Insurance

We are contracted providers (“in network”) with many PPO health plans.
For a complete list, click here.

We can not accept HMO insurance plans.

IMPORTANT! We urge you to exercise caution when determining the provider network for your insurance. In an effort to offer lower cost health care policies, insurers have recently been creating “narrow provider network” plans. Medical practices that agree to be part of these “narrow network” plans agree to receive lower payment for their services. In effect, the insurers are passing the burden of the cost reduction to the medical practices in exchange for a greater number of patients in network. This would naturally appeal to big health care practices or systems that rely on seeing a large number of patients for their financial well-being. Our small practice with limited patient volume does not allow us to accept discounted payments from insurance companies.

It is extremely difficult to identify all narrow network plans; that is something that we are continually working on with insurers. Please note the following plans for which we are NOT IN NETWORK:

Blue Shield:
Promise Plan
Tandem Plan

Cigna:
Local Plus Plan

HealthNet:
PureCare Plan
Community Care Plan

Please contact your insurance directly to be certain that your Coast Pediatrics Del Mar or Carmel Valley pediatrician is in your provider network. Call our office for our tax ID# and our physicians’ NPI# that you can use to verify network status when choosing insurance for your family.

**NOTE for Qualcomm employees: Qualcomm has added the choice of “Qualcomm Premier PPO – Scripps” to insurance options for their employees. We are in network for this plan, however it will be the equivalent of a high-deductible plan for your family.

Insurance Guidelines

Co-pays are due at the time of visit.

As contracted providers with insurance plans, we have agreed to accept certain payment amounts for most services that we provide, such as well checks, sick visits, vaccines, vision and hearing tests, etc. Each insurance policy is unique, though, even within the same health plan. Some carriers will not pay for certain services or will limit the number of well checks per year. We cannot know specifically what will be covered by your plan nor can we verify this at the time of the appointment. We encourage you to discuss your benefits with your carrier; if needed please review our schedule of well child visits prior to your visit. Please rest assured that our practice is guided by what is medically necessary for your child, as well as by guidelines from the American Academy of Pediatrics.

Newborns must be added to your insurance plan within the first 30 days after birth for hospital charges to be paid by your insurance.

You are ultimately responsible for all charges incurred regardless of insurance payment.

Out-of-Network Insurance

If we are not contracted with your insurance, we can still provide medical care to your family as out-of-network providers. This means that we don’t have negotiated rates for our services with your carrier. We encourage you to contact your insurance carrier to determine your plan’s out-of-network benefits, to see what they will cover. You may also contact us for a list of our charges for the most common billing codes. We are happy to bill your insurance, but you are ultimately responsible for all charges incurred regardless of insurance payment. As with all out-of-network providers, there will be a difference between our charges and the amount that your insurance pays. Any balance remaining after insurance payment is due from you within 30 days. If your insurance does not pay us within 60 days, we will charge your credit card that you will be required to keep on file. Keep in mind that this balance payment will be eligible for reimbursement from health savings or flexible spending accounts.

No Insurance

We also welcome families choosing not to use medical insurance. Payment is due at time of service.

We accept Mastercard, Visa, and personal check.

For any billing questions, please contact our biller at billing@coastpediatrics.com