Transcription
Southcoast Health NetworkHospitals and PhysiciansPlan and Product Participating Listas of June 2022Aetna (Includes Coventry)Participating Products:Aetna Select (Similar to POS)HMOQuality Point of Service (QPOS)Aetna Health Network Only (Similar to PPO)Aetna Open Access Elect Choice (Similar to PPO)Aetna Open Access HMOOpen Access Aetna Select (Similar to POS)Aetna Choice POSAetna Choice POS IIAetna Premier Care Network Choice POS (excludes SHN Neurology, Orthopedic, Cardiology, OBGYN, and General Surgery)Aetna Health Network Option (Similar to PPO)Aetna Open Access Managed Choice (Similar to PPO)Aetna Limited Benefits Insurance Plan (PPO)Open Choice PPOManaged Choice POSElect Choice EPOAetna Voluntary Group Medical Plan (Indemnity Plan)Traditional ChoiceMeritain HealthAetna Medicare Freedom (PPO) - patient can choose any non-par physicianAetna Medicare Plans (HMO/PPO) - Effective 7/1/2019Aetna Medicare ExplorerNon-Participating Products:Aetna of RIEffective 10.15.13*Southcoast Physicians Only - Rhode Island providersParticipating Products:Aetna Select (Similar to POS)HMOQuality Point of Service (QPOS)Aetna Health Network Only (Similar to PPO)Aetna Open Access Elect Choice (Similar to PPO)Aetna Open Access HMOOpen Access Aetna Select (Similar to POS)Aetna Choice POSAetna Choice POS IIAetna Health Network Option (Similar to PPO)Aetna Open Access Managed Choice (Similar to PPO)Aetna Limited Benefits Insurance Plan (PPO)Open Choice PPOManaged Choice POSElect Choice EPOAetna Voluntary Group Medical Plan (Indemnity Plan)Traditional ChoiceAetna Medicare Plans (HMO/PPO) - Effective 7/1/2019Non-Participating Products:AllWays Health Parnters (f/k/a Neighborhood Health Plan of MA)Name Change Effective 1/1/2019Participating Provider:Commercial HMO & PPOMassHealth - This Plan will begin to fade out in our area due to the new Medicaid ACO.ConnectorCareNon-Participating Products:Value HMO Plan Effective 7/1/2021 (City of Boston Employees)HMO Select Network (New as of 1/1/2021)Blue Cross Blue Shield of MAParticipating Products:PPO/EPOHMO BlueHMO Blue Network with Hospital Choice Cost Sharing FeatureHMO Blue New EnglandHMO Blue New England Options v.4HMO Blue New England Options v.5HMO Blue New England Network with Hospital Choice Cost Sharing FeatureHMO Blue Options v.4HMO Blue Options v.5Network Blue New England Value Plan (HMO)Network Blue New England Premium Plan (HMO)IndemnityMedicare HMO BlueMedicare PPO BlueNYC Medicare Advantage Plus (PPO Plan)PPO Blue Options v.4PPO Blue Options v.5PPO Blue Select
Southcoast Health NetworkHospitals and PhysiciansPlan and Product Participating Listas of June 2022Blue Care Elect Preferred (PPO)Preferred Blue PPO v.4Preferred Blue PPO v.5Preferred Blue PPO Network with Hospital Choice Cost Sharing FeatureMedex ChoiceSteward EPO - Steward employees that use Southcoast will be Tier 2 (larger out of pocket expense)Non-Participating Products:HMO Blue Select (Limited Network)Advantage Blue Performance Saver (Blue High Performance Network - Limited Network) (ED/UCC will be paid at PPO rates. All other services,patient has 100% cost share as OON)Blue Cross Blue Shield of RIParticipating Products:PPO Plans:Basic BlueBasic Blue DirectBlue SolutionsBlue Solutions for HASBlue Solutions Select RIClassic BlueDSNP (effective 1/1/22) Falls under Medicare AdvantageHealthMate Coast to CoastVantage BlueVantage Blue DirectVantage Blue Select RIHMO Plans:Access Blue New EnglandAnchor - State of RI Effective 1/1/2020HMO Blue New EnglandBlue Choice New EnglandBlueChipBlue Chip AdvanceBlue Chip ExtraBlue Chip with FlexBlue Chip without FlexBlue Chip Value HMOMedicare Plans:BlueChip Medicare (Lab Exclusion - Eastside Lab)Plan 65BlueChip for Medicare Advance - Specialists OnlyHealthmate for Medicare PPONon-Participating Products:BlueChip Direct Advance - New Product 1/1/18BlueChip for Medicare Advance - PCPsBlueChip for Medicare Advance replaces BlueChip for Medicare Select Effective 1.1.16WellSense Health Plan - BMC Healthnet PlanParticipating Products:MassHealth (This includes all new BMCHP Medicaid ACO Plans)MassHealth CarePlusConnectorCare Plan Types I, II, IIIQualified Health Plan (QHP) Silver WrapQualified Health Plan (QHP) Silver Non-WrapSenior Care Options (Effective 3/1/18)Special Kids Special Care Plan (SKSC)Non-Participating Products:Commercial Platinum, Gold or Bronze PlansCigna - Contracted as of 1/1/2021Participating Products:Cigna HMO/NetworkCigna Healthcare Seamless Network - New EnglandOpen Access Plus, OA plus, Choice Fund OA PlusOpen Access Plus, OA plus, Choice Fund OA Plus with CarelinkPPO, Choice Fund PPOLocalPlusNon-Participating Products:Connect Individual & Family Plan (IFPs)Commonwealth Care Alliance - Participating as of 1/1/2022Participating Provider as of 1/1/2022SCOOneCareMedicare AdvantageCommunity Care Cooperative (C3)Effective 3/1/2018:Not contracted but All Southcoast Hospitals and Specialists are accepting this plan.Referral and/or Auth will be required.FallonParticipating Products:
Southcoast Health NetworkHospitals and PhysiciansPlan and Product Participating Listas of June 2022Direct CareSelect CarePreferred Care (PPO )Tiered Choice - Tier 1Navicare Effective 1.1.17 - In Epic under Medicare Managed CareNon-Participating Products:Senior PlansMassHealth Plans or any of the new Medicaid ACO PlansSteward Community CareTiered Choice * Currently only offered in Berkshire, Hampden, Hampshire & Worcester counties
Southcoast Health NetworkHospitals and PhysiciansPlan and Product Participating Listas of June 2022Point32Health - Harvard PilgrimParticipating Products:National Plans:Harvard Pilgrim Access America PlansChoice and Choice Plus for Passport ConnectChoice Plus and Options PPO PlansStudent Insurance Plan PPO PlanHMO Plans:Harvard Pilgrim ChoiceNet Best Buy HMO PlanHarvard Pilgrim Choice Net HMOHarvard Pilgrim HMO & Best Buy HMO Plans with Focus Network OptionFocus Network - MAFocus Network - MA LimitedHarvard Pilgrim HMO PlanHarvard Pilgrim HMO Plan LPHarvard Pilgrim Hospital Prefer HMOHarvard Pilgrim Core Coverage HMOHarvard Pilgrim GIC Primary Choice Plan HMOHarvard Pilgrim Best Buy HMO PlanHarvard Pilgrim Best Buy HSA HMO PlanHarvard Pilgrim Tiered Copay HMOHarvard Pilgrim Non-Group HMO PlanNet Option HMONet Option - LP HMOPOS Plans:Harvard Pilgrim POS PlanHarvard Pilgrim GIC POS PlanPPO Plans:Choice Net PPOHarvard Pilgrim ChoiceNet Best Buy PPO PlanHarvard Pilgrim PPO PlanHarvard Pilgrim PPO LPHarvard Pilgrim Hospital Prefer PPOHarvard Pilgrim Best Buy PPO PlanHarvard Pilgrim Best Buy HSA PPOHarvard Pilgrim Commonwealth Choice PlansSenior Plans:Medicare Advantage Stride HMO - Moving to TMP HMO 1/1/2022Harvard Pilgrim Medicare Enhance PlanHarvard Pilgrim Medicare Supplement PlanPlans Adminstered by Health Plans, Inc:Health Plans, Inc.Employer Specific Plans:Health Plans, Inc. - Southcoast Health PlanAtrius Health SelectBIDMC Select HMOBIDMC Choice POSBMC Tiered HMOHP - Lahey Health Select HMOHPHC Plan for PartnersNorthstar Preferred CareDraper HMOReliant Select HMONon-Participating Products:New Hampshire Network HMOMaines ChoiceHP - Lahey Health Limited HMOBMC SelectElevate HealthStride of New Hampshire (HMO)Point32Health - Tufts Health Public PlansSouthcoast PCP's will accept Tufts Health Together if patient is willing to switch to BMCHP.Participating Products:Tufts Health Together (MassHealth) - Referral and/or Auth may be required for Hospital and Specialty ServicesTufts Health Direct (Connector Plans - see below for list of Plan Names)*Tufts Health Direct ConnectorCare Plan Type I*Tufts Health Direct ConnectorCare Plan Type II*Tufts Health Direct ConnectorCare Plan Type III*Tufts Health Direct Platinum Zero*Tufts Health Direct Platinum 500*Tufts Health Direct Gold 500*Tufts Health Direct Gold 1000*Tufts Health Direct Gold 1500*Tufts Health Direct Gold 2000*Tufts Health Direct Silver*Tufts Health Direct Bronze*Tufts Health Direct CatastrophicTufts Health Extend (Medical Security Program for Unemployed)Non-Participating Products:Choice PlanTufts Unify Plan (Dual eligible 21-64)
Southcoast Health NetworkHospitals and PhysiciansPlan and Product Participating Listas of June 2022Tufts Health RITogether/RI Medicaid THPP PlanPoint32Health - Tufts Health PlanParticipating Products:Standard Network Plans:HMO, POS, PPO, and EPO Basic, Value, and Premium PlansAdvantage HMO, and PPO, and SaverMedicare Complement PlanHealth Pact (RI) PlanTiered Provider Network Plans:Choice CopayYour Choice 2-Tier HMO, POS, PPO, and EPOYour Choice 3-Tier HMO, POS, PPO, and EPOLifespan Premier Choice 2 - Tier HMO, PPO, EPONavigator PPOGIC Plans:Navigator & Spirit (PPO, EPO)Medicare Plan:Tufts Health Plan Medicare PreferredTufts Health Plan Senior Care Options Effective 1.1.17National Network Plan:Carelink (MA and RI Plans)Limited Network Plans:Select HMO, EPO, and Advantage HMO SelectOther:Christie Student Health - Effective August 2015Non-Participating Products:Steward Community ChoiceTufts US Family - can accept patient if authorized by PayerMedicaidParticipating ProviderIndividual practices may have their own contract with the Plan.MedicareParticipating ProviderMultiplanContracted as of 6/1/2021 for Hospitals, Physicians, and VNA.This includes PHCSNeighborhood Health Plan of RISouthcoast Physicians Group (Specialists Only) - Includes Integrity PlanNo Hospital Contract or PCP ContractPartners HealthCare ChoiceEffective 3/1/2018:Not contracted but All Southcoast Hospitals and Specialists are accepting this plan.Referral and/or Auth will be required.Steward Health ChoiceEffective 3/1/2018:Not contracted but All Southcoast Hospitals and Specialists are accepting this plan.Referral and/or Auth will be required.TPAsParticipating ProviderPriority HealthGeneral Insurance Service CenterInnovative Health
Southcoast Health NetworkHospitals and PhysiciansPlan and Product Participating Listas of June 2022United HealthcareParticipating Products:UHC Options PPOUHC SelectUHC Select HMOUHC Select PlusUHC Charter/Charter BalancedUHC Charter HMOUHC Charter PlusUHC ChoiceUHC Choice EPOUHC Choice PlusThe Empire Plan - Effective 1/1/2021UHC Choice HMO/ Choice Plus HMOUHC All Savers PlansHarvard Pilgrim Options PPOHarvard Pilgrim ChoiceHarvard Pilgrim Choice PlusUHC CoreUHC Core EssentialUHC Core HMO/Core Essential HMOUHC Anchor Plans (for State of RI employees)UHC Heritage PlusUHC Heritage Select POS/HMO/EPOUHC Heritage Select AdvantageUHC Navigate PlusUHC Navigate/Navigate BalancedUHC Navigate HMO/Navigate Balanced HMO/Navigate Plus HMOUHC Navigate EPOUHC Passport Connect Options PPOUHC Passport Connect ChoiceUHC Passport Connect Choice PlusUHC Compass Plus (only if member holds an OPEN NETWORK PLAN - will pay to Choice Plus - otherwise non-contracted)UHC Compass/Compass Balanced (only if member holds an OPEN NETWORK PLAN - will pay to Choice Plus - otherwise noncontracted)UHC Compass HMO/Compass Balanced HMO/Compass Plus HMO (only if member holds an OPEN NETWORK PLAN - will pay to ChoicePlus - otherwise non-contracted)Medica Choice with United HealthCare Choice PlusAARP Medicare AdvantageUHC Medicare Advantage PlansUHC Nursing Home Plan PPO SNPUHC Senior Care Options HMO SNP (Evercare)United HealthOneUMRNon-Participating Products:UHC Oxford PlanUHC NHP HMO/POS/POS AccessUHC Definity HealthSignature Value PlansUHC MD IPA/MD IPA PreferredPacifiCare Signature Elite Plus (TX & OK only)Optimum Choice HMOOptimum Choice Preferred POSUHC Compass Plans - see above for "Open Network" plansMedicare SelectMedicare Advantage Private Fee-For-Service PlansRI Compass Plan (Exchange Plan effective 1.1.15)UHC RI Medicaid (Ritecare) Product of Community Plans - Termed 12/31/2019UHC Rhody Health Product of Community Plans - Termed 12/31/2019UnicareParticipating Products:Basic (Indemnity)Plus (PPO)Community Choice (PPO)
Open Access Plus, OA plus, Choice Fund OA Plus with Carelink PPO, Choice Fund PPO LocalPlus Non-Participating Products: Connect Individual & Family Plan (IFPs) Commonwealth Care Alliance - Participating as of 1/1/2022 Participating Provider as of 1/1/2022 SCO OneCare Medicare Advantage Community Care Cooperative (C3) Effective 3/1/2018:
