Insurance

Below is a current 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 HMO More >>

• 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
• HMO Blue
• 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 CARE-OUT.
• Value Options - Great West Healthcare Only - NOT ALL CLINICIANS ARE PARTICIPATING, MUST CALL TO VERIFY.
• Participate: 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

VMG 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.

Listed below, 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

Last Revised 10/17/06

FINANCIAL GUIDELINES FOR HEALTH CARE SERVICES

Thank you for choosing to receive your health care at Valley Medical Group. This document contains important information concerning financial responsibility for services received.

PLEASE PRESENT YOUR INSURANCE CARD AND BE PREPARED TO PAY YOUR COPAY AT EVERY VISIT

FINANCIAL RESPONSIBILITY

As a courtesy to you, we will bill your health insurance company directly in most cases. You will be responsible for payment of any co-payment or deductibles 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 at the time of your visit. To make payment arrangements, please contact our billing department at the telephone number below. If you receive a payment from your insurer directly for your care at Valley Medical Group, please make sure to remit that amount to our Billing Department promptly so that we may credit your account appropriately.

CO-PAYMENTS
Per your insurance guidelines, co-payments are due and payable at the time of your visit. We accept MasterCard, Visa, and Discover Card. If you pay by check and it is returned, a $15 service fee will be added to your account.

REFERRALS/SPECIALTY CARE
Your insurance plan may require that prior authorization be obtained for certain services in order to provide reimbursement. Please contact your insurance company for their referral requirements before receiving services. If your visit requires a referral, you are responsible for obtaining this referral through your primary care physician. A referral is not a guarantee of coverage so plese check with your insurer prior to receiving services.

NON-COVERED SERVICES
It is very important that you take the time to read and understand the information provided to you by your insurance company. Usually, most of this information is in your member handbook. 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 bill your insurance company and payment is denied for any valid reason, payment remains your responsibility.

WHERE TO GO IF YOU HAVE QUESTIONS
Our billing staff is available to help you with questions about our policies and your account balance. They can be reached Monday through Friday, 8:00 a.m. - 4:30 p.m. at 866-431-4077.

FOR QUESTIONS ABOUT YOUR INSURANCE POLICY & GUIDELINES, PLEASE CALL THE TELEPHONE NUMBER ON YOUR INSURANCE ID CARD.

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