Participating Insurance List - Last update 2017 January
Our office is a specialty practice. If you belong to an HMO or any plan that requires prior authorization from your Primary Care Provider (PCP), YOU MUST
HAVE AN ACTIVE REFERRAL FOR EACH VISIT AND BRING YOUR COPAYMENT WITH YOU AT EACH VISIT! If you receive medical care at our office without
the authorization form from your PCP, you will be responsible for the charges at the time of the visit.
Our office DOES DOES NOT accept WORKERS' COMPENSATION or MOTOR VEHICLE ACCIDENT INSURANCES
- if you have a current workers' comp case, you need to let us know in advance to determine your eligibility to use your health plan!
If you have a question about whether we participate with your particular insurance, please contact our billing office and we will be happy to help you.
If your insurance changes, please let us know as soon as possible so we can keep your records up to date. You will be required to present your
insurance card(s) at each visit.
Aetna PPO (All Non-HMO Products)
Alameda Alliance for Health - Referral from PCP required before 1st Visit
Anthem Blue Cross PPO (*excluding all plans purchased via Covered California or Individual market; ***BUT since all these plans are high
deductible plans anyway, you would have to pay your deductibles; good news is: labs, imaging, medications are still provided by your in-network
providers eg. Quest Labs, Lab Corp, NorCal Imaging, Silicon Valley Imaging, and your pharmacy plans; therefore you are limited to paying office visit
portion only)
Blue Shield of CA - PPO (*excluding all individual and Covered California PPO, EPO plans starting 2017; BUT see note above***)
Choice Care Network (part of Humana)
Cigna PPO (Open Access Plus)
Coventry Health Network: (AKA "First Health" / CCN PPO)
First Health Network PPO / CCN PPO (A Coventry Health Care Company)
Great West Heatlth Plan of CA: All HMO, PPO, POS (AKA "One Health Plan" - HMO, PPO) - Now belongs to Cigna
Health and Welfare Insurances:
Hills Physicians Medical Group IPA - Referral from PCP Required- Yearly! --- Dr Shibuya only
Humana POS Open Access
Interplan PPO / HealthSmart
Medicare (Part B active)
Multiplan PPO (AKA - Admar Corporation, BCE Emerges, BPS Healthcare, ProAmerica)
Pacific Care = United West
Pacific Health Alliance PPO
PHCS (Private Healthcare Systems): PPO, EPO
Physicians Medical Group of San Jose IPA (all plans - Referral from PCP required before 1st visit, and each visit afterwards)
Three Rivers Provider Network
United Health Care / United West
Washington Senior Care
Insurances that our office does NOT accept:
Affinity Medical Group/ Affinity IPA *1
Alta Bates Medical Group
Bay Valley Medical Group *2
Anthem Medi-CAL / Blue Cross - Medi-CAL **
BRMS (Benefits & Risk Managemenet Services).
CCN (CCN Managed Care HMO)
CHCN [Community Health Center Network] - Medi-CAL *3
Easy Choice - Medicare Advantage Plan in Alameda County only-contract via Hill Physicians (effective 2014-2016)
John Muir Medical Group
Kaiser Permanente
Kaiser Medi-CAL
Medi-CAL - Sorry, our office is CLOSED to any NEW straight Medi-Cal patients
Palo Alto Medical Foundation (PAMF) - ALL HMO plans who has PAMF as Medical Group
Stanford Health Care Alliance/ University HealthCare Alliance
Tricare
** For patients with Anthem/Blue Cross Medi-CAL, you can go to Highland Hospital Rheumatology Clinic located at 1411 East 31st Oakland, CA at (510)
437 - 4800. The patients will need to be referred to the rheumatology clinic from the urgent care clinic located in the ER. The urgent care clinic is open 7
days a week from 9 AM to 9 PM
*1 - Affinity Medical Group has their own contracted rheumatologist http://www.affinitymd.com/provider-search/
*2 - Bay Valley Medical Group has their own contracted rheumatologist http://www.bayvalleymedicalgroup.com
*3: CHCN has their own contracted rheumatologists, call 510-297-0200 for more information http://chcnetwork.org/patient-services/
Our office is a specialty practice. If you belong to an HMO or any plan that requires prior authorization from your Primary Care Provider (PCP), YOU MUST
HAVE AN ACTIVE REFERRAL FOR EACH VISIT AND BRING YOUR COPAYMENT WITH YOU AT EACH VISIT! If you receive medical care at our office without
the authorization form from your PCP, you will be responsible for the charges at the time of the visit.
Our office DOES DOES NOT accept WORKERS' COMPENSATION or MOTOR VEHICLE ACCIDENT INSURANCES
- if you have a current workers' comp case, you need to let us know in advance to determine your eligibility to use your health plan!
If you have a question about whether we participate with your particular insurance, please contact our billing office and we will be happy to help you.
If your insurance changes, please let us know as soon as possible so we can keep your records up to date. You will be required to present your
insurance card(s) at each visit.
Aetna PPO (All Non-HMO Products)
Alameda Alliance for Health - Referral from PCP required before 1st Visit
Anthem Blue Cross PPO (*excluding all plans purchased via Covered California or Individual market; ***BUT since all these plans are high
deductible plans anyway, you would have to pay your deductibles; good news is: labs, imaging, medications are still provided by your in-network
providers eg. Quest Labs, Lab Corp, NorCal Imaging, Silicon Valley Imaging, and your pharmacy plans; therefore you are limited to paying office visit
portion only)
Blue Shield of CA - PPO (*excluding all individual and Covered California PPO, EPO plans starting 2017; BUT see note above***)
Choice Care Network (part of Humana)
Cigna PPO (Open Access Plus)
Coventry Health Network: (AKA "First Health" / CCN PPO)
First Health Network PPO / CCN PPO (A Coventry Health Care Company)
Great West Heatlth Plan of CA: All HMO, PPO, POS (AKA "One Health Plan" - HMO, PPO) - Now belongs to Cigna
Health and Welfare Insurances:
- * Boilermakers, Laborers, Operating Engineers, Pipetrades, Teamsters, Northern California Bakery, Retail Clerks, Soft Drinks & Machinists
Hills Physicians Medical Group IPA - Referral from PCP Required- Yearly! --- Dr Shibuya only
Humana POS Open Access
Interplan PPO / HealthSmart
Medicare (Part B active)
Multiplan PPO (AKA - Admar Corporation, BCE Emerges, BPS Healthcare, ProAmerica)
Pacific Care = United West
Pacific Health Alliance PPO
PHCS (Private Healthcare Systems): PPO, EPO
Physicians Medical Group of San Jose IPA (all plans - Referral from PCP required before 1st visit, and each visit afterwards)
Three Rivers Provider Network
United Health Care / United West
Washington Senior Care
Insurances that our office does NOT accept:
Affinity Medical Group/ Affinity IPA *1
Alta Bates Medical Group
Bay Valley Medical Group *2
Anthem Medi-CAL / Blue Cross - Medi-CAL **
BRMS (Benefits & Risk Managemenet Services).
CCN (CCN Managed Care HMO)
CHCN [Community Health Center Network] - Medi-CAL *3
Easy Choice - Medicare Advantage Plan in Alameda County only-contract via Hill Physicians (effective 2014-2016)
John Muir Medical Group
Kaiser Permanente
Kaiser Medi-CAL
Medi-CAL - Sorry, our office is CLOSED to any NEW straight Medi-Cal patients
Palo Alto Medical Foundation (PAMF) - ALL HMO plans who has PAMF as Medical Group
Stanford Health Care Alliance/ University HealthCare Alliance
Tricare
** For patients with Anthem/Blue Cross Medi-CAL, you can go to Highland Hospital Rheumatology Clinic located at 1411 East 31st Oakland, CA at (510)
437 - 4800. The patients will need to be referred to the rheumatology clinic from the urgent care clinic located in the ER. The urgent care clinic is open 7
days a week from 9 AM to 9 PM
*1 - Affinity Medical Group has their own contracted rheumatologist http://www.affinitymd.com/provider-search/
*2 - Bay Valley Medical Group has their own contracted rheumatologist http://www.bayvalleymedicalgroup.com
*3: CHCN has their own contracted rheumatologists, call 510-297-0200 for more information http://chcnetwork.org/patient-services/
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| Fremont Rheumatology Arthritis, Osteoporosis, and Auto-Immune Diseases Barry Shibuya M.D. and Christine Elias M.D. |