Practice Policies & Information

North Coast Family Medical Group practice policies and information.

North Coast Family Medical Group practice policies and information

Billing

NCFMG is contracted with and will bill for services to various insurance plans on your behalf. However each plan may have individual networks that we do not participate in. It is strongly recommended that you verify the correct PCP assignment and/or network participation with your insurance company’s customer service number to avoid unforeseen patient financial responsibility. In most cases, we do not accept Worker’s Compensation or bill third parties such as Motor Vehicle Insurance or Attorney offices. We are contracted with few Covered CA plans at this time, please check with your insurance to make sure we are contracted and our staff will assist as well; however, the patient ultimately accepts responsibility for assuring that the insurance is accepted at our office.

Depending on your insurance type, NCFMG can perform limited laboratory services and procedures. If your insurance type mandates us to use outside contracted facilities, we will refer you to these facilities. Any billing concerns with these referred services must be communicated with the outside facility’s (Laboratory or Imaging Center) billing department.

Payment policy

Cash patients will receive 50% discount when paid at the time of service. We accept Cash, Check, Visa, Discover and MasterCard. There is a $25 charge for returned checks. We do not bill for co-payments; you may be required to reschedule your appointment if you arrive to your appointment with no method of payment..

Form fees

Form completion is a non-medically necessary additional service requested by the patient and is not billable to insurance. Payment is required upon form completion. Please contact our office to inquire about fees.

Collection policy

If no payment is received on your account 90 days after your responsibility is determined, the account will be automatically transferred to an outside collection agency and you may be terminated from the practice. To avoid this, we highly recommend open communication with our billing department. We understand that many patients suffer from financial hardships. We are willing to work with you to arrange manageable payment plans or discounts in order to continue our relationship as your healthcare provider.

Understanding insurance

Health Maintenance Organizations (HMO)
When you select a HMO insurance plan, you are assigned a Primary Care Physician (PCP) within a specific Independent Physician Association (IPA). The IPA we belong to is Primary Care Associates Medical Group/North American Medical Management (PCA/ NAMM). This association coordinates care through your insurance company and its network of PCPs and Specialists. Referrals to Specialists must be approved by the IPA. In order to maximize your HMO benefit, your PCP is your initial point of contact for medical treatment with the exception of a life-threatening emergency. In which case, you should contact an emergency medical facility or 911 immediately.

Preferred Provider Organizations (PPOs)
When you select a PPO insurance plan, that plan will provide a list of contracted or in-network providers that you can access without PCP referral. Certain procedures may require authorization from the plan, which the ordering or servicing provider will obtain on your behalf. Some PPO plans have non-contracted or out of network benefits which generally increase the patient’s cost.

For more information about how your health insurance works, visit: https://familydoctor.org/online/famdocen/home/pat-advocacy.html

Medical record release information

Prescription Refill Information

  • Prescription refills should be requested by your pharmacy and we ask that you give us 48 hours for routine prescriptions.  Simply have your pharmacy call us at (760) 942-0118 and press option #2 or the pharmacy can electronically request it via SureScripts.  You may call your pharmacy to check the status of your refill. Routine prescription requests are not accepted after 5pm or on weekends.
  • Some medications and mail order prescriptions require a written prescription. Please contact our office directly for these requests.