Frequently Asked Questions

Affinity contracts with HealthNet (healthnet.com) and United Healthcare (uhc.com) Medicare Advantage plans for our entire service area and with SCAN (scanhealthplan.com) in Contra Costa County. Contact your health insurance broker or the plans directly to get more information about coverage. When you select a plan, request Affinity Medical Group as your medical group.

Send payments to:
Affinity Medical Group

P.O. Box 21390

El Sobrante, CA 94820

If you feel you have received a bill in error, please contact Member Services at 1 (888) 309-2221.

Depending on your health plan benefits, your medical supplies may be covered. Ask your Affinity PCP to submit a referral for these items.

Please contact your Primary Care Provider to request a referral if you need to see a specialist. Specialist visits, with the exception of Open Access, require an “Authorization” from Affinity Medical Group.

Open Access is one of the ways Affinity makes your healthcare simpler and easier to access. Female members do not need a referral from their PCP for routine obstetrical and gynecological services if the OB/GYN selected is a participating AMG provider.

An Emergency is defined as a sudden illness or injury, such as a chest pain or uncontrolled bleeding. In cases of life-threatening emergency, go to the nearest emergency room or call 9-1-1.

For all other urgent care matters, call your primary care physician’s office. There is an on-call physician 24 hours a day, seven days a week. The on-call doctor will advise you what to do next.

It is important that you call your doctor’s office as soon as you can, preferably within 48 hours of the episode, to involve your doctor in your care as soon as possible.

A Primary Care Physician (PCP) is the doctor you select to be your personal physician. He or she can be specialized in Internal Medicine, Family Practice or Pediatrics. The relationship you have with your PCP is very important. You will work with your PCP to manage your health, and he/she will authorize visits to most specialists when necessary (except for visits to OB/GYN specialists, which can be made without a referral).

Call your Primary Care Provider’s office for:

• Medical problems
• Appointments
• Referrals to specialists

You can reach your PCP 24 hours a day for consultation. Please save routine matters for regular business hours.

Call your health plan for:

• Prescription drug and other benefit coverage information
• To change your doctor or your address
• To order ID cards

Call Affinity’s Member Services department for:

• Assistance with billing problems
• Information on resources to manage your health

Affinity’s Member Services department is available Monday – Friday, 8:00 a.m. – 6:00 p.m. at 1 (888) 309-2221.

Use our Provider Search function to find out if your doctor is with Affinity or to find an Affinity doctor in your area.

Affinity contracts with most major HMO health plans as well as Medicare Advantage plans.

Affinity Medical Solutions is the Management Services Organization for Affinity Medical Group and a wholly-owned subsidiary of Affinity Medical Group.

No, the request would go to the members Health Plan for the second opinion. The second opinion is exactly that a second opinion.  If the member needs to have services rendered, then the member would have to be redirected back into the group.

No, as long as the patient is only having a plain film or basic x-ray no auth is necessary as long as patient goes to a Par provider.

No, you would need to submit the claim to the primary insurance first and then submit the claim to AMS along with the Explanation of Benefits (EOB).

No.  No copayment should be collected from the member. Two claims should be submitted to AMS one for the primary and one for the secondary.

No, AMG will only review authorizations for those members that have United (Secure Horizons, Pacificare) or Scan.  All other plans are subject to the terms and conditions of the individual member’s Health Plan.

If you are a group of Doctors then you will want to register with your TX ID so that you can include all Doctors listed under the Group. If you are an Independent Provider you will register under your NPI as an Individual Provider.

You can go to our Affinity website at affinitymd.com and in the orange box click the link that says “Click Here to access the Affinity Provider Portal”.  If you are a new user, click on Register  to create your account, then follow the prompts for New Provider registration.  If you have any questions, please call Customer Service at 800-615-0261.

The Provider Portal is Affinity’s web-based system that increases efficiency by helping providers manage membership, coordinate referrals and authorizations, and pay claims.

Yes, you can enter an Urgent auth on the portal system and mark the box EXPEDITE.  Also please fax over a hard copy of the auth by going to the Affinity website to print the auth form.  At affinitymd.com click on Providers then scroll half way down the page and click on the link to Print Authorization Form.

Reference the authorization number that was issued to you when you entered it manually and mark it URGENT. Fax auth form to 510-662-3492.

Yes you can contact the following Health Plan by calling:

Aetna: 800-756-7039
Anthem Blue Cross: 800-333-0912
Blue Shield: 800-541-6652
Cigna: 800-244-6224 24 Hrs
Health Net: 800-638-3889
Pacific Care: 800-624-8822
Scan: 800-559-3500

Mail appeals to:
Affinity Medical Solutions

Attn: Appeals Dept
320 Blume Drive, Suite 260
Richmond, CA. 94806

Yes, you can submit your claims to any of the following Clearinghouses:

Clearinghouse  (Submitter Number)

• EMDEON  (46594)
• CENTRICITY  (GEC91952P)
• OFFICE ALLY  (46594)

Submit all claims to:
Affinity Medical Group
P.O. Box 21390
El Sobrante, CA 94820

Call Sergio Wagner at (510) 662-3418 or email swagner@AffinityMD.com

Call Provider Support at (800) 615-0261 between 8:00 a.m. and 5:00 p.m. Monday – Friday.

Affinity Medical Group is fully delegated for credentialing with contracted Health Plans.  However, each Health Plan must perform a final credentialing verification in order to process your application. This process can take an additional 30-60 days. When this process is completed, your name will be included in each Health Plan Provider’s Directory.

25,000 lives are in our care, including 5,000 seniors.

Approximately 100 primary care providers and 600 specialists.

Yes.  We are constantly working to expand our network of facilities and providers.

Affinity has contracts with most of the facilities in the East Bay. A complete list is available here.

• Aetna
• Anthem Blue Cross
• Blue Shield of California
• CIGNA
• Health Net
• United Healthcare (excludes Rossmoor Medical Associates PCPs)
• SCAN (Contra Costa County only)

Contact Network Management for more information at (510) 662-3416.

Alameda County and Contra Costa County. We have a very strong presence in West Contra Costa County, Alameda Island, Castro Valley, Walnut Creek, and Rossmoor Senior Community.