Frequently Asked Questions
Providing you with the answers you need
What is a medical group? A medical group is an organization of doctors and the professionals who support them in caring for patients. We work with many health insurance and hospital partners to bring you the best in healthcare, wherever you live in the Bay Area.
What hospitals do you use? Brown & Toland Physicians connects you to leading hospitals, labs and community health services throughout the Bay Area – from California Pacific Medical Center in San Francisco to The Alta Bates Summit Medical Centers in Oakland and Berkeley. <a href="/patient-services-facilities/hospitals-labs/">See the full list of plans</a>.
Does Brown & Toland work with my insurance? Brown & Toland is contracted with many leading health insurance plans. If you have or enroll in any of these plans, you can select us as your medical group. <a href="/patient-services-facilities/hospitals-labs/">See the full list of plans</a>.
What is a Primary Care Physician (PCP)? A Primary Care Physician is the doctor you select to be your main doctor if you enroll in an HMO plan. Your PCP works with you to make decisions about your care and to recommend specialists when medically appropriate. Your PCP plays many roles – primary caregiver, health care advisor, coordinator of specialty care and patient advocate – and can include: <p></p> <ul> <li>Family/General Practitioners (doctors who treat patients of all ages)</li> <li>Internists (doctors who treat adults and may have a subspecialty)</li> <li>Pediatricians (doctors who treat children)</li> </ul> It’s easy to find a Brown & Toland PCP with Find a Doctor. You can search by name or specialty, get directions and more.
What is a specialist? A specialist is a physician who focuses on one area of medicine, such as allergies or vascular surgery. If you have an HMO plan and need to see a specialist, your primary care physician will refer you to one. Women can go directly to an OB/GYN in the same medical group; they don’t need a referral from their PCP. People in PPO plans can usually go directly to any specialist but pay less when they see one in the their health plan’s network.
What is a referral? A referral is a recommendation from your doctor to see a specialist or get a specific service. If you have an HMO, you need a referral from your PCP before getting other types of care. Your PCP will fill out a referral form and either mail the referral to the specialist or give it to you, so you can bring it to your first appointment. To check the status of a referral, first call your PCP, and then call Referral Services at <a href="tel:415-972-6002">415-972-6002</a>. Members do not need a referral from their PCP to see an OB/GYN, ophthalmologist, or podiatrist in the same medical group.
What is an authorization? Some services required an OK from either the health plan or medical group before you get them. The OK is the authorization. <br> For example, an authorization could be required for specialist care to make sure it is a medical necessity and covered by a patient’s health insurance. Authorization requests are initiated by your PCP and typically processed within 14 days, except in urgent situations. You will be notified by mail when the authorization has been processed. To check on the status of your authorization, call Customer Service at <a href="tel:415-972-6002">415-972-6002</a> or <a href="tel:8002255637">800-225-5637</a> (TTY: 711).
What if my authorization is denied. How may I appeal? The first step is to contact your health plan. To do this, you will need the authorization number. If you do not have the authorization number, please contact Customer Service at <a href="tel:415-972-6002">415-972-6002</a> or <a href="tel:8002255637">800-225-5637</a> (TTY: 711).
How do I change my personal or benefit information? Contact your health plan directly – or your employer if you have coverage through your job. Your health plan is responsible for updating your personal and benefit information, and they will notify us with any changes.
My company changed health care insurers. Can I keep my current physician? You can keep your doctor if your new health care insurer works with us. The best thing to do is call us at <a href="tel:415-972-6002">415-972-6002</a> as soon as you learn your company is switching plans.
I got a bill from my doctor saying I have to pay because I don’t have coverage. It looks like they billed my old insurance. What do I do? Please contact our Customer Service at <a href="tel:415-972-6002">415-972-6002</a>. We will then make the necessary changes to your account and rebill the correct insurance plan.
Who should I call for...? <strong>Call your doctor for:</strong><br> <ul> <li>Medical problems or questions</li> <li>Appointments</li> <li>Referrals to specialists (if you have an HMO)</li> </ul> <strong>Call your health plan for:</strong> <ul> <li>Prescription drug and other benefit coverage information</li> <li>To change your PCP or your address.</li> <li>To obtain an insurance ID card</li> <li>Information about your premiums</li> </ul>
What do I do in case of an emergency? An emergency means that there are sudden and severe symptoms that have to be taken care of right away. In cases of life-threatening emergency, call 9-1-1 or go to the nearest emergency room. <br> For all other urgent care matters, there is a doctor on call at your physician's office 24 hours every day. The on-call doctor will advise you what to do next. After any health crisis, it is important that you call your physician's office, within 48 hours if possible, so that your doctor can be involved in your care.
I received a letter from you asking me whether or not a visit to my doctor was related to an accident. I have not been involved in an accident, what should I do? Often medical treatment related to an accident is covered by the auto insurance of another party. We simply need to know if your medical expenses should be billed to another insurance company. Please answer the questions and mail the questionnaire back to us.
How do I appeal a medical review request that has been denied? You must appeal any denial determination directly to your health plan. All appeal information is included in the denial notice sent to you and your physician.
Who do I call to make a complaint? We want to know if you have a complaint or a concern. You can call us at <a href="tel:415-972-6002">415-972-6002</a> and we will try and take care of it. You also can call your health plan company, using the number on the back of your health plan ID card.
What is an Annual Health Assessment? Similar to a physical exam, an Annual Health Assessment is performed once a year and is important to evaluating your health. During your 30 minute to one hour appointment, a nurse practitioner or physician assistant will perform simple tests, such as documenting your weight, blood pressure and body mass index. In addition, they will review your current medications, preventative screenings (for example, a colonoscopy or mammogram) and chronic conditions if needed. This information is then shared with your Primary Care Physician so they can provide you with best quality care. Call an AHA Appointment Coordinator at <a href="tel:415-780-9696">415-780-9696</a> (TTY: 711) to schedule an appointment.