare sup) are included. Specify which region, refer to attached resource
            2. Americas Choice Provider(ACPN)
               1. Great West
                  1. Healthsmart/Interplan
                  2. Healthnet
                     1. Medex
                        1. Networks by Design
                           1. UMR
                           2. GEHA
                     2. Prime Health Services
                  3. Coventry/ First Health
                  4. Humana
2. Medicare

   Annotations:

   • (1-800-633-4227) provider line- cannot release details, only veiryf pt is active. *** Verify Medicare is primary/ Secondary/ replacement

Annotations:

• Treat as a PPO Plan

1. Anthem EPO

   Annotations:

   • *** unless Pathway/ EPO Select **** Northgate collect copay
2. Aetna EPO

   Annotations:

   • "non urgent services no covered" if not deemed urgent, EPO may deny claim altogether

Annotations:

• HMO plans are non deductible based plans that only charge a copay at time of service. Virtually all HMOs require a Referral for any specialist 

1. Monarch Healthcare

   Annotations:

   • (888) 767-2222 or (949) 923-3200 Provider line if Monarch is not updated w new pt info
   1. Molina
2. Mercy Physicians Medical HMO
3. Scripps Physicians Medical Group

   Annotations:

   • Use PO box 7250 *** DO NOT ACCEPT SCRIPPS HEALTH PLAN/ CLINIC.  CONSIDERED OON. $137 AND CC AUTH APPLIES 
4. Community Health Group

   Annotations:

   • *** USE PO BOX 210100  COMMNITY HEALTH CHOICE/ COMMUNITY HEALTH PLAN NOT ACCEPTED. OON PLANS AND $137 APPLIES 
5. Sharp Community Medical

   Annotations:

   • *** NOT ACCEPTED: Sharp Reese Steely
6. Rady's
7. UCSD

Annotations:

• *** Must have US claims Address NOT of of country  *** may accept fax Auth or payment via phone