Hill Physicians wants to make it as easy as possible for you to find the answers to your questions. If you have a question or issue that is not addressed here, please contact Customer Services.
A health plan is a company that provides healthcare insurance. Among the different types of health plans are health maintenance organization (HMO) plans, preferred provider organization (PPO) plans, and point of service (POS) plans. Hill Physicians works with some of the leading California healthcare insurance companies that provide HMO health plans. See our list of affiliated health plans.
A medical group is an organization of physicians that contracts with health plans and manages the provision of healthcare for a large number of health plan patient-members. An IPA, or independent practice association, is a medical group whose physicians are in independent practice. The physicians usually maintain their own offices, separate from other physicians in the IPA.
Hill Physicians Medical Group is the nation’s and northern California’s largest IPA. Read more about us.
Hill Physicians works with the leading HMO health plans to give you access to the largest network of independent physicians in northern California. See the list of our affiliated health plans.
A primary care physician (PCP) is responsible for coordinating all of your healthcare needs, including managing your annual exams, preventive care, routine illnesses and minor injuries, prescription medications and referrals to specialists and hospitals. Learn tips about how to select a physician.
To change your primary care physician, you must contact your health plan. The contact information for your health plan is on your insurance card, or is available through your plan’s website. Some physicians may belong to more than one medical group, so be sure to clearly indicate Hill Physicians as your medical group when you select your physician.
To see a list of our physicians and learn more about their education, specialties and office locations, check our Physician Directory.
A family physician treats both adults and children; an internist primarily treats adults. Family physicians are specially trained to handle family concerns and relationships and may also offer general gynecological services. Internists specialize in the diagnosis and treatment of disease.
Typically, pediatricians treat children up to the age of 18. However, you may wish to establish a relationship with a family physician or other primary care physician that treats adults before your teenager reaches that age.
You have a number of issues to consider when selecting a medical group. For suggestions on what to consider and information on how to enroll or how to change medical groups, check our How to Select a Medical Group page.
If you need to make any changes to your enrollment information – for example, to change your address or add a dependent – you must contact your employer or health plan directly. Your health plan will notify Hill Physicians of the changes.
Emergencies and Urgent Care
For any life-threatening emergency, call 911 or go directly to the nearest hospital emergency room.
In a life-threatening situation, always call 911 or go to the nearest emergency room. Life-threatening situations are those medical situations that may result in permanent physical impairment or death if not treated immediately, such as chest pains, excessive bleeding and broken bones. You do not need to wait for authorization to visit the emergency room; however, you must inform your primary care physician and health plan, usually within 48 hours of your visit. (Check your health plan rules.)
In non-life-threatening situations, first contact your primary care physician and describe your symptoms. Your physician will advise you on the appropriate course of action.
We work with urgent care facilities throughout northern California that offer convenient access for non-life-threatening emergency medical needs. See the list of our urgent care facilities.
Hospitals
As a Hill Physicians member, you have access to some of the best hospital and urgent care resources in your community. If you have a need for hospital care, your physician will work with you to determine the hospital that best meets your needs. We also contract with urgent care facilities throughout northern California that offer convenient access for non-life-threatening emergency medical needs. See the list of our affiliated hospitals and urgent care facilities...
Important: The specific services available to Hill Physician members from each hospital may vary. Please consult with your physician about your questions on hospital services. Or, you may contact our Customer Services Department for additional information.
Lab and Other Services
The name of the lab you should contact to schedule the test should be on the lab service request form provided by your physician. Additional contact information is listed below. Please note: For all lab services, you must have a lab service request form from your physician detailing the requested lab tests. The patient is responsible for paying for any lab services provided without a referral from the physician.
Laboratory Service Providers Quest Diagnostics
(800) 952-5691
Quest Diagnostics
Health Care Clinical Laboratory (San Joaquin only)
(209) 467-6430
When you receive a referral for a mammogram from your physician, the referral request will include information on how to find a convenient mammography facility.
Your physician will discuss with you any requirements for physical therapy services and will provide you with the necessary referral information, including how to find a convenient facility.
Referrals, Medical Review Requests and Second Opinions
A referral is a written communication that enables your primary care physician (PCP) to send you to a Hill Physicians participating specialist. Your primary care physician may refer you to a specialist whenever your physician thinks it is necessary (e.g., your condition is outside the scope of your physician’s practice or expertise). Referrals do not require the prior approval or authorization of Hill Physicians.
Your PCP will complete a referral form and either send it to the specialist or ask you to bring it to your first appointment. Referrals are valid for one year.
For convenience and efficiency, we allow you to “self-refer” to a specialist for the following services:
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Obstetrics and gynecological services: You may self-refer to a Hill Physicians OB/GYN.
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Annual vision exam: If annual vision screenings are included in your health coverage, you may self-refer to an ophthalmologist or optometrist. Be sure to check your health plan to see if you must use a designated vision provider in order for the service to be covered.
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Behavioral health: If you have a mental health benefit as part of your health plan, you may self-refer to a behavioral health provider from the health plan’s behavioral health network. For more information, call the phone number on your health plan card.
While our physicians may make a referral without prior approval, they must consult with Hill Physicians on certain services, including (but not limited to) inpatient hospital stays, outpatient surgeries, MRIs, CAT scans, durable medical equipment, chemotherapy and radiation therapy. Our medical team reviews each authorization to ensure that the most appropriate course of treatment is considered. We process urgent authorization requests within 24 hours and most routine, non-urgent requests within 2 working days. Complex requests may take longer to review.
You must appeal any denial determination directly to your health plan. All appeal information is included in the denial notice sent to you and your physician.
Obtaining a second opinion is easy. Your PCP will refer you to another qualified Hill Physicians provider. If your PCP is unable to assist you, contact our Customer Services Department. Your health plan also may be able to help you find another provider.
Billing and Premiums
All premiums are handled by the health plans. The contact information for your health plan is on your insurance card, or is available through your plan’s website.
You should mail or fax a copy of your bill directly to Hill Physicians (click here for contact information). We will reimburse the Health Department. If you already paid the bill, please contact the Health Department for reimbursement. If you are a Blue Shield member, please mail your claim to Blue Shield at the address on your health insurance identification card.
If Quest Diagnostics is billing you directly for service, then Quest probably does not have your insurance information. Contact Quest Diagnostics at the toll-free number listed on the bill to provide Quest with the required insurance information.
Please contact your health plan directly. The health plan will reimburse you for this service, if appropriate. The contact information for your health plan is on your insurance card, or is available through your plan’s website.
Letters from Hill Physicians
Often medical treatment related to an accident is covered by the auto insurance of another party. The letter and questionnaire we sent is intended to find out if your medical expenses should be billed to another insurance company. If you have not been involved in an accident, please answer “no” to all the questions and mail the form back to us. If you have been involved in an accident, please answer the questions appropriately and mail the questionnaire back.
We use this questionnaire to help us determine if your physician should be billing another insurance plan that is providing primary benefits to you. If you or your dependents have more than one insurance plan, please fill out the information and mail it back. If you have only one insurance plan, please state so and return the form. For convenience, you may use our Online COB Questionnaire to send us the required information.