We accept the following insurances:
- HMOs: Our office accepts most HMO plans. Please call your insurance company to see if they accept our medical group. We are participants of “Children’s Physicians Medical Group” also known as “Rady Children’s Health Network”. Please select a physician from our office as your child’s PCP (Primary Care Physician). If you have Health Net Medi-Cal, United Medi-Cal, Aetna Medi-Cal or California Kids Care, and Blue Shield Promise Health, select one of our providers under this insurance group as well by calling the Member Services number located on your insurance card.
- PPOs: We accept most PPO plans. It is important to verify with your insurance company that we are in your plan’s “in-network” of providers. You can still be seen at our office if we are considered “out of network”, but you will incur higher out of pocket costs.
- Tricare: We accept Tricare Select and Tricare Prime. If you have Tricare Prime, please select one of our physicians as your child’s PCM (Primary Care Manager).
- Medi-Cal plans accepted in Our Intermittent Clinic with Borrego Community Health Foundation: Accepted Medi-Cal plans include, straight Medi-Cal, Molina, Community Health Group, and Blue Shield Promise Health (formerly Care 1st). To select our office for each of these insurance groups, call the Member Services number located on your insurance card and provide your insurance company with the following information to be seen at our location:
Molina Medi-Cal:
Provider Name: BORREGO COMMUNITY – FLETCHER WAY
IPA/Group Name: INTEGRATED HEALTH PARTNERS
Community Health Group:
PCP: Provider of your Choice from our office
Site: L- LA MESA PEDIATRIC MEDICAL GROUP
IPA: BORREGO COMMUNITY HEALTH FOUNDATION
Blue Shield Promise Health (formerly Care 1st Medi-Cal):
Provider Name: BORREGO HEALTH LA MESA PEDIATRIC CLINIC
IPA/Group Name: INTEGRATED HEALTH PARTNERS- BORREGO MEDICAL GROUP
**WE DO NOT ACCEPT:
- Molina Covered California HMO plans
- Blue Cross Covered California
- International insurances
- Blue Cross PPO Select Plan
Billing Policies
We accept most insurance plans. If you are planning to switch plans or have any questions regarding your insurance, please call the member services number located on your insurance card. Verify with your insurance directly that we are in network with your policy. It is important to update our office every time a change is made to your insurance. It is your responsibility to provide current insurance information to help ensure accurate billing. Please note, that you are financially responsible for all medical treatment provided to your child at our office that is not covered by your insurance plan. All co-pays are due at the time off the visit.
Please remember to add your newborn to your insurance policy as soon as possible. Most insurances will cover the newborn under their Mother’s insurance policy 30 days after birth, but only if the baby is added to the same insurance plan the mother used at time of birth. The general newborn policy applied to newborns to allow the parents ample time to turn in all necessary paperwork. Each insurance policy is individual and may have different rules and processes with different requirements, it’s good to know exactly how your insurance plan works for you. Please verify all information with your insurance coverage for your newborn by calling member services on the Mother’s insurance card. We would like to make sure that sure the newborn is eligible to be seen at La Mesa Pediatrics through your policy and all the future visits.
If you have Medi-Cal, Molina, Care 1st, or Community Health Group Medi-Cal, your child is eligible to be seen in our office. If the mom has Medi-cal, we can assist you in our office to process the baby’s Medi-Cal with a Gateway at the first newborn visit. You will still need to add the baby to your insurance as soon as possible for continued coverage.
You will need the newborns individual insurance card for the 2-month visit.
We look forward to caring for your baby at La Mesa Pediatrics and would like to avoid any confusion and unnecessary uncovered cost from the insurance company.
Please be courteous to all patients and providers and notify our office if you are unable to keep a scheduled appointment. Please call our office with a minimum of 12 hours notice to cancel or reschedule your appointment. This will avoid preventing another child from being seen during that time. Failure to call our office to cancel or reschedule your appointment in advance may result in a $25.00 “no show” fee. This fee is not covered by your insurance company and will be your responsibility to pay.
* * If you have any further questions regarding insurance, please contact our billing office at (619) 464-6434 and select the option for the billing department.
