WellSpring Medical Group - FAQ



				WellSpring Medical Group 45 Castro Street Suite 423 San Francisco, CA 94114 Office: (415) 551-9758 Fax: (415) 437-5434 Business Hours: Monday - Friday 9:00am - 5:00pm
		Frequently Asked Questions What is a Physician Assistant (PA)? What is a Medical Assistant (MA)? How do I make an appointment? How soon can I get an appointment? What insurance do you accept? How do I know if my visit and/or services will be covered by my insurance? What do I need to bring on my initial visit? When do I need to arrive? What do I do in an emergency? What if I need care outside of regular office hours? How do I transfer my medical records? How do I pay my bill? How do I refill my prescription? What if my prescription is not covered by my insurance plan? Do I need a referral to see a specialist? How do I get my lab results? What is an advance healthcare directive and how can I obtain one? What is a Physician Assistant (PA)? A Physician Assistant is a mid-level practioner who has had extensive medical training which enables them to evaluate, diagnose, treat, order tests, and prescribe medication. The PA can evaluate and diagnose illnesses, perform complete history and physical exams, PAP exams, and minor office procedures such as biopsies and wart treatments. The Physician Assistants work as a team with the physicians, consulting with them regularly regarding your care. They allow for greater flexibility in scheduling appointments to meet your needs. What is a Medical Assistant (MA)? A Medical Assistant has training in medical procedures and medical administration. They help and assist the medical providers (Physicians and Physician Assistants) by performing tasks such as ear lavages, injections, and blood pressure readings. They are able to generate and complete authorization requests for prescriptions and tests/referrals for specialists. How do I make an appointment? Call our main number at 551-9758. If you reach our voicemail, please do leave a message with your name and a number you can be reached at and we will call you back as soon as possible. How soon can I get an appointment? If you are having an urgent situation we will get you in the same day or the next day based on the severity of your symptoms. Non-urgent appointments can generally be scheduled within 1 week. Routine physical exams are generally scheduled within 2 weeks. If you have a chronic condition that requires regular follow up visits, it is best to make your next appointment at the conclusion of your current visit. Please note that urgent appointments will be scheduled with whomever is available. What insurance do you accept? We are contracted with all HMO plans through Brown and Toland. If you have an HMO, you must select either Dr. Virginia Cafaro or Dr. Mark Higgins as your PCP (Primary Care Physician). To do this, contact the member services number on your insurance ID card. Please insure that the effective date of your selection of either physician as your PCP is prior to the date of your visit. The HMO plans we are contracted with through Brown and Toland are: Aetna HMO Blue Cross HMO(Californiacare) Blue Shield HMO Cigna HMO Healthnet HMO Healthnet Seniority Plus One Healthplan HMO Pacificare HMO Other contracted insurances are: Aetna PPO Aetna Managed Choice Aetna Elect Choice Aetna EPO Accordia Admar BCE Emergis Blue Cross PPO Blue Shield PPO Capp Care Carpenter's Health and Welfare Trust Fund Choice Care CCN Cigna EPO and PPO First Health Great West PPO Guardian Life PPO Healthnet PPO Health Service Systems Medicare Part B Pacificare PPO PHCS Preferred Health Network United Healthcare PPO Please note: If your insurance plan is not listed above please contact the plan at the number on your card and inquire if they are contracted with Virginia Cafaro or Mark Higgins. How do I know if my visit and/or services will be covered by my insurance? Many plans do not cover visits for preventative care such as physical exams and vaccinations. Services considered cosmetic in nature are also usually not covered. This applies mostly with PPO plans. We advise patients to refer to their plan description or contact the plan's member services number to determine if they have benefits for the above type services. What do I need to bring on my initial visit? When do I need to arrive? If you have not already filled out your new patient paperwork (you can download this from our website) we request that you arrive 30 minutes prior to your appointment to complete your paperwork and give us time to verify your insurance. If you have already completed your paperwork, please arrive 15 minutes prior to your appointment so that we may verify your insurance. Bring your paperwork with you. Please bring your insurance card with you. If you do not have a card, we will need the name of your insurance carrier and a phone number to verify your coverage. If we cannot verify your coverage we will require payment at the time of your visit. Once we have received payment from your insurance carrier we will refund you the appropriate amount due. What do I do in an emergency? If you are having a life threatening emergency (examples: chest pain, severe breathing problems, shock, major trauma or loss of blood) call 911 or go directly to the nearest emergency room. This applies 24 hours a day. What if I need care outside of regular office hours? If you are having a life-threatening emergency call 911 or go directly to the nearest emergency room. If you are having an urgent medical condition please call our answering service at 415-753-4787 and ask for the doctor on-call for WellSpring Medical Group. How do I transfer my medical records? To have your medical records transferred from another physician to us or from us to another physician, it is necessary to complete an " Authorization for Disclosure of Patient Health Information" form. You can download this form and fax or mail it to whomever the records are being requested from. How do I pay my bill? Copays are required to be paid at the time of service. If you have a deductible and/or percentage co-insurance we will bill you after your insurance has processed the claim. We accept cash, checks, VISA, Mastercard and American Express How do I refill my prescription? If your prescription is out of refills, please contact your pharmacy directly. They will then fax us for an authorization for additional refills. Please plan ahead and allow at least 1 to 2 business days for refills to be approved. What if my prescription is not covered by my insurance plan? Most insurances now have drug formularies. Medications that are on the formulary are covered. If the medication is not on the formulary we may be able to submit a prior authorization to request coverage. The pharmacy will notify us directly if your medication needs a prior authorization. Please allow at least 48 to 72 hours for prior authorizations. Even if we complete a prior authorization your insurance plan may still deny coverage. We do not have control over this. If the medication is approved it may have a higher copay than medications that are on your formulary. This is dictated by your plan. Every plan has their own formulary that changes from year to year. Do I need a referral to see a specialist? If you have an HMO plan with Brown and Toland you must request a referral from us before seeing a specialist. The only exceptions are for podiatry(feet) ophthalmology(eyes) and gynecology(women). These specialists do not require a referral from us. You should only see the specialist directly if we are unable to treat the problem for you. Some other types of managed care plans may require that you obtain a referral from us before seeing a specialist. Please check your plan booklet. How do I get my lab results? Often lab results are discussed in follow up visits with your provider. If it is not necessary for you to make a follow up appointment we will contact you regarding any abnormal lab values that require attention. You can always call the medical assistants at 415-551-9758 x22 (Mark) or x30 (Jason) to inquire about your results. Most test results are back in 2-5 days. Some tests may take 1 to 2 weeks. What is an advance healthcare directive and how can I obtain one? The Advance Health Care Directive is written instructions which communicate your wishes about the care and treatment you want if you reach a point where you can no longer make your own health care decisions. Under California law adult persons with decision making capabilities have the right to accept or refuse medical treatment or life-sustaining procedures. Artificial nutrition and hydration are among the medical procedures you have the right to accept or refuse. REASONS WHY YOU MAY WANT TO PREPARE AN ADVANCE DIRECTIVE To ensure you receive the care and services you desire. To ensure the refusal of treatment at a determined stage if you have previously stated your desires to do so. To designate the person you would like to make decisions on your behalf. To ensure that family and friends understand your wishes regarding health care. If you do not make you wishes clear, your family members and friends may not agree about what type of care and treatment you would want. It is possible that your desires will not be carried out, since a conflict may lead to a lengthy court delay. Being prepared with an Advance Directive, you can say WHAT types of treatment you want, and WHO you want to speak for you. THE DURABLE POWER OF ATTORNEY FOR HEALTH CARE This is a legally binding document that allows the person you choose (the "agent") to make health decisions for you if and when you are no longer able to make such decisions. You should select a person who knows you well, and whom you trust. Your agent may be a relative or a friend, but must not be your attending doctor. The Durable Power of Attorney for Health Care allows your agent to make any and all health care decisions for you once you are no longer able to decide. This includes routine medical decisions, as well as more complicated decisions. Your agent can even decide to withdraw or withhold life-sustaining procedures if you give your agent that authority. To be valid, the document must be signed by you. The document must also be witnesses by two qualified adult witnesses. Those persons not eligible to be witnesses are your doctor, nurse, their employee or any other healthcare professional. You DO NOT need a lawyer to fill out a Durable Power of Attorney of Health Care. The Durable Power of Attorney for Health Care allows you, in writing, to declare your desire to receive or not receive life-sustaining treatment under certain conditions. You may list any instructions you want pertaining to health care. For additional information and a copy of the Advance Directive form, click on the link below: California Coalition for Compassionate Care Advance Health Care Directives You can also contact: California Department of Aging 1600 "K" Street Sacramento, CA 96814-4020 916-322-3887 Toll Free: 1-800-510-2-2- or State Ombudsman Program 916-323-6681



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