INSURANCES

November 10, 2016 admin No comments exist

Insurance Information

  • We accept almost any insurance company. We are preferred Network Providers for most of the health networks. We are providers for virtually all PPO’s, and if we are not, we can still treat you as out-of-network providers.  Please feel free to contact us, or call us at 408-945-0300 , if any questions.
  • If you have HMO insurance (Physician Medical Group (PMG), Santa Clara Family Health Plan (SCFHP), Healthy Family and Santa Clara Independent Provider Association (SCIPPA), you  must be registered as a patient for Silicon Valley Medical Clinic or clinic's one of the clinic's physician Dr. Malhotra or Dr. Sanchez.
    Just call your IPA or HMO insurance and it should be easy to do this. If not, please call us at 408-945-0300 and we will gladly help you.  For HMO or MediCal, Dr. Malhotra or Dr. Sanchez must be the primary care provider.
  • If you have MediCal insurance, you will need to enroll in SCFHP or Blue Cross MediCal, and register as a patient for Dr. Neema Malhotra. Just call them and it should be easy to do this. For HMO or MediCal, Dr. Malhotra must be the primary care provider.
  • We do not accept Kaiser insurance. If you are immigration medical exam, we will work with your Kaiser insurance to order and coordinate tests and immunizations.

    Make your appointment

    To serve you better, please make an appointment by calling 408-945-0300 for Pediatrics and Family members.

    You can click here to Book an Appointment

    If you are calling us for Laser, Botox, Juvederm, Skin Rejuvenation and Medical Aesthetics services, Please call direct 408-945-0400 for FREE consultation.

    Also bring with you:

    • A copy of your current insurance card

    • A copy of your (or your child's) immunization history

    • A driver's license or some other ID card to identify 

      Please Bring Your Insurance Card 

      We will submit a claim to all primary and secondary insurances.  Please remember to bring your current insurance cards to your appointment.  Once your insurance company has processed your claim, we will bill you for the remaining balance.  Payments are expected upon receipt of your statement.  We accept Visa, MasterCard, American Express, Cash, Checks, Debit Cards, Flexible Savings Account (FSA) and Health Savings Account (HSA).

      If You Are Uninsured 
      If you are uninsured, or if we are unable to verify coverage, we require a minimum $120.00 payment at your first office visit which will be applied to your charges. We offer a 20% cash discount on physician’s services to uninsured, self paying patients paid prior to the service.

      How do deductibles, coinsurance and copays work?

      When both you and your health insurance company pay part of your medical expense, it’s called cost sharing. Deductibles, coinsurance and copays are all examples. Understanding how they work will help you know when and how much you have to pay for care.

      Deductible

      • A deductible is the amount you pay for health care services before your health insurance begins to pay.

      Let's say your plan's deductible is $3,500. That means for most services, you'll pay 100 percent of your medical and pharmacy bills until the amount you pay reaches $3,500. After that, you share the cost with your plan by paying coinsurance and copays.

      Coinsurance

      • Coinsurance is your share of the costs of a health care service. It's usually figured as a percentage of the amount we allow to be charged for services. You start paying coinsurance after you've paid your plan's deductible.

      Here's how it works. Tara has allergies, so she sees a doctor regularly. She just paid her $2,500 deductible. Now her plan will cover 70 percent of the cost of her allergy shots. Lisa pays the other 30 percent; that's her coinsurance. If her treatment costs $150, her plan will pay $105 and she'll pay $45.

      If Tara  has a PPO plan, she has the option to see any doctor she wants. If she goes to an out-of-network doctor, her plan will still share the cost, but her percentage of coinsurance will be higher. And, if the medical service she gets is more than what her plan would pay for an in-network doctor, she'll have to pay the different. We are In-Network Provider for most of insurance companies.

      Copay

      • A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service. You may also have a copay when you get a prescription filled.

      For example, a doctor’s office visit might have a copay of $30. The copay for an emergency room visit will usually cost more, such as $250. For some services, you may have both a copay and coinsurance.

      Please note that insurances usually do not cover Aesthetics procedures, until it is a medical necessity. We expect payment at the time of service.

      Unpaid Accounts 
      We assign all unpaid accounts to an outside collection agency that report to a national credit bureau.  They will add additional penalties and interest to the unpaid amount. Any bounced NSF check will
      be charged $35 fee plus other collection fees.

      Following Guidelines 

      Physicians must follow accepted national guidelines when determining what your charges (level of service) will be.  They must code your visit based upon what services were provided and cannot take into account particular health plan benefit designs.  Consequently we are unable to switch the visit reason and diagnosis in order for a claim to be covered by your insurance.  If you think there is an error on your account, please contact the billing office immediately.  We will review your concern with the physician and let you know the outcome.

Leave a Reply

Your email address will not be published. Required fields are marked *