Doing What's Right For Our Community

PROVIDING EXPERT CARE WHILE SOCIAL DISTANCING

We Will Remain Open for VIRTUAL CONSULTATIONS and post-operative follow ups. Give us a call to schedule your online consultation today!

For up to date information on office hours and availability, please contact us.

Bay Area Sleep and Breathing Solutions

Billing and Insurance

Our office is currently in network with most major commercial PPO insurance plans. You will be responsible for ALL co-pays, deductibles and non-covered services. We accept all major credit cards, and personal checks. We do not accept cash.

Our billing office will first submit a claim to your insurance carrier(s). When the claim is processed, your insurance will also send an Explanation of Benefits (EOB) to you. Please note that the name of the provider on the EOB will be "UCSF Clinical Integrated Partners"

For covered services, you will also be responsible for anything that is patient responsibility, including deductible, co-insurance, etc.  If you have questions about your benefits, please contact your insurance provider.

For any questions related to claims and billing, please contact McKesson Billing

Phone: 1(833) 353-6885   Email: CIP@mckesson.com.

Health Insurance Providers

Dr. Matthew Mingrone accept most major Preferred Provider Organization (PPO) plans. As an in-network provider with most major insurance carriers and medical groups, your access to care increases, even if you switch insurance carriers.

We are listed as participating providers for the following:

  • Aetna
  • Cigna
  • United Healthcare
  • Blue Shield of California 
  • Anthem Blue Cross
  • Healthnet
  • Caremore
  • Tricare
  • SCCIPA HMO
  • Medicare

In network coverage often means that you will pay a copay at the time of the visit and if you have a deductible in most cases you will get a bill for the rest of the visit at the contracted rate that your insurance has negotiated up until the point that you have met your deductible. If you would like to confirm that exact amount that a visit will cost you then you can contact our office for billing codes and call your insurance to verify your current deductible status and the contracted rate for these codes that is set by your insurance.

Some services may or may not be covered as a part of your individual insurance plan including:

  • Lab work
  • Nasal Endoscopy
  • Sleep Studies
  • Imaging

For these services listed above, the best way to find out whether you have coverage or not is to contact your insurance company directly. You are the only one who will be able to get the correct answer on this since the details of your plan and the contract you signed with your insurance are unique to you and the obligation of the insurance company to provide this information is to you alone.

Working With Your Insurance

Health insurance can seem quite confusing - and different plan options have different rules and regulations depending on which state you live. It is ultimately up to you, the patient, to understand the details of your plan’s terms, benefits and coverage options in order to avoid any unexpected costs and hassles.

A Note on Testing:

We will seek prior authorization for any test(s) ordered by your physician. Due to changes in insurance carrier policies, many patients have plans with a high deductible. Please note prior authorization does not guarantee payment from your insurance provider. You may still be responsible for additional payment depending on your insurance benefits.

Please contact your insurance company to determine your deductible and any potential charges you may incur.

Glossary

Below is a list of basic terms you may come across while learning more about health insurance:

Co-pay/Co-payments
A cost-sharing arrangement between an insured person and health insurance company wherein the insured person pays a fixed dollar amount for covered medical services. For example, a PPO may require a $20 "co-payment" for normal services delivered during a physician office visit; after which the insurance company often pays the remainder.

Coinsurance
A cost-sharing arrangement between an insured person and health insurance company wherein the insured person pays a stated percentage of expenses for covered medical services after the deductible amount, if any, was paid.

Deductible
A cost-sharing arrangement between an insured person and health insurance company wherein the insured person is required to pay a fixed dollar amount each benefit period (typically a year) before the health insurance company will reimburse for covered health care expenses. Plans may have both per individual and family deductibles.

Exclusion Period
A period of time during which an insurance company can delay their coverage for a pre-existing condition. Sometimes this is called a pre-existing condition waiting period.

Explanation of Benefits (EOB)
Statement sent by insurance companies to persons who have experienced a claim under the health plan. An EOB details the charges for the services received, the amount the health insurance company will pay for those services, and the amount the insured person will be responsible for paying.

Health Maintenance Organization (HMO) 
A prepaid health plan which covers certain aspects to patient treatment; for instance: doctors' visits, emergency care, surgery, lab tests and therapy. In a HMO, one must choose a primary care physician who then coordinates all care and makes referrals to any specialists that may be required. Also in a HMO, one must use the doctors, hospitals and clinics participating in a specified network (usually within a specified geographic area).

Indemnity Health Plan 
These plans are also sometimes called "fee-for-service"; and existed primarily before the rise of HMOs and PPOs. With indemnity plans, the individual has their choice of providers without effect on reimbursement. The fees for healthcare services are defined by the health care providers and vary from physician to physician, hospital to hospital.

Lifetime Maximum
A cap on the benefits paid for the duration of a health insurance policy.  Many policies have a lifetime limit of $5 million, which means that the insurer agrees to cover up to $5 million in covered services over the life of the policy.  Once the $5 million maximum is reached, no additional benefits are payable.

Managed Care Plan
Health insurance plan which generally provides comprehensive services to their members (“enrollees”), offering financial incentives for patients to use their participating providers in a specified network. HMO and PPO plans are both examples of a managed care plan.

Network Provider
Physicians, hospitals or other providers of medical services that have agreed to participate in a managed care network - offering their services at discounted rates and meeting other negotiated contractual provisions. They are also sometimes called "participating providers”.

Out-of-Pocket Maximum
The total dollar amount an insured person is required to pay for covered medical services during a specified period, such as one year. This may also be called the “stop-loss limit” or “catastrophic expense limit”.

Preferred Provider Organization (PPO) plan 
A health insurance plan where coverage is provided through a network of selected health care providers (such as hospitals and physicians) who have negotiated contracts with the insurance company to offer their services at discounted costs. Enrollees may go outside the network for care, but this would most likely incur larger costs to the enrollee (e.g.: a higher deductible or higher, non-discounted, charges from the providers).

Primary Care Physician (PCP)
The primary contact for enrollees within a health plan, this is often a family physician, internist, or pediatrician. In a managed care plan (e.g.: a HMO or PPO), a PCP monitors patient health, treats and/or coordinates most patient health problems, and if required by the plan, refers patients to specialists when necessary.

Prior Authorization
A review of the need for health care services or products, before services are rendered or products are provided. This term refers to a decision made by the health insurance plan provider to cover or not cover the charges before any services/products are provided.

Usual and Customary (U&C) Charge
The basis for how conventional indemnity plans operate. U&C charges is a term used for commonly charged or prevailing fees for health services within a geographic area.  A fee is generally considered to be reasonable if it falls within the parameters of the average or commonly charged fee for the particular service within that specific community. This is sometimes also referred to as "Reasonable and Customary (R&C) Charge". In contrast, PPO plans often operate on a negotiated (fixed) schedule of fees.

Glossary References
http://www.bls.gov/ncs/ebs/sp/healthterms.pdf 
http://www.ehealthinsurance.com/health-insurance-glossary/terms-a/

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San Francisco Office

450 Sutter St
Ste 1404
San Francisco, CA 94108

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More Info Directions (415) 926-6300

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2504 Samaritan Dr
Ste 20
San Jose, CA 95124

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