Frequently Asked Questions
What types of insurance do you accept?
Even though my name in ALL PPO Directories is listed as an “out of network” provider, we are actually “in network” through ProHealth Partners, A Medical Group, that is contracted with most major insurances. Please check the “Insurances and Affiliations” section for details and please do not hesitate to call us if you have any questions.
PPO’s: We are currently “in-network”, through ProHealth Partners, A Medical Group, with following plans: Aetna, Anthem Blue Cross, Blue Shield of California, Cigna, HealthNet, United HealthCare and Tricare. We are in process with Humana and other PPO carriers.
COVERED CALIFORNIA: We are currently contracted providers, through ProHealth Partners, A Medical Group, with three of the main products pertaining to Covered California. They are Blue Cross, Blue Shield and HealthNet.
HMOs/IPAs: We now accept AltaMed, CHOC Health Alliance, Family Choice, Greater Newport Physicians, HealthCare Partners/Talbert/Arta, MemorialCare Medical Foundation, Noble Mid Orange County, Prospect, St. Joseph/HOAG and Fountain Valley, Regal/ADOC. We are in process with most major HMOs/IPAs including Edinger Medical Group, Monarch HealthCare, Seaside, SCS and United Medical Group.
Caloptima: We are now able to take care of Direct Caloptima patients. We now accept Medicare, Medi-cal and CCS patients.
Do I need to bring my insurance card to my office visit?
You will need to bring your insurance card and copayment at every visit.
How does it work for us if our insurance company is still not contracted with your clinic or with your medical group, ProHealth Partners?
If this is the case, we will not be able to bill your insurance as an “in-network” provider. Therefore, you will be required to provide our office a payment at the time of your “appointment” or the time of “checking-in”. At the time of your visit, you will receive a “superbill” and a receipt to submit to your insurance company, if you wish, for reimbursement. If you have other questions, you may contact your insurance company prior to the appointment for more information about “how to obtain a Letter of Agreement, or LOA” and “out-of-network” coverage, deductibles and other limitations.
How much do the appointments cost for “out-of-network” patients?
– Typical initial consultations (99245) are 60 minutes and the fee is $300.
– Follow-up appointments (99215) are 30 minutes and the fee is $150.
New visits for more complex conditions like Headache, Epilepsy, Autism Spectrum Disorder and ADHD typically require at least 90 minutes, compared to the typical one hour for new visits. This is due to the nature for those conditions requiring long and detailed history, and certain in-office Questionnaires/testing/education.
– Extended initial consultations (99245+96111) are 90 minutes and the fee is $ 400.
What forms of payment does your office accept?
We accept cash, credit cards and checks.
How does that work for us in terms of “authorization”?
For PPOs you do not need an authorization. For HMO patients you will need an authorization from your primary care provider prior to scheduling an appointment. At the time of your appointment you will need your insurance card and copayment. Our office will take care of the billing as well as any test, referral and follow-up authorizations which may be required.
How do I get a prescription refill?
We typically prescribe enough refills until the recommended follow-up appointment. This means that if you are running low on medication, you should realize that your follow-up appointment is approaching. Under special circumstances when a medication refill is needed prior to your follow-up appointment, please have your pharmacy fax us a refill request.
Are laboratory tests and other studies ordered during the visit covered by my insurance?
Our clinics are not associated with outside testing sites. You may want to check with the facility performing the studies or your insurance company to see what’s covered before doing the tests.
How does your office handle laboratory orders and results?
Our office is electronically linked to Quest and Labcorp. Orders to other laboratories will be manually prescribed and provided to you at time of visit. You will need to check with your insurance carrier for tests coverage. Our staff will do their best to call other laboratories to have results faxed to our office. We cannot guarantee timely response from those laboratories.
Does your office call us with laboratory and studies results?
From our experience, reporting results by phone has never been that simple, even if the results are normal or negative. Other unexpected questions and concerns usually arise during the phone conversation and unanticipated time is spent that disturbs our schedule flow. For this reason, all results should be discussed in the office. Exceptions can be decided based on the circumstances. Moreover, we occasionally do not receive the reports or we may not have your correct contact information. So, we encourage you to give us a call several days after the testing is completed so that we can help you tracking the results.
Does your office handle the Referrals to other specialists/therapist?
Although, under certain circumstances, we may prefer certain providers or centers, we cannot guarantee that they will be covered by your insurance plan.
Do you do telephone consultations?
Under certain circumstances, it is more appropriate to discuss certain information or issues by phone than in a follow-up appointment. This is left to our office discretion. Please be aware that most insurance carriers do not consider phone consultation or follow-up and do not reimburse the physician for time spent, no matter how long it is.
Can I e-mail Dr Elbalalesy?
There are two ways to send an electronic message to Dr. Elbalalesy. The preferred way is through the Optum Patient Portal. The patient portal is free and is the most secure method to exchange any health-related (HIPAA) information between a patient and the physician and all communications through the portal are then part of the permanent, electronic medical record. We encourage patients to take advantage of this tool that is available at no cost. This would require a one-time set-up, please contact the office for assistance with this initial process.
It is recommended that you NOT send a regular email to Dr. Elbalalesy. Please be advised that there is no guarantee of security if you send health information through this option and the messages could end up misdirected to other recipients, not received, or be stored in an unsecured remote server.
How is your parking?
Is there handicap access? There is ample parking space including handicap access in both locations.