FAQs

Podiatry Plan is a single specialty medical group founded in 1982. We contain almost 500 podiatrists in California and Nevada who contract at a specific fee schedule to provide services to health care insurance companies, ERISA trust funds and Medicare carriers.

Becoming a Podiatry Plan member involves a formal Peer Review process similar, if not identical, to the process you undergo for hospital privileges. You may download the application and necessary documentation list in this section.

Can anyone apply to become an approved provider in Podiatry Plan?

Yes, any licensed podiatrist in California or Nevada can apply. There is no application fee. Podiatrists are accepted once a year, following a review of their application and documentation, and only if there is need for their services in the location of their offices.

How do I know what the fee schedule will be?

Podiatry Plan has many contracts and the fee schedule varies for both location and client. Generally our fees are slightly higher than Medicare for surgery, slightly lower for office visits and higher for radiology. Yes, we cover routine office visits and orthotics.

If you are accepted you will receive an exact fee schedule for each contract and you will have 30 days to either accept our invitation or decline the contract.

Is Prior Authorization required for surgery or other services?

Yes. Our clients are most interested in our data about elective surgery. We require conservative care before authorizing surgical care. We often review x-rays. There is no authorization for orthoses but there is for custom molded shoes. All other services are deferred to your judgment but we reserve the right to monitor your utilization, a request by our clients. Authorization is usually made within 24 to 48 hours.

Do you charge to become a member of Podiatry Plan?

Yes. There are annual dues of $75, which covers the Peer Review process each year. If you do not see enough patients to justify this cost your dues are returned to you at the end of the year and your membership will not be renewed.

How do I get paid?

Your office or billing services will send all your claims for contracted services to our office in San Francisco.If your claim does not have the proper fee for a particular contract we will adjust the claim. You will receive a check and an EOB for your services. Payment is made within 30 days and in most cases sooner. Your staff can trace a claim through our office and you can confirm eligibility through our office. We rarely have phone waiting time.

Please email us for other answers to your questions or call and ask for Provider Services. The panel only opens for new members once a year, usually October, and notification is made before the end of the calendar year.

© 2015 Podiatry Plan Incorporated