Insurance FAQ


FREQUENTLY USED TERMS


  • Premium: The monthly fee a patient pays to her insurance carrier for the benefit of insurance coverage.

 

  • Deductible: The amount a patient must pay before insurance will pick up any costs. Usually waived for preventative care.

 

  • Out of Pocket Maximum (OOP): The maximum amount a patient will spend for in-network services in a given contract year.

 

  • Co-Payment: Flat dollar amount due by the patient for a given office visit or hospital admission.

 

  • Co-Insurance: A percentage of the contracted rate due by the insured patient.

 

  • Explanation of Benefits (EOB): The breakdown of charges, adjustments, and payments an insurance carrier makes for a given claim. This is not a bill.

MEDICARE


  • Medicare: Medicare is a Federal health benefit for all residents over the age of 65 and others with long term disabilities.  Most patients have a supplemental policy coverage to offset their out-of-pocket responsibilities, but Medicare is always the primary policy.  Medicare patients are subject to an annual deductible and co-insurance, like any PPO insurance plan.
  • What does Medicare Pay For?
    • While Medicare pays for many services, it does NOT pay for annual well-woman exams.  Medicare differentiates between the annual wellness exam, a general physical performed by a PCP, and annual well-woman exam, as performed by a specialist or OBGYN physician.  Medicare will pay for a pelvic exam and pap smear once every 24 months, but does not pay for the office visit itself.  
    • Problem-focused exams and treatment of diagnosed conditions are typically a covered benefit of Medicare.
    • Golden Gate OBGYN recognizes that paying the annual well-woman exam can become a financial burden to patients, which is why we ask our Medicare patients to review  an Advanced Beneficiary Notice (ABN) at the time of their annual well-woman visit. The ABN allows our Medicare patients to still receive their annual well-woman exam from a Golden Gate physician at a discounted rate.

OBSTETRICAL BILLING


  • All routine, prenatal office visits are bundled with the delivery and billed after the baby is born.   This is called Global Billing.  Should you change insurance carriers in the middle of your pregnancy, we will bill your insurance for the visits you had and then bill your new insurance for your remaining prenatal visits with delivery. Any additional services outside of routine prenatal visits are billed separately and usually incur additional charges (i.e. ultrasounds, injections, prenatal testing). 
  • Global billing refers to the physician fees only and does not include the hospital’s fees for admission or delivery.

 


GOLDEN GATE ACCEPTS INSURANCE


To verify our participation with your specific insurance policy, please contact your insurance company directly and provide them with our Tax ID number. We can be found listed as: UCSF Physician Group, with Tax ID: 46-4256391.

If you have further questions, contact our billing team for assistance.

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