Insurance Participation

Peninsula Gastroenterology participates with most major PPO insurance plans and a limited number of HMO plans. Because participation can vary by your specific plan, network, and medical group, we encourage you to confirm your benefits and our participation with your insurance carrier before receiving services.

For HMO plans, Peninsula Gastroenterology participates with Hill Physicians and Santa Clara County IPA (SCCIPA). Participation with a medical group does not necessarily mean that we participate with every insurance carrier or plan associated with that group. Referral and authorization requirements may also vary by plan.

We also accept TRICARE, which requires authorization from the patient's primary care provider, as well as many student health plans, which typically require a referral.

Facility Coverage Matters, Too

If you may need a procedure, your insurance coverage with Peninsula Gastroenterology is only one part of determining whether we can accept your plan. Your plan must also provide access to an appropriate in-network facility where our physicians perform procedures.

Our physicians perform procedures at Atherton Endoscopy Center, El Camino Health, and Sequoia Hospital, depending on the procedure and clinical circumstances.

In some cases, Peninsula Gastroenterology may be in network while none of the facilities available to our physicians are in network. If there is no appropriate in-network facility available for your plan, we may be unable to accept your insurance even though Peninsula Gastroenterology itself is considered in network.

Please note: Peninsula Gastroenterology does not obtain Letters of Agreement (LOAs) or single-case agreements for procedures at out-of-network facilities.

Plans We Commonly Do Not Accept

The following list includes plans and networks we commonly do not accept and is not intended to be exhaustive:

• Oscar EPO
• Blue Cross Covered California
• Blue Cross Pathway EPO and PPO
• Stanford Health Care Alliance
• Medi-Cal / Health Plan of San Mateo
• Alignment PPO
• UnitedHealthcare CORE PPO
• UnitedHealthcare Oxford Liberty Network
• Imperial Health Plan
• SCAN Health Plan
• Central Health Plan
• Chinese Community Health Plan (CCHP)

Exceptions and special circumstances may apply. For example, Peninsula Gastroenterology accepts Cigna + Oscar plans. We also accept Alignment HMO plans except those associated with NEMS or PAMF.

Insurance participation is subject to change. Please confirm with your insurance carrier that Peninsula Gastroenterology and, when applicable, the facility where your procedure will be performed participate with your specific plan and network.