Insurance Plan Information

Insurance Plan Information

Considering Your Health Plan Options

Swedish is included in many health insurance plans. Since plan coverage can change, check with your health insurance company for specific information.

If you are selecting a plan through the Health Insurance Exchange.  Make sure Swedish is included in the plan's network:

Health Insurance Exchange information

Medicare Advantage (Medicare Part C) information


Please note that medical professionals providing services at Swedish may or may not be contracted with the same insurance plans as the hospital.

This insurance acceptance information applies to all Swedish campuses, Swedish Medical Group clinics, Minor and James Medical, PET/CT Imaging, and First Hill Diagnostic Imaging, unless otherwise specified.

 

Aetna
Bridgespan
Amerigroup
Asuris
Beechstreet
BridgeSpan
Cigna
Community Health Plan of Washington
Coordinated Care
CorVel
Coventry/Firsthealth
First Choice Health Network
Greatwest Healthcare
Group Health Cooperative
Healthy Options/Washington Apple Health
Health Management Network
Holland American Cruise Lines
Humana
Interplan

Interlink Transplant Services
Labor & Industries
LifeWise Health Plan of Washington
Medicaid/Washington Apple Health
Medicaid Out of State
Medicare
Molina Healthcare
Multiplan/PHCS
New West Medicare
OptumHealth
PacifiCare
Premera Blue Cross
Regence Blue Shield
Soundpath Health
Three Rivers Provider Network
Tricare Prime Standard and Extra
United Healthcare (UHC)
Uniform Medical Plan
Veteran's Affairs (VA)
Veteran's Affairs VAPC3 Program (TriWest)

 


Aetna: All Aetna programs are accepted.

  • Aetna's Aexcel Network is comprised of a select number of specialties. As of January 1 2014, Swedish is designated for: general surgery, neurosurgery, obstetrics and gynecology, orthopedics, and vascular surgery. Minor and James is designated for gastroenterology, orthopedics, and otolaryngology Other Swedish and Minor and James groups are considered non-Aexcel providers. 

Amerigroup: Healthy Options/Washington Apple Health and Medicare Advantage plans are accepted.

Asuris: Contracted through Regence Blue Shield.

Beechstreet: Swedish is contracted with the Beechstreet network and accepts most third party administrators using this network.

BridgeSpan: Swedish is not contracted with BridgeSpan (an affiliate of Regence). An authorization from BridgeSpan is required for persons to be seen, otherwise the services will be applied to an out of network benefit.

Cigna: (including Greatwest Health, Seafarers Welfare Plan, NALC, and Masters Mates and Pilots) – All Cigna programs are accepted.  Acceptance does not include discount card programs.

Community Health Plan of Washington: Swedish accepts CHPW Healthy Options/Washington Apple Health and CHPW Medicare Advantage for specialty care only, including OBGYN. Swedish is not contracted for primary care. CHPW Community Health Essentials (Exchange plan) is accepted for primary and specialty care. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group in order to come to Swedish.

Coordinated Care: Healthy Options/Washington Apple Health and Ambetter (Exchange plan) are accepted.

CorVel: Swedish is contracted with this disability management PPO.

Coventry/Firsthealth: Most products are accepted.

First Choice Health Network: All products are accepted.

Greatwest Healthcare (now owned by Cigna): All GWHC products are accepted.

Group Health Cooperative: Options PPO and Access PPO are accepted. Options, Alliant Plus/Connect, and Clear Care PPO are accepted with an authorization from GHC, otherwise they will be applied to an out of network benefit. Other GHC products are not accepted.  SMG Pine Lake accepts all GHC products.  

Healthy Options/Washington Apple Health: Swedish accepts Molina, Coordinated Care, Amerigroup, United Healthcare, and, for specialty providers only, Community Health Plan of Washington as providers for the Medicaid Managed Care plans Healthy Options, Washington Apple Health, and Children’s Health Program (CHIP). Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group in order to come to Swedish.

Health Management Network (HMN): Swedish is contracted with this PPO.

Holland American Cruise Lines: Swedish is contracted with Holland America for services related to the Maritime Medical Act.

Humana: All Humana programs are accepted, including Medicare replacements (Choice and Gold) and commercial plans through the Choicecare Network. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group in order to come to Swedish.

Interplan (now Healthsmart): Most products are accepted.

Interlink Transplant Services: Transplant related services only.

Labor and Industry: L&I is accepted, including self-insured L&I carriers.

LifeWise Health Plan of Washington: Plans using the LifeWise Preferred and LifeWise Assurance Company LifeWise AC network are accepted at all locations.
 
Plans using the LifeWise Connect network are in-network at Swedish Edmonds (most facilities and clinics), Edmonds Birth and Family, Ballinger Primary Care, Children’s Clinic Edmonds, Mill Creek Primary Care, and Swedish Heart and Vascular Edmonds and Stevens Pavilion locations only. All other Swedish locations are considered out-of-network with LifeWise Connect. An authorization from LifeWise is required for persons to be seen, otherwise the services be applied to an out-of-network benefit.

Medicaid/Washington Apple Health: Swedish is contracted with Washington State Medicaid, although zip codes residential zip code restrictions may apply at some primary care locations.

Medicaid Out of State: Swedish will accept specialty care referrals for out-of-state patients with Medicaid. Patients referred with out-of-state Medicaid MUST have approval from their out-of-state Medicaid plan. If there is no approval, the services will not be paid. Note: Out-of-state Medicaid patients may not establish in primary care.

Medicare: Swedish accepts original Medicare.  

Molina Healthcare: Healthy Options/Washington Apple Health, Medicare Advantage plans, and Molina “Marketplace” (Exchange plan) are accepted. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group in order to come to Swedish.

Multiplan/PHCS: All Multiplan/PHCS programs are accepted.  Acceptance does not include discount card programs.

New West Medicare: Not contracted.

OptumHealth: Transplant related services only.  Optum is a division of United Healthcare.

PacifiCare (now UnitedHealthcare West):  Swedish accepts all commercial and Medicare replacement programs.

Premera Blue Cross:All Swedish locations are in-network with the following Premera networks:

  • Premera Heritage and Heritage Plus 1
  • Premera Foundation and Foundation Plus 1
  • Premera Global
  • Premera Medicare Advantage

Plans using the Premera Heritage Signature and Premera Heritage Prime networks are in-network at Swedish Edmonds (most facilities and clinics),Edmonds Birth and Family,Ballinger Primary Care, Children's Clinic Edmonds,Mill Creek Primary Care,and Swedish Heart and Vascular Edmonds and Stevens Pavilion locations only. All other Swedish locations are considered out-of-network with Premera Heritage Signature and Premera Heritage Prime. An authorization from Premera is required for persons to be seen, otherwise the services be applied to an out-of-network benefit.


Private Healthcare Systems (PHCS)/Multiplan: All Multiplan/PHCS programs are accepted.  Acceptance does not include discount card programs.

Regence Blue Shield: Swedish accepts all Regence Blue Shield plans including Blue Cross/Blue Shield out-of-state and Asuris, with the exception of Regence Medicare Advantage BlueAdvantage HMO.

Soundpath Health (formerly Puget Sound Health Partners): Swedish is contracted with Soundpath.  Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group in order to come to Swedish.

Three Rivers Provider Network: Swedish is not contracted with TRPN, but will bill as a courtesy.

TRICARE: Swedish accepts TRICARE (Prime, Standard, and Extra). Zip code restrictions may apply for primary care locations. TRICARE for Life is billed secondary to Medicare and does not require a contract.

United Healthcare (UHC): Swedish accepts most United Healthcare products.  Including plans branded through Oxford Healthcare, AARP Medicare Complete, Goldenrule and plans FKA PacifiCare, Secure Horizons, and Evercare. Swedish is contracted with United Healthcare Community Plan Healthy Options/Washington Apple Health. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group in order to come to Swedish.

Uniform Medical Plan (now part of Regence Blue Shield): Swedish is contracted.

Veteran’s Affairs (VA): To have the US Department of Veterans Affairs pay for services, Veterans’ benefit recipients are required to receive care at a VA facility or have the VA authorize services at a non-VA facility (Swedish is a non-VA facility). The VA will also pay in case of an emergency.

Veterans Affairs Patient-Centered Community Care (VAPC3)/TriWest: VAPC3 program members require an authorization from VAPC3/TriWest to receive care at Swedish.
 

Behavioral Health Networks

Some plans use other companies for Mental Health and Chemical Dependency claims.  Swedish is contracted with these plans:

  • Aetna Health Management
  • Cigna Behavioral Health
  • Cenpatico (Coordinated Care)
  • Health Systems International (Intercontinental)
  • Humana (LifeSynch)
  • Managed Health Network (MHN)
  • Optum Health (TRICARE only)
  • Wellpoint Behavioral Health.

Swedish does not contract with, but will still bill:

  • ValueOptions
  • Optum Health

2014 Health Insurance Exchange Plans

Bridgespan:Swedish is not contracted with BridgeSpan (an affiliate of Regence). An authorization from BridgeSpan is required for persons to be seen, otherwise the services be applied to an out of network benefit. 

Community Health Plan of Washington (uses the First Choice Health Network): Swedish accepts the Community Health Plan of Washington Exchange plan which is using the First Choice Health Network for primary and specialty care.

Coordinated Care: Swedish accepts the Coordinated Care Ambetter Exchange plan.

Group Health Cooperative: Swedish is not contracted with Group Health Cooperative (GHC). An authorization from GHC is required for persons to be seen. SMG Pine Lake accepts all GHC products. 

LifeWise Health Plan of Washington (using the LifeWise Connect Network):Plans using the LifeWise Connect network are in-network at Swedish Edmonds (most facilities and clinics), Edmonds Birth and Family, Ballinger Primary Care, Children’s Clinic Edmonds, Mill Creek Primary Care, and Swedish Heart and Vascular Edmonds and Stevens Pavilion locations only. All other Swedish locations are considered out-of-network with LifeWise Connect. An authorization from LifeWise is required for persons to be seen, otherwise the services be applied to an out-of-network benefit.

Molina: Swedish accepts the Molina Marketplace Exchange plan.

Premera Blue Cross (using the Premera Heritage Signature Network):Plans using the Premera Heritage Signature network are in-network at Swedish Edmonds (most facilities and clinics), Edmonds Birth and Family, Ballinger Primary Care, Children’s Clinic Edmonds, Mill Creek Primary Care, and Swedish Heart and Vascular Edmonds and Stevens Pavilion locations only. All other Swedish locations are considered out-of-network with Premera Heritage Signature. An authorization from Premera is required for persons to be seen, otherwise the services be applied to an out-of-network benefit.


Updated on July 24, 2014

 

 

Health Insurance Questions?  We’re Happy to Help.

Get in touch with the Swedish Customer Service Line:

Call us at 206-701-7771 between 8 a.m.-6 p.m. Mondays through Fridays.


Free Help Sessions

Free hands-on assistance is available for those signing up for a new plan through the Health Benefit Exchange.
Make an appointment to come in for assistance by calling Swedish at 206-386-6996 between 8:30 a.m. and 4:30 p.m. Monday through Friday.