Dr. Jaureguito & Dr. Dhanoa: 510.739.6520
Dr. Besh: 510.857.1000
Insurance & Billing
Authorizations
Our staff will work with you to contact your insurance company and make a formal request. Each insurance company's response time varies. If you do not hear from our office concerning a request for authorization within five working days, please call us to inquire the status of the request. New conditions often require authorization before you can be treated.
Payments
Please remember that all co-pays are due at the time of your visit. For your convenience, we accept Visa and MasterCard. FORM offers cash and payment plans for qualifying patients. Our billing office is happy to answer your payment questions at 510.505.1090.
Insurance Plans
Below is a list of the insurance that we currently accept at FORM. We accept all PPO’s & most EPO’s, auto insurance, Medicare & Workers Compensation. We will gladly accept most Palo Alto Medical Foundation plans. FORM is not currently contracted with HMO’s. If you do not see your insurance listed below, please call our billing specialists at 510.857.1000 and they can answer any insurance related questions.
| Company | Network | Accepted |
|---|---|---|
| AARP | Y | |
| AdMar | PPO | Y |
| Aetna Aexcel | PPO | Y |
| Aetna Managed Choice | Y | |
| Aetna Open Choice | PPO | Y |
| Aetna Select Choice | PPO | Y |
| Alameda Alliance | Y | |
| Beech Street | Y | |
| Benesight | Y | |
| Blue Shield | PPO, EPO | Y |
| Blue Cross | PPO, EPO | Y |
| BPS Healthcare | PPO, EPO | Y |
| Carpenters Health & Welfare | Y | |
| Chubb | Y | |
| Cigna | PPO | Y |
| CCN | Y | |
| Coventry Health Network | Y | |
| ESIS | Y | |
| First Health | PPO | Y |
| Great West (One Health) | EPO, PPO | Y |
| Guardian | Y | |
| Health Managed Care | Y | |
| Healthnet | PPO | Y |
| Humana | Y | |
| Interplan | PPO | Y |
| Kaiser | WC | Y |
| Keenan | Y | |
| Medi-Cal | N | |
| Medicare | Y | |
| MultiPlan | PPO | Y |
| Nippon Life | Y | |
| One Call Medical | WC | Y |
| Pacificare | PPO | Y |
| Palo Alto Medical Foundation | Y | |
| Patriot Risk Services | Y | |
| Preferred Health Network | PPO | Y |
| Principle Life Insurance | PPO | Y |
| Pro America | PPO | Y |
| Private Healthcare Systems | Y | |
| Prudent Buyer | Y | |
| State Compensation Fund | WC | Y |
| Teamsters Benefit Trust | Y | |
| Three Rivers Provider Network | Y | |
| Tricare | Y | |
| TriWest | Y | |
| Unicare | Y | |
| United Healthcare | PPO, EPO | Y |
| Washington Senior Care | Y | |
| WAUSAU | Y | |
| Workers Compensation | Y | |
| York | Y | |
| Zurich W/C | Y |