Benefits vary from plan to plan. Some visits, procedures or tests, may not be covered by your insurance. Balances not paid by your insurance are your responsibility and will be billed to you on a monthly statement. Please contact your insurance company for benefit specific questions including coverage, participation, referral information, restrictions, deductible status and co-pay requirements.

Types of Insurance

HMO:

An HMO is a Health Maintenance Organization. When you join an HMO, you will be asked to choose a primary care physician (PCP). Your PCP will take care of your routine healthcare needs and coordinate any necessary specialty care. Before you can see a specialist, your PCP will request an authorization for a specialty referral based on your health plan’s guidelines.

If you are covered by one of our contracted HMOs, Redlands-Yucaipa Medical Group will conveniently take care of most paperwork, so you do not have to complete claim forms. HMOs are designed to manage the costs of medical care, which means members enjoy lower out-of-pocket expenses compared to other types medical insurance. Visits to the doctor’s office, hospital charges and many other medical care expenses are often covered at 100% after a small copayment. Generally, preventive care, prescription drugs, routine physicals, lab tests, vision exams, well-baby care, and maternity visits are covered. HMO plans do not typically require you to pay an annual deductible before services are covered and usually have no lifetime maximums.

HMO Insurances Accepted by Redlands-Yucaipa Medical Group

› Help for Questions About the HMO Authorization Process:

UM decision making is based only on appropriateness of care, service and existence of coverage. Redlands-Yucaipa Medical Group does not specifically reward practitioners or other individuals for issuing denials of coverage or service care. Financial incentives for UM decisions makers do not encourage decisions that result in underutilization. The Utilization Management (UM) staff is available for callers with questions about approvals, denials, or UM criteria eight hours per day, Monday – Friday. Patients can call 1-866-230-2835.

PPO:

A PPO is a Preferred Provider Organization. When you join a PPO, you will have a choice of providers to seek care from within the PPO network. You will have a deductible and/or copay if you go to a provider within the network.

A PPO negotiates arrangements with a network of doctors, hospitals and other providers who accept lower fees from the insurer for their services. If you choose to go to a physician or hospital outside your PPO network you will have much higher out-of-pocket expenses.

If you are covered by one of our contracted PPOs, Redlands-Yucaipa Medical Group will bill your carrier for services rendered, so you do not have to complete claim forms.

POS:

A point of service plan, or POS plan, is a type of managed care health insurance system. It combines characteristics of both the HMO and the PPO. Members of a POS plan do not make a choice about which system to use until the point at which the service is being used.

Medicare

Medicare Part B is the medical insurance portion of Medicare, which covers physician services, outpatient hospital care, and many other services typically covered under health insurance plans. Part B is financed through monthly premiums paid by enrollees and by contributions from the federal government.

If you are covered by Medicare Part B, Redlands-Yucaipa Medical Group will bill Medicare for services rendered, so you do not have to complete claim forms.

Beaver Medical Group also accepts many Medicare plans including Medicare Advantage plans that cover the costs of many services not covered by straight Medicare.

To View A List of Medicare Advantage Plans Accepted by RYMG, please click HERE