Frequently Asked Questions
Providing you with the answers you need
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.
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:
- Family/General Practitioners (doctors who treat patients of all ages)
- Internists (doctors who treat adults and may have a subspecialty)
- Pediatricians (doctors who treat children)
It’s easy to find a Brown & Toland PCP with Find a Doctor. You can search by name or specialty, get directions and more.
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.
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 415-972-6002. Members do not need a referral from their PCP to see an OB/GYN, ophthalmologist, or podiatrist in the same medical group.
Some services required an OK from either the health plan or medical group before you get them. The OK is the authorization.
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 415-972-6002 or 800-225-5637 (TTY: 711).
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 415-972-6002 or 800-225-5637 (TTY: 711).
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.
You can keep your doctor if your new health care insurer works with us. The best thing to do is call us at 415-972-6002 as soon as you learn your company is switching plans.
Please contact our Customer Service at 415-972-6002. We will then make the necessary changes to your account and rebill the correct insurance plan.
Call your doctor for:
- Medical problems or questions
- Referrals to specialists (if you have an HMO)
Call your health plan for:
- Prescription drug and other benefit coverage information
- To change your PCP or your address.
- To obtain an insurance ID card
- Information about your premiums
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.
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.
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.
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.
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 415-780-9696 (TTY: 711) to schedule an appointment.