Insurance Guide

SJ Medical Group accepts most major insurance plans (PPOs, IEHP, HMO & Medicare). If SJ Medical Group is contracted with your current health plan, we will bill your insurance on your behalf. Your plan may require copayments and deductibles that should be paid when you check in for care. We must have your current and accurate information to submit claims to your insurance company. Please remember to always bring your insurance card and we will verify your insurance at check-in prior to each visit.

If you currently do not have insurance, you may qualify for one of the Covered California Health Plans. In 2014, individuals can choose a health plan via the new State Marketplace, Covered California.

Read more about Covered California here: www.coveredca.com

Benefits vary from plan to plan. Some visits, procedures or tests, may not be covered by your insurance. Balances not paid by your insurance are your responsibility and will be billed to you on a monthly statement. Please contact your insurance company for benefit specific questions including coverage, participation, referral information, restrictions, deductible status and co-pay requirements.

Insurance Types

PPO

A PPO is a Preferred Provider Organization. When you join a PPO, you will have a choice of providers to seek care from within the PPO network. You will have a deductible and/or copay if you go to a provider within the network.
A PPO negotiates arrangements with a network of doctors, hospitals and other providers who accept lower fees from the insurer for their services. If you choose to go to a physician or hospital outside your PPO network you will have much higher out-of-pocket expenses.

If you are covered by one of our contracted PPOs, SJ Medical Group will bill your carrier for services rendered, so you do not have to complete claim forms.

PPOs contracted with SJ Medical Group

 

Inland Empire Health Plan (IEHP) is a not-for-profit, rapidly growing Medi-Cal and Medicare health plan in California.

As a leader in the healthcare industry, IEHP upholds a high standard for the delivery of care to their members, service to providers, and partnerships with various communities. IEHP offers programs in Medi-Cal (including adults, seniors and people with disabilities), Healthy Kids, IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan), and IEHP Medicare DualChoice (HMO SNP).

HMO

An HMO is a Health Maintenance Organization. When you join an HMO, you will be asked to choose a primary care physician (PCP). Your PCP will take care of your routine healthcare needs and coordinate any necessary specialty care. Before you can see a specialist, your PCP will request an authorization for a specialty referral based on your health plan’s guidelines.

If you are covered by one of our contracted HMOs, SJ Medical Group will conveniently take care of most paperwork, so you do not have to complete claim forms. HMOs are designed to manage the costs of medical care, which means members enjoy lower out-of-pocket expenses compared to other types medical insurance. Visits to the doctor’s office, hospital charges and many other medical care expenses are often covered at 100% after a small copayment. Generally, preventive care, prescription drugs, routine physicals, lab tests, vision exams, well-baby care, and maternity visits are covered. HMO plans do not typically require you to pay an annual deductible before services are covered and usually have no lifetime maximums.

Most HMO Insurances Accepted by SJ Medical Group

Medicare

Medicare Part B is the medical insurance portion of Medicare, which covers physician services, outpatient hospital care, and many other services typically covered under health insurance plans. Part B is financed through monthly premiums paid by enrollees and by contributions from the federal government.

If you are covered by Medicare Part B, SJ Medical Group will bill Medicare for services rendered, so you do not have to complete claim forms.

SJ Medical Group also accepts many Medicare plans including Medicare Advantage plans that cover the costs of many services not covered by straight Medicare.

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