Insurance Information

Associates In Women’s Health Care is contracted with most insurance plans. Please review the list below. If you do not see your insurance plan listed, feel free to contact the billing office or you can check your insurance company website under “find an In-network provider”. 

Please be aware that if you have HMO coverage, we are only contracted with Sutter Independent Physicians, Sutter Medical Group, and Hill Physicians. You must have an SIP, SMG or HPMG Primary Care Physician to be considered in-network when you see one of our OB/GYN Specialty Physicians or Nurse Practitioners. Please note you can self-refer for OB and GYN services. You do not need a referral from your PCP to schedule an appointment. 

List of some current Insurance Contracts 

• Aetna
• Blue Cross
• Blue Shield
• Cigna
• First Health
• Medicare
• PHCS
• Sutter Health Plus
• Sutter Select
• Tri-Care Network (most services require referral and authorization from PCM)
• United Health Care
• Western Health Advantage (includes Advantage Referral)

We accept many other Commercial plans. Please contact your insurance company to verify network status.

We currently are not accepting Medi-Cal or HMO Medi-Cal Plans. This includes Medi-Cal as a primary insurance or as a secondary insurance. 

Insurance Terms & Definitions

It is important to understand the following definitions that insurance companies use when you are choosing your next insurance carrier. If you need help in evaluating the different plans you are offered, contact your insurance broker or the benefits representative at your place of employment.

PPO – Preferred Provider Organization

Having a PPO means that you can see the physician of your choice. Physicians may be “in-network” with the PPO or “out-of-network”. Physicians who join a network offer their services to the insurance company at a discounted rate. If your physician is not contracted (out-of-network) with the insurance company, your PPO should still cover some of the exam. The exact coverage is different for each policy and should be listed in your insurance booklet that was provided with your card. Additionally, PPO’s do not require a primary care physician or any referrals.

POS – Point of Service

The patient may use the plan like an HMO or use it like a 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 and coverage similar to a PPO plan.

HMO – Health Maintenance Organization

Any organization that provides delivery of health maintenance, usually through a specified medical group such as Hill Physicians or Sutter Medical Group. A Primary Care Provider (PCP) manages all specialist referrals with the exception of OB/GYN services. You are required to stay within the same medical group for all your care.

EPO – Exclusive Provider Organization or Select Plans

A delivery system similar to an HMO, which consists of a contracted panel of providers. The difference from HMO is that the patient is not assigned to a specific medical group. If the patient seeks treatment from an out- of- network provider, the services may not be covered. These types of plans are increasing and have a limited amount of “Exclusive” or “Select” providers in our area and the list of In-network providers changes often. Please check your insurance company’s website or call customer service before seeking care at any facilities, this includes hospitals, surgery centers, laboratory and radiology. 

Usual and Customary Charges

A term that insurance companies use to cap the insurance companies’ payments. If the physician is contracted, the amount is what the insurance company will pay for a procedure or service. If the physician is out-of-network, the insurance company will pay a percentage of the “usual and customary” charge. Because a contract does not exist between the physician and the insurance company, the patient is responsible for the difference between the usual and customary, as well as their percentage charge.

Co-Insurance

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

Deductible

A fixed amount that the patient contributes in payment for medical services during a specified period. Example: The insurer policy may state that the patient has a $2000.00 deductible per year. The first $2000.00 in services billed to the insurance company would be patient’s financial responsibility.

Co-payment

A provision under a health insurance policy where the patient assumes a fixed amount of the costs of covered services such as a $50.00 co-payment per office visit.

Exclusions

Specific conditions not covered, or services not paid for under a health insurance contract. Typical exclusions may be cosmetic or elective surgery, infertility services or some preventative care.

Flexible Spending Account or Health Savings Accounts

This type of account is set up through your employer and allows you to designate pre-tax deductions to reimburse you for qualifying medical expenses that your insurance company does not pay. There are specific Internal Revenue Service guidelines in setting up and using this type of account. Your Human Resources Department should be able to discuss this type of account with you.

Dual Insurance

Exists when you are covered by both your company and your partner’s or parent’s company or if you are covered through your employment and have purchased individual coverage in addition. Typically, the insurance through your employer is primary and the insurance through your partner’s employer is secondary. In most cases the guidelines for both insurance companies would need to be met to have both carriers cover the claim. 

Out-of-Network

Out-of-network means that a provider does not have a contract with your health insurance plan provider. This can result in the patient being financial responsible for the full price of treatment. Some health plans, such as an HMO plan, will not cover care from out-of-network providers at all, except in an emergency.

Patient Cost Estimates

Patient cost means the cost of a medically necessary health care service that is incurred as a result of the treatment being provided to the patient.   Please inquire with our Billing Department (916) 782-2229 to get an estimate prior to seeking treatment in our office.

The pricing information provided is a best estimate and is not a guarantee of what the patient will be charged.  Please understand that in many cases it is impossible to predict the final charges that will result from your services, as there are many variables involved in the actual services, such as the length of time spent in procedure, exam, surgery, specific equipment used, supplies and medications required, additional tests ordered by the physician, or any unusual special care or unexpected conditions or complications that may occur during the course of service.  Separate charges should also be expected from an outside laboratory when specimens are collected, this includes urinalysis, PAP Smears, cultures, and biopsies. 

Office Visits, New Patients: 99202-99205  $175-440

Office Visits, Established Patients: 99212-99215   $150-280

Preventive Annual Well-Woman, New Patient 99384-99387 $337-562

Preventive Annual Well-Woman, Established Patient 99394-99397 $281-470

Colposcopy with Biopsy 57454 -57455   $289-558

Intrauterine Insertion 58300  $441

Obstetrical Ultrasounds 76801-76819   $300-600

Complete Obstetrical Care with Vaginal Delivery 59400   $6183.00