Insurance Information

At Associated Obstetrics & Gynecology, we accept and participate in many insurance plans (see list). Many plans require that you make a co-payment at the time of your visit. For your convenience, we accept cash, checks, and most major credit cards. Please be prepared with your insurance card and co-pay at the time of your visit.

To determine if a physician participates with your plan, see the book of network providers supplied by your insurance company. Also note that some plans require authorization before your visit. Please read the policy or check with your insurance company before making an appointment. We also have insurance specialists who can answer many of your questions.

 

Accepted Managed Care Plans

• Aetna

• Blue Care Network

• Blue Choice

• Blue Cross Traditional

• Blue Preferred GM, Ford, Mpsers

• Blue Preferred Plus

• Care Choices

• Cigna PPO, HMO

• Community Blue PPO

• Great West

• HAP

• Healthchoice

• Healthplus

• M-Care

• Medicare

• Medicare Advantage

• Multi Plan

• PPOM

• Preferred Choices

• Priority Health

• Private Healthcare

• Pro America

• United Health Care

Insurance Terms

 

Health Maintenance Organization (HMO)

A HMO is any organization that provides delivery of health maintenance, usually through a specified medical group such as the San Jose Medical Group. A Primary Care Provider (PCP) manages all specialist referrals with the exception of OB/GYN services.

 

Preferred Provider Organization (PPO)

A PPO is a health delivery system consisting of a panel of providers that offer their services at a discounted rate. PPO’s do not require a primary care physician. They do require that the patient see a participating physician to receive the discounted rate. If a patient elects to see a non-participating physician, she may be responsible for a larger portion of the bill.

 

Exclusive Provider Organization (EPO)

An EPO is a health delivery system consisting of a panel of providers. If the subscribers do not utilize the services of the panel providers “exclusively,” then they lose benefit coverage for any services provided by non-panel providers.

 

Point of Service (POS)

The patient may use this plan like an HMO or PPO and be able to choose their health care providers. With the HMO option, the patient is responsible for a co-payment. With the PPO option, the patient may have a deductible.

 

Co-insurance

Co-insurance is a requirement under a health insurance policy where the patient is responsible for a portion of the cost of covered services. (Example: The insurance company may be required to pay 80% leaving the subscriber to pay 20% as co-insurance. Usually the health insurance policy provides that the insurer reimburses a specified percentage of the covered services after deductible.)

 

Deductible

A deductible is a fixed amount that a patient contributes in payment for medical services during a specified period. (Example: The insurer policy may state that the patient has a $200 deductible per year. The first $200 in services billed to the insurance company would be denied a reimbursement, as the deductible is the patient’s responsibility.)

 

Co-payment

Co-payment is a provision under a health insurance policy where the patient assumes a fixed amount of the costs of covered services such as a $10 co-payment per office visit.

 

Exclusions

Exclusion is a specific condition not covered or service not paid for under a health insurance contract. Typical exclusions may be cosmetic or elective surgery or preventive care.