Billing & Insurance

Billing & Insurance 2018-02-02T18:33:56+00:00

Pacific Retina billing office staff hopes the information available here will help make your visit with our physicians go smoothly.

If you belong to an HMO, POS, or PPO, whether through a medical group or not, please make sure that you completely understand what is needed in the way of either a referral or authorization, before your appointment. Otherwise, your visit may not be covered by your insurance.

As a courtesy we file all your insurance claims for you if you provide the current insurance address. We ask that co-payments be made at the time of your visit. If you are not currently covered by medical insurance you will be expected to make payment at the time of your visit. The Billing Office staff will be glad to discuss fees with you in advance of your appointment.

Pacific Retina physicians participate with most insurances in the Bay Area. Our doctors belong to many Medical Groups. However, they are NOT members of the following groups:

  • Brown & Toland Medical Group
  • John Muir

and we will not be able to help you get a referral for your visit if you have one of these insurance plans.

Our Insurance Affiliations

Pacific Retina is directly affiliated with several Medical Groups in the Bay Area. A member’s care is managed by their Primary Care Provider, who needs to be involved in all decisions about specialist services.

  • Affinity Medical Group including:
    • Rossmoor Region
    • Tri-Valley Region
    • Alameda Medical Group
    • Eden Medical Group
    • Pinole Medical Group
    • San Leandro Medical Group
  • Bay Valley Medical Group
  • Hill Physicians Medical Group
  • Palo Alto Medical Group
  • Alta Bates Medical Group*
  • Sutter Delta Medical Group*
  • Sutter East Bay Medical Group*
    * denotes a limited relationship

Insurance Companies

Pacific Retina is also affiliated with the following insurance companies:

  • Aetna
  • Blue Cross
  • Blue Shield
  • Champus/Tricare
  • Cigna
  • HealthNet
  • PacifiCare
  • United Health Care


In addition to standard MediCal coverage, Pacific Retina has relationships with the following insurances to care for Managed MediCal patients:

  • Alameda Alliance
  • Blue Cross HMO/MediCal (CMSP)
  • Contra Costa Health Plan
  • CHCN
  • Highland
  • Solano Partnership


Pacific Retina physicians are Participating Providers for Medicare and Railroad Medicare.

A Medicare patient will receive a statement from us only when the balance due is the patient’s responsibility. Usually because the deductable has not been met or a secondary coverage has transferred the balance to the patient.

Managed Medicare Insurance – Senior HMO Plans have become much more popular in the last few years. These offer Medicare patients the option to control their out-of-pocket expenses. The patient has the option of picking from either Stand Alone coverage or Medical Group coverage. If they have enrolled in a Medical Group coverage they will pick a Primary Care Provider who will direct them to specialist care (BARA doctors are specialists).

In Northern California, they are offered by the following insurance companies:

  • Stand Alone Coverage
    • Freedom Blue
    • Humana
    • United
  • Medical Group Coverage
    • Health Net – Senority Plus
    • United/AARP – Secure Horizon

Pacific Retina physicians see Senior HMO Plans through the following Medical Groups:

  • Affinity Medical Group:
  • Hill Physicians Medical Group

Managed Senior HMO Products are also available through Alameda Alliance, Centers for Elder Independence, Contra Costa Health Plan and Solano Partnership and must have a referral to be seen.

If you require further information, please feel free to contact our Billing Office by calling (925) 522-8858.