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Insurance

Having health insurance is important given the complexity of the surgeries and the potential need for staged reconstructions and surgical revisions. 

Prior to scheduling a consultation, we require all new patient forms, photo ID, as well as a copy of the front and back of your insurance card. If you have received the COVID-19 vaccine, please send us a copy of the vaccination card as well. Below are the insurance companies we are currently in-network with. Before your appointment we will verify your insurance in and out of network benefits. We will review any out of pocket costs (copays, deductibles, co-insurance) due at the time of your consultation.

Phone/Video Consultations: We understand it can be challenging to travel to our office for a consultation. MoZaic Care does offer phone or video consults. A link via OhMD will be texted to you to access the video visit. Please be advised there may be times when the surgeon requests an in-person visit due to your medical history. We will verify your benefits to see if telemedicine is a covered benefit under your plan. If so, we will bill your insurance accordingly otherwise you will be considered self-pay. Please see our "fees" page for the pricing. 

For any HMO, Managed Medi-cal, and Narrow Network/EPO Plans, prior-authorization is required from your referring physician or Primary Care doctor for your initial consultation. Our office will give you the necessary information to give your physician's office in order to request authorization. Once you are established with our office, we will request any needed follow-up authorizations from your insurance. 

**PATIENTS ARE RESPONSIBLE FOR NOTIFYING OUR OFFICE OF ANY CHANGES TO THEIR HEALTH INSURANCE. PLEASE BE ADVISED THAT IF YOU SWITCH TO AN INSURANCE WE DO NOT ACCEPT IN THE MIDDLE OF YOUR CARE, YOU WILL BE CONSIDERED SELF-PAY FOR ALL SERVICES. PLEASE CALL OUR OFFICE IF YOU HAVE ANY QUESTIONS.**

We are in network with:

  • Blue Shield of California PPO (including Covered CA plans

  • Blue Cross of California PPO (including Pathway PPO/EPO/HMO, HPN EPO & Select PPO and Covered CA plans )

  • San Francisco Health Plan

  • If you have an out of state Blue Cross/Blue Shield plan, we are able to see you, as long as you have out of state coverage. Referrals and authorizations may be needed. 

Canadian Insurance:

  • OHIP and British Columbia - if you receive prior funding approval, we can work with your insurance. Unfortunately, they do not cover telemedicine consultations. *Please be advised that OHIP only covers penile inversion vaginoplasty at this time. The peritoneal pull-through technique is not covered for primary or revision surgery.*


We are out of network with:

  • Aetna
  • Blue Cross Medi-cal
  • Meritain Health
  • Contra Costa Health Plan
  • Valley Health Plan
  • Multi-plan
  • PHCS
  • Health Net 

We do not accept:

  • Medicare

  • Private Commercial Medicare Plans 

  • California Straight Medi-cal

  • Non-California Straight Medicaid Plan

  • United Healthcare

  • Cigna

  • Oscar Health

  • Tricare

  • LA Care

  • Health Plan of LA

  • Health Care LA, IPA

  • Partnership Healthplan Medi-Cal

  • Community Health Center Network (CHCN)

  • Molina Health

  • Alameda Alliance Medi-cal

  • Harvard Pilgrim Health Care

  • GEHA

  • Kaiser

  • Health Net Medi-cal

  • IEHP

  • Central CA Alliance Medi-cal

* If you do not see your insurance listed above, please contact our office to see if we can work with your health plan.

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For information purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here https://openpaymentsdata.cms.gov. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.

 

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