We’re getting calls from some of our patients with questions about recent EOB’s they received after a visit to our office. They used to come here and have those visits covered, now they are being told we are out-of-network and their visits are covered at a much lower rate. We are just as confused about these changes and have spent lots of time on the phone with different insurance carriers to clarify how these changes will impact our patients.
if you are confused about the topic of insurance in general there are several great resources: the Robert Wood Johnson foundation has this guide, there are articles by the Boston Globe and CNN, and even About.com has this answer. But you should also confirm your coverage with your insurance carrier. Some people have been moved from their existing plan to one that is more restrictive, and PWG may not be in that network.
Some insurance companies have sold or consolidated their networks which have also resulted in more restricted networks, and once again PWG may be considered out of network. Our billing company just sent us this information:
This is in regards to patients with the Sutter Select UMR, not the UMR administered by UHC. Effective 01/01/14 these UMR POS policies were absorbed and all switched to UMR EPO policies. Since we don’t have a Sutter Select contract, we are out of network. And since we are not Sutter affiliated there is no way to obtain a contract. I checked the card and there are the PHCS and First Health network on there as well. The representative told me the PHCS was for ER services outside of California and the First Health was for ER services within California. Therefore, there are no out of network benefits.
Quickest way to distinguish the UMR Sutter Select patients is that most of the ID # start with the letter Y or will have their employer in the top right hand corner on the front of the card which is Mills Peninsula
If you have any insurance or billing questions feel free to call our billing office at 650-288-0600 option 7, or email them to billing@pwgrwc.com.