Above all, we work to meet your health needs. This may mean that the insurances we accept may change from time to time. Below you will find the insurance plans that we currently accept.  Please note that most insurance plans require a co-payment, which is due at the time of service. After your appointment, your insurance will be processed and you will be billed for any services not covered by your insurance plan.

If you are uncertain as to whether a particular service is covered, please contact your insurance company directly. If your plan is not listed below, please call us at (714) 549 – 4081 and we will do our best to help you determine your out-of-network coverage benefits.

PPO Plans: We accept all PPO plans.

HMO Plans: We accept only the Edinger Medical Group (EMG) and Greater Newport Physicians (GNP) HMO plans.

Medicare: We accept all Medicare patients.

Medi-cal/Cal-optima: We accept Medi-Cal as part of your Secondary coverage (i.e. we accept patients that are Medicare/Medi-Cal) but do not accept Medi-Cal-only/Caloptima Direct plans.

UNDERSTANDING YOUR COVERAGE

Receiving confusing information from your insurance company or our office’s billing department can be frustrating. These are some key terms that you may want to review so that you can better understand your coverage and responsibilities.

Referral: A referral is an authorization from your insurance company for you to see a specialist. A referral has to be requested by your primary care doctor and submitted to your insurance company. Referrals are not always required for you to see a specialist, it depends on your insurance plan.

Co-Payment a.k.a. “Co-Pay” – A copayment is an amount that your insurance has assigned you to pay when you have a medical appointment. Your co-pay at your primary care doctor may be different than your co-pay at a specialist’s office. Please note that Dr. Ananth is a rheumatology specialist, so the specialist co-pay rate applies. Your co-payment amounts are listed on your insurance card, and are due at the time you have your appointment.

Deductible – Your deductible is the amount of money that you have to pay out of pocket before your insurance will start to pay. Deductible amounts are different with every insurance plan.

Co-insurance – Even after you meet your deductible, some plans require you to pay a co-insurance. The co-insurance amount is usually a percentage that your insurance company requires you to pay for every claim that they pay on. For example, if you have a 10% co-insurance, and your insurance company gets a claim for $100.00, they will pay $90.00 and you will pay $10.00.

Out of Pocket Maximum or Cost Sharing Cap – This is the maximum amount of money you have to pay out of your pocket per year. This amount does not usually include your deductible or co-payments, but does include your co-insurance payments. After you reach your out of pocket maximum, your insurance covers you claims at 100%, so you no longer have to pay co-insurance amounts.

In-Network Benefits – Your insurance company makes contracts with doctors and facilities to provide care at lower costs. If you see a doctor, or go to a facility that has a contract with your insurance, you are going to an in network provider. This means that your costs are reduced because your insurance company’s costs are reduced. The networks of which Dr. Ananth is a part are listed above.

Out-of-Network Benefits – Some insurance plans do not offer out-of-network benefits, so you will want to check with your insurance company before you go to a provider that is not contracted with your insurance. If your insurance does provide out-of-network benefits, you will usually end up having more out-of-pocket costs because out-of-network benefits usually have a higher deductible and higher co-insurance amounts.