Insurance Referrals and the Patient's obligations

There are many different types of insurance carriers. It is your responsibility to know what is required from your insurance plan to see a Specialist. Dermatologists are Specialists so please refer to your Specialist benefits under your plan. Your insurance card is a form of payment with our office so it is important that you bring your insurance card to all medical appointments. You will be financially responsible for all copays, co-insurances, annual deductibles based on fee schedules created by your insurance company.

HMO Medical Plans

  • Brown and Toland Medical Group
  • Hills Physicians Medical Group
  • Sutter West Bay Medical Group.

Canopy

If you have an insurance card with the word Canopy on it, that is the ONLY time we can accept a John Muir or Meritage Medical Group patient.

Referrals

Since COVD19, the HMO plans are less lenient about referrals and will not process your claims without them. These are the rules of the plan you chose, not the rules that we have created. We apologize for any inconvenience.

Tricare active duty and student health plans as well as some other PPO/POS/EPO types of plans require referrals/preauthorization as well. Check your plan benefits in regards to seeking care at a Specialist office before scheduling an appointment with our office.

ALL of these plans have strict rules. Your PCP is considered your gatekeeper and you must get permission from your PCP in the form of referral. The PCP may give you a referral from their own database but that is not sufficient. Your HMO plan will deny your medical care as a result.

PPO Plans

We accept MOST insurance plans. Some insurance websites are not updated properly so it is best to ask our office if we accept your particular plan.

Some notable exceptions are Workers Compensation, MediCal, Blue Shield High Performance Network (HPN), Blue Shield Tandem PPO Network and Covered California’s Anthem Pathway Tier plans. We do not accept these plans.

Our office is here to help so if you are unsure, please email visit@450derm.com for additional support regarding your insurance.