What's co-insurance?

What's co-insurance?

Co-insurances are a kind of financial responsibility. This is the kind of scenario and setup that is typical of PPO plans. 

Co-insurance shares are typically a percentage of the fees charged. So if a doctor's fees end up being $100 for the day, and your co-insurance share is said to be 20%, your financial responsibility would be—? You guessed it: $20. 

What's the difference between health insurance and a health plan?

What's the difference between health insurance and a health plan?

It's seem to be a pure matter of nuanced semantics, but it's quite a fundamental difference. it's best to understand it as we understand insurance in a more traditional scenario: for cars. 

We don't want to get into accidents. And more often than not, we are rather attached to personal, fashionable belongings such as our cars—we name them; we spend a bunch of time in them; etc. Point is, we try to avoid using the car insurance that protects us from financial ruin when we [knock on wood] get into a car accident. 

We don't want to use our car insurance. 

Same is the case for health insurance—somewhat. It's supposed to work like this. It's there to protect us from financial ruin in case we get gravely ill. We're not supposed to want to exercise on those benefits, and yet, soon as we get us some good ol' company sponsored health insurance: we're like kids in a candy store, and the first thing we try to do is max out our benefits: seeing all kinds of doctors, seeing if we can get whatever tests done that we can get ordered. 

I got a msg about a bill. What should I do next?

I got a msg about a bill. What should I do next?

Best thing to do would be to contact a healthcare advisor by sending us a msg in turn. There are too many nuanced details that, to build a form to accommodate for this scenario would make for an egregious task to complete on your end— and we know that you don't have time for that. So, send us a msg, and we'll get this all sorted out ASAP. 

Who maintains PediaHealthMedicalGroup.com and its content?

Who maintains PediaHealthMedicalGroup.com and its content?

PediaHealth Medical Group, its physicians and other personnel, and its partners have contracted the content and web development out to a company called SBCPH, Inc. — a healthcare business services company headquartered in the San Francisco Bay Area. 

They've been taking care of our social media, patient support services like email responses, etc. for years. They keep us "current" and young. :) 

Why don't most health insurance HMO plans charge co-pays for preventative care benefits?

Why don't most health insurance HMO plans charge co-pays for preventative care benefits?

First off— Do you know what the difference is between health insurance and a health plan? There's a fundamental difference, and if you're not totally aware of it, read this

So, being aware of that difference, you know that there's an incentive for insurance companies to not have their subscribers utilize their benefits. It's like car insurance— You're not really incentivized to use it; i.e. you don't really want to get into an accident and have to utilize your car insurance benefits. 

Same with health insurance— You don't really want to get sick: But it does happen. When it does, and you come in for a "sick visit," you have to pay a co-pay (your financial responsibility as a subscriber). 

But— When you go in for an annual physical, or if you go in to see the doc for shots or something preventative: Now, that's a different story. That helps insurance companies. That helps them because that helps you stay healthy for a longer period— i.e. you won't have to "cash in" (utilize) those health insurance benefits (i.e. sick visits / visits to the doctor for when you present with a clinical symptom). 

I got a bill for a co-pay, what does this mean?

I got a bill for a co-pay, what does this mean?

A co-pay is a kind of financial responsibility. Most health insurances and even supplemental and government sponsored health plans obligate the member or patient to some kind or some degree of financial responsibility. Co-pay requirements will vary depending on the type of benefit that the health insurance is currently called to cover— for example, many health insurance HMO products do not charge a patient a co-pay when the insurance subscriber utilizes a kind of preventative care benefit— such as seeing the doctor for an annual physical.

Want to know why? See: "Why health insurances don't usually charge co-pays for preventative care."

See also:

What is a co-pay? 

What is a share-of-cost? 

Can I register a new patient online?

Can I register a new patient online?

Yep, you sure can. The best way to do this is by sending us a msg. From there, we'll ask all the necessary questions. Different data will be needed depending on the patient's age, health insurance, etc. 

You know what else you can do online? 

  • Request refills. 
  • Schedule / reschedule appointments. 
  • Speak to a physician. 
  • Consult with a physician using Medifi. 

Resources

  • Learn more about Patient Fusion. 
  • Learn more about using our Facebook page as a resource.

What shots are my kids due for?

What shots are my kids due for?

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What's HIPAA?

What's HIPAA?

HIPAA stands for: "Health Insurance Portability and Accountability Act." The acronym is often pronounced— in the healthcare world— as "hip-uh."

The "portability" part— You know how there was a law (an "act") that was passed that allows you to take your phone number wherever you go, whether you change providers from Verizon to Spring to— whatever? Yes, a law needed to be passed for you to be able to keep your cell phone number.

In the same way, a law needed to be passed for you to be able to bring your health data and your health insurance wherever you go: from job to job; from location to location; etc. That's the "portability" part of the act.

The "accountability" part of it involves protecting the information. You have to protect, but so do the medical professionals that work with the sensitive info, like doctors. We have to take precautions to make sure that your personal health data stays that way— personal; and never falls into the public domain. 

The consequences of this is that we can't readily and freely talk about your very, very personal issues without first running through procedures that ensures that you are the right person to talk to about these sensitive things. Have any other questions about HIPAA? Send us a msg. 

How can I schedule an appointment?

How can I schedule an appointment?

There are a number of ways to schedule an appointment with PediaHealth. Most efficient / quickest way to schedule an appointment is to do so online, either by sending us a message or via the Patient Fusion phone app

  • Get more info on scheduling.
  • Get more info on doctor visits (visit types). 

What health insurances and health plans does PediaHealth take?

What health insurances and health plans does PediaHealth take?

PediaHealth and our physicians accept almost every health insurance available to consumers (Aetna; Blue Cross; Blue Shield; United Healthcare). We're also members of most major health plans (i.e. Health Plan of San Mateo; San Francisco Health Plan) and physician groups, (i.e. Hill Physicians Medical Group). We're also accredited as government providers (Medi-Cal). 

What is Medifi?

What is Medifi?

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What is PediaHealth?

What is PediaHealth?

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Where is PediaHealth located?

Where is PediaHealth located?

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Privacy Statement & Medical Disclosure

Privacy Statement & Medical Disclosure

Your privacy is important to us. To better protect your privacy, we provide this notice explaining our online information practices and choices you can make about the way your information is collected and used. To make this notice easy to locate, we make it available as a link on our home page, and at every point where personally identifiable information may be requested.

Disclaimer

Disclaimer

DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for informational purposes only. 

Experiencing a medical emergency?

Experiencing a medical emergency?

It should be obvious to just about anybody that you wouldn't go to a website like WebMd or anything of the sort if you were trying to rectify or resolve a medical emergency. 

Any reasonable personable person would know that what they should do is call 9-1-1. So if you are in physical distress— If you are in a medical emergency; if you are in physical danger— then by all means, do what you'd normally do, and call 9-1-1. Call local emergency services. Tell them what you're going through, and stop reading this. We can touch base and get back in touch with each other later. 

Remember that this is an informational site at best. We're here as "one big massive flyer" to you, to help get you in the info you will need, might need, and probably do need to navigate through the complex mess that is American Healthcare.