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The future of quality healthcare for you       and your family.
Contracted Health Plans

Fees
The physicians at the Pacific Palisades Medical Group, Inc. (PPMG) have a very competitive and reasonable fee structure. If you have any special circumstances, please contact our office management.

NEW 2019-Direct Contract Primary Care Option
The Direct Contract form of reimbursement is becoming a very popular method of primary care financing as insurance billing and reimbursement becomes increasingly more complex and cumbersome. With the direct contracting model, the physician and the patient establish a direct financial relationship outside of his or her insurance, and all costs for primary care visits are covered by one fixed annual fee. The PPMG Direct Contracting option allows patients to have unlimited access to their primary care physician for all their primary care needs for a very reasonable annual fee of $500. This convenient and inexpensive option covers all services received from our office including physician visits and in-office ancillary services. Our office will not require co-pays or deductibles, will not send an insurance claim or bill the patient for any of these services.

Services included:
  • All non-emergent reasonable office-based primary care services including annual wellness exams, physicals, well-women exams, and well child care visits
  • Urgent care visits for common ailments
  • Routine follow-up for chronic medical conditions
  • Office-based diagnostic tests including EKGs and office labs
  • Annual influenza vaccination
Services excluded:
  • Immunizations and vaccinations other than annual influenza vaccination
  • Medical devices or supplies
  • Long-term psychiatric counseling beyond brief episodic or routine primary care counseling
Advantages:
  • No insurance hassles for primary care services
  • Fixed annual fee for primary care services with no hidden costs, deductibles or co-pays
  • Cuts out the problematic insurance “middleman” between you and your primary care physician
Cost:
  • $500/year


Contracted Health Plans with Preferred Provider Insurance Organizations (PPO)
Effective 1/01/2017 all physicians within the PPMG are contracted providers with the following PPO health plans:
  • UC Care (only) Blue Cross
  • Blue Shield of California
  • Blue Cross/Blue Shield Affiliated Plans using Blue Shield in California
  • Health Net
  • Medicare
  • United Health Care
For these insurance plans the PPMG's billing office will send claims for all physician services to your PPO insurance and will accept the PPO contracted rate for covered services as payment in full, less any deductible or co-payments. You will be billed for any balances you owe at the end of each monthly billing cycle. Co-payments are due at the time of your service.

Non-Contracted PPO Insurance Plans
For patients who have PPO insurances that are not contracted with the PPMG, payment for services rendered is due at the time of service. The PPMG will send an initial claim form to your insurance company for all physician services, as a courtesy for you. Any balances owed will be billed at the end of each monthly billing cycle.

Laboratory, Radiology and Other Diagnostic Tests
Non-office based laboratory tests, radiological services and most other ancillary services are separately billed by the source of the service, usually UCLA Healthcare, Quest, Tower Imaging or Providence/St. John's. These entities are contracted with most all health plans. You will receive separate statements and bills for these services that are not part of your fiscal relationship with the PPMG.

Health Maintenance Organization (HMO) Plans
Effective 01/01/2019 the PPMG will not be contracted with any HMO type of healthplan. HMO covered patients who wish to see PPMG physicians will be billed as cash patients or can take advantage of our Direct Contracting option as a convenient way to receive their primary care needs from this office.