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Plan Types
Accepted Insurance

Below is a listing of insurance plans accepted by Valley Medical Group, P.C. If you do not see your plan or insurer on the list, please contact our Billing Department to inquire further before obtaining services. You may reach our Billing Department at 866-431-4077.

HMO Plans:

  • Aetna
  • Blue Cross Blue Shield of Massachusetts
    HMO BLUE and all Blue Shield HMO Products
    Blue Care 65, Medicare HMO Blue, Medicare Advantage
  • Cigna Health Plan
  • Connecticare - Only Gatekeeper and Open Access HMO plan
    Does not include eyecare.
  • Great West Health Care (formerly One Health Plan)
  • Harvard Pilgrim Health Care
  • Health New England
    Medicare Advantage Plans
  • Masshealth
    PCCP plan
    Boston Medical Center Healthnet
    Commonhealth
    Healthy Start - Behavioral Health - Psychiatrists only
  • One Health Plan (see Great West Health Care)
  • Tufts Health Plan
    Medicare Preferred PPO
  • United Healthcare

Indemnity Plans:

  • AARP
  • Aetna
  • Blue Cross/Blue Shield (i.e. Major Medical plan)
  • GIC I
  • Guardian
  • John Hancock
  • Mass Health
    Standard Plan - Behavioral Health - Psychiatrists only
  • Medicare
  • Medex
  • Unicare
  • United Health Care

All Traditional Indemnity Plans
Traditional indemnity plans do not require you to be seen by a participating provider. You have the option to go to any practitioner of your choice. However, you are typically responsible for a percentage of the charges.

Point of Service (POS) Plans and PPOs:

  • Aetna
  • Atlantic
  • Blue Cross Blue Shield of MA - Medicare PPO Blue
    Eye Care - Routine only for PPO plans. - BC65 - Sick visits, patient must see Ophthalmologist
    Federal members cannot be seen for Routine
  • CCN - part of Healthcare Value Management (HCVM)
  • Champus/Tricare - Standard plan only - VMG listed as Certified Out-of-network provider. Patient will have a higher out of pocket expense.
  • Cigna
  • Connecticare
  • Consolidated Health Plan (CHP)
  • First Health Network (see Healthcare Value Management)
  • GIC - Unicare
  • Harvard Pilgrim Health Care
  • Healthcare Value Management (HCVM)
    CDH is not a participating Hospital in this plan
  • Health New England
  • HMC PPO
  • Meritain Health - N.A. Administrators/Preferred - Beech St. Corp.
  • Northeast Health Direct
  • PHCS (Private Healthcare Systems) - PPO plan only 
    American LIFECARE part of PHCS effective 3/1/05
  • Pioneer
  • Tufts - CIGNA - CareLink
  • United Healthcare
  • HCVM; HMC PPO, PHCS, and TRPN, and consolidated health plan are a conglomerate network of a group of insurance carriers. The network logo must be on the card. 

Behavioral Healthcare Plans:

  • Aetna PPO Behavioral Health
  • Cigna Behavioral Health
  • Magellan Behavioral Health
    HMO Blue New England
    Blue Choice New England
  • Network Blue New England
  • BCBSMA  
  • Blue Choice plan 1 aqnd 2
  • Network Blue
  • Aetna/USH
    Does not include Verizon and N.E. Utilities members
  • Medicare
  • Merit Behavioral Health
  • MHNet - Mental Health Network (formerly Integra) - PPO Contract Only
  • PacifiCare Behavioral Health Inc. - HPHC, Health Plans Inc. (HPI)
  • Tricare MH Benefits
  • United Behavioral Health (UBH)
    Connecticare
  • GIC Indemnity and Indemnity Plus plans
    Commonwealth Tufts PPO
    Verizon employees (BCBSMA)
    Fleet employees
    If patient is employed with any other employers or medical benefits with Tufts Health Plan (HMO), UBH must be contacted to verify if UBH is the behavioral health carve-out.
  • Value Options - Great West Healthcare Only - Not all clinicians are participating, must call to verify.
    Participating: K. Dezenzo; F. Fassler; D. Friedenson; L. Hall; G. Kriebel; J. McKelvey; K. Rosenbaum; and B. Saco-Laurens
    Not Participating: J. Feinman; S. Gesuelle-Hart; E. Forman; R. Hincks; J. McCarthy-Lenz; J. Schwartz

Check the back of the card for behavioral health services.

Eye Care Carve Outs:

  • Davis Vision - Blue Care 65
  • Davis Vision - BCBSMA PPO

Valley Medical Group recognizes that insurance coverage can be complicated and confusing. The plans and insurance carriers listed above are subject to change and your individual benefits may change or your coverage may be limited by your plan, insurer, or employer.

If you have a question about your individual insurance benefit, please contact your insurance company. Since you are ultimately responsible for payment for services, it is important that you are aware of your benefits. Please see the Financial Guidelines for Health Care Services section below for more information.

Listed here, for your convenience, are the phone numbers for the major health plan Member Services departments. If your insurance is not listed below, look on your member card or contact your employer for this information.

  • Blue Cross Blue Shield of Massachusetts: 800-486-1136
  • Tufts Affiliated Health Plans - HMO: 800-843-1008;  PPO: 800-423-8080
  • Harvard Pilgrim Health Care: 800-421-3550
  • Health New England: 800-842-4464
  • Pioneer: 800-423-4586
Patient Financial Guidelines for Health Care Services

Thank you for choosing to receive your health care at our medical office. This document contains important information about your financial responsibility for services you receive. We want you to be informed about the costs of care and your obligations. Please be sure to contact our office and ask any questions you may have.

TO AVOID ERRORS AND TO HELP US SERVE YOU BETTER
PLEASE BE SURE TO PRESENT YOUR INSURANCE CARD AT EVERY VISIT

Financial Responsibility
You are responsible for payment of any co-payment, deductable, or coinsurance required by your insurance plan. If your insurance company denies or delays payment, we will bill you directly. If you do not have medical insurance, you are expected to pay for all services at the time of your visit. We accept MasterCard, Visa and Discover Card. We also accept personal checks. If you pay by check and your check is returned, it will be necessary to charge a $15 handling fee to cover our costs with the banks.

Co-Payments
Co-payments, co-insurances, known deductable amounts and all other balances on your account are due at the time of your visit. If absolutely necessary, we can make arrangements for a reasonable payment plan over a short term period of time. Please contact our Billing Department.

Custodial/Divorce Situations
In situations where a custodial for divorce/separation agreement calls for "split responsibility" for payment for medical services, we bill the full amount due to that person presenting for the services. If that person is a child, the parent/guardian bringing the child is expected to pay for services.

Referrals/Specialty Care
You insurance plan may require that prior authorization be obtained for certain services. Please contact you insurance company to see if there are any referral requirements before receiving services from us. If it's required, you are responsible for obtaining the referral from your plan or primary care physician. Please remember that a referral is not a guarantee of coverage by your health plan.

Non-Covered Services
All insurance companies have limits on the services they cover and it is extremely important that you know your membership eligibility, benefits, limitations and exclusions under your specific plan. If we do not participate with your insurance plan we will submit a bill to your carrier as a courtesy. However the financial obligation remains your responsibility. If we bill your insurance and payment is denied for any reason, payment remains your responsibility.

Where to Go if You Have Questions
Our Billing Staff is available to help you if you have any questions regarding our policies or your account. To reach a Billing staff member, please call (866) 431-4077, Monday-Friday, 8:00am-4:40pm.

I authorize payment of medical benefits to Valley Medical Group, P.C. for services received (including government benefits). I consent to and authorize Valley Medical Group, P.C. to use and disclose any of my health information, including my medical records, for purposes concerning payment for health care services provided to me.

FOR QUESTIONS REGARDING YOUR INSURANCE POLICY AND HEALTH PLAN, PLEASE CALL THE TELEPHONE NUMBER ON YOU INSURANCE/ID CARD

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Who/What/Where More Information
Copyright © 2013 by Valley Medical Group. All rights reserved.  |  Amherst: 413.256.8561  |  Easthampton: 413.529.9300  |  Greenfield: 413.774.6301  |  Northampton: 413.586.8400