Insurance

Insurance

Insurance

Network

We are contracted with numerous insurance plans. Please contact the plan you are considering to confirm Noe Valley Pediatrics is in-network with your plan. There are more and more narrow networks plans being offered that we are not considered in network providers for. Please verify our Tax id (45-1793779) and office location: 3700 24th Street, San Francisco, with your insurer to confirm our participation with your plan.

Please note: Noe Valley Pediatrics has only one office location: 3700 24th Street, San Francisco. We have found that some of the insurance carrier websites have incorrect provider directory listings.

It is the responsibility of the patient or family to know and understand the policies and benefits of their insurance plan. This includes:

  • Co-payments
  • Covered hospitals and laboratory
  • Prior authorization and referral procedures
  • In-network and out-of-network provider participation status

Should you have any questions regarding your insurance, contact Suzy in the billing department:

(415) 282-5501
nvpedi@gmail.com

OR

(707) 577-8044

Billing

Questions

A note about co-pays

Please be aware that copays are due at the time of service. There will be a $10.00 administrative fee charged for any copays needing to be billed.

IT IS VERY IMPORTANT TO NOTIFY YOUR INSURANCE CARRIER OF YOUR NEWBORN WITHIN THE FIRST 30 DAYS OF LIFE.

Most insurance companies require that you add your newborn within 30 days of birth (some even sooner). If this is not done, your insurance carrier can refuse to add your newborn to your plan. For our HMO patients, it is required that you select one of the physicians at Noe Valley Pediatrics as your child’s Primary Care Physician within the first 30 days of birth.
At every office visit, be prepared to show your current insurance card and make your co-payment if your plan requires so. If your child is sent with a caregiver, please make sure that they are prepared to make the co-payment. There is a $10.00 administration fee for failure to pay your copay at the time of service.

HMO Plans

We are a member of Brown and Toland Medical Group (BTMG). This is the only Health Maintenance Group that we are contracted with. It is important that if you are a member of BTMG and receive care in our office, that your child’s Primary Care Physician is assigned to one of the physicians in our office. (Dr. Schwanke, Dr. Anne, Dr. Kaplan and Dr. Hurd)

Covered California

Noe Valley Pediatrics participates in two Covered California SHOP (Small Business Health Options Program) offered by Blue Shield and Health Net. These are small group plans, not Individual Family Plans.

Individual Family Plans

Noe Valley Pediatrics does not participate in the Individual Family Plans offered by Blue Shield and Anthem Blue Cross. (On or off exchange).

Noe Valley Pediatrics participates in one Individual Family Plan:

  • Health Net PPO
  • Please contact your member services to verify if our practice is participating in your plan and to verify your benefits.

Medi-Cal

Noe Valley Pediatrics does not participate in any of the Medi-cal plans.​

Well Child

Visit Charges

Many insurance plans require no copay or other out of pocket cost for routine well child examinations. However if in the course of that routine exam issues come up beyond the scope of routine health discussion such as significant dietary problems, school problems, chronic complaints about abdominal pain, allergy or headache it may require additional time for discussing these issues.

In those cases requiring extra physician time, an additional diagnosis and charge will be added proportionate to time spent. Adding that secondary diagnosis frequently triggers out of pocket costs such as copays and deductibles. An acute illness at the time of the well exam will also usually trigger additional billing and out of pocket expense. Here in our practice we are making sure that our billing reflects the care given during a visit.
Please note that there is a missed appointment fee of $50 for a no show or a late cancellation of a well child exam (less than 24 hours)

Notify our office if there is a change in insurance coverage. E-mail a copy of your new insurance card (both front and back) to the NVP front desk at nvpfronteam@gmail.com. Failure to do so results in unnecessary billings to insurance companies only to find out that the policy has lapsed. Incorrect or outdated information will delay your claim and you may be held responsible for full payment.