Referral Policy - Personal Health Policy

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.

Please note: skin exams are not considered a preventative service. Your Primary Care Physician (PCP) is responsible for all of your preventative care services.

HMO Medical Plans

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

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.

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.

Note: Failure to obtain a referral before you are seen in our office may result in the appointment being rescheduled or a denied medical claim if you insist on being seen and not rescheduled. We apologize for this in advance but again, but these are the rules of the HMO plans.

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.

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.