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:

2017 Medicare Advantage Plans

2017 Washington Health Benefit Exchange Plans


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, and PET/CT Imaging, unless otherwise specified.


 

Aetna: Swedish Medical Group clinics, and Swedish Ballard, Cherry Hill, Edmonds and First Hill hospitals are in-network with all Aetna networks, with the exception of certain Aetna Whole Health plans. Swedish Issaquah hospital is out-of-network with Aetna Medicare Advantage PPO, as well as certain Aetna Whole Health plans.

  • Aetna Whole Health, Providence Swedish Health Alliance – in-network for primary and specialty care
  • Aetna Whole Health, Polyclinic – in-network for specialty care only
  • Aetna Whole Health, Pacific Medical Center – in-network for specialty care only
  • Aetna Whole Health, Rainier Health Network – out-of-network for all services

Aetna's Aexcel Network is comprised of a select number of specialties. Aetna’s Aexcel Network is comprised of a select number of specialties. Swedish groups are considered non-Aexcel providers.

Amerigroup: Healthy Options/Washington Apple Health and Medicare Advantage plans are accepted.Patients assigned to an Independent Practice Association (IPA) may require a special authorization from that group in order to come to Swedish.

Asuris: Contracted through Regence Blue Shield.

Blue Cross Blue Shield (BCBS) Out-of-state
Swedish is in-network with most Blue Cross Blue Shield out-of-state plans.

Boeing Blue Cross Blue Shield (BCBS)
Swedish is in-network with all Boeing BCBS plans, with the exception of plans using the UW Accountable Care Network.

BridgeSpan: Swedish is in-network with the BridgeSpanProvidence-Swedish Health network plan. Swedish is out-of-network with all other BridgeSpan plans.

Cigna:  Swedish is in-network with the Cigna PPO network (including Great West Health-GWH). 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. 

Swedish is in-network for primary and specialty care with the Community Health Plan of Washington Exchange plan which uses the First Choice Health network.

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): ): Swedish is in-network with the Cigna PPO network.

Healthsmart (formerly Interplan). Most plans are in-network.

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: Swedish is in-network with the following Humana plans:

  • Humana Choice PPO (Medicare Advantage)
  • Humana Gold Plus HMO (Medicare Advantage)
  • Plans using the Humana commercial network (including the Choice Care Network)
  • Humana Medicare supplement plans

Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group in order to come to Swedish.

Interlink Transplant Services: Transplant related services only.

Kaiser Foundation Healthplan of Washington (formerly Group Health Cooperative): 

  • Swedish is in-network with Options PPO, Access PPO, and Omni PPO. 
  • Options and Alliant Plus/Connect are in-network with an authorization from Kaiser, otherwise charges will be applied to an out-of-network benefit. 
  • Core, Alliance, and Medicare Advantage HMO products are in-network with an authorization from Kaiser. 
  • Elect PPO is in-network with Swedish hospitals, but out-of-network with Swedish physicians. 
  • Swedish Pine Lake is in-network with all Kaiser Foundation Healthplan of Washington products.

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

LifeWise Health Plan of Washington: Effective Jan. 1, 2017, all Swedish locations are considered out-of-network for LifeWise Connect (the network used for Exchange plans). However, all locations will remain in-network for the LifeWise Preferred network.  Learn more.

Medicaid Fee for-service/Washington Apple Health: ): Swedish accepts Washington State Medicaid fee-for-service, although zip codes residential restrictions may apply at some primary care locations.

Medicaid Managed Care (Washington Apple Health) and Children’s Health Program (CHIP): Swedish accepts Molina, Coordinated Care, Amerigroup, United Healthcare, and, for specialty providers only, Community Health Plan of Washington. Patients assigned to an Independent Practice Association (IPA) may require a special authorization from that group in order to come to Swedish.

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. Please note: out-of-state Medicaid patients may not establish in primary care.

Medicare: Swedish accepts original Medicare.

Molina Healthcare: Medicaid/Healthy Options (Washington Apple Health), Medicare Advantage, and Molina “Marketplace” (Exchange plan) are in-network. Patients assigned to an Independent Practice Association (IPA) may require a special authorization from that group in order to come to Swedish.

Multiplan/PHCS: Swedish is in-network with Multiplan/PHCS.  Acceptance does not include discount card programs.

New West Medicare: Swedish is out-of-network.

OptumHealth: Transplant related services only.  For information on Optum Health Behavioral Solutions, please reference the Behavioral Health Networks section.

Premera Blue Cross : 

Swedish is considered in-network with the following Premera networks:
  • Premera Foundation and Foundation Plus 1
  • Premera Heritage and Heritage Plus 1
  • Premera Global
  • Premera Medicare Advantage
  • Premera Medicare Supplement
Effective Jan 1, 2017, Swedish is considered out-of-network with the following Premera networks.  Learn more
  • Premera Heritage Prime (includes WEA Easy Choice B and WEA Basic Plan)
  • Premera Heritage Signature
  • All Premera Personal Care Partner networks

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

Regence Blue Shield: Swedish is in-network with with all Regence networks, with the exception of:

  • UW Medicine
  • EvergreenHealth Partners-Virginia Mason
  • The Everett Clinic
  • Multicare
  • Peacehealth
  • UMP Plus – PSHVN
  • UMP Plus – UW Medicine ACN
  • Regence BlueAdvantage HMO (Medicare Advantage)

Soundpath Health: Swedish is in-network with Soundpath Health.  Patients assigned to an Independent Physician Association (IPA) may require a special authorization from that group in order to come to Swedish.

Three Rivers Provider Network: Swedish is out-of-network 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) and United Healthcare West (formerly PacfiCare): Swedish is in-network with most UHC products. Including most plans branded through Oxford Healthcare, AARP Medicare Complete, and Goldenrule. However, Swedish is out-of-network with UHC Charter. 

Swedish is in-network with United Healthcare Community Plan Healthy Options/Washington Apple Health. Patients assigned to an Independent Practice Association (IPA) may require special authorizations from that group in order to come to Swedish.

Uniform Medical Plan (administered by Regence Blue Shield): Swedish is in-network with UMP PPO. Swedish is out-of-network with UMP Plus – PSHVN and UMP Plus – UW Medicine AHN.

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 the case of an emergency.

Veterans Affairs Patient-Centered Community Care (VAPC3) and Veterans Choice (administered by TriWest): VAPC3 and Veterans Choice program members require an authorization from 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)
  • Optum Health Behavioral Solutions
  • Wellpoint Behavioral Health
  • Value Options

Swedish does not contract with, but will still bill:

  • Managed Health Network (MHNet) 

2017 Medicare Advantage Plans

Amerigroup: Swedish is in-network with Amerigroup Medicare Advantage. 

Community Health Plan of Washington: Swedish is in-network with Community Health Plan of Washington Medicare Advantage for specialty care only. 

Humana: Swedish is in-network with the following Humana plans:
  • Humana Choice PPO (Medicare Advantage)
  • Humana Gold Plus HMO (Medicare Advantage)
Patients assigned to an Independent Practice Association (IPA) may require a special authorization from that group in order to come to Swedish.

Molina: Swedish is in-network with all Molina Medicare Advantage plans. Patients assigned to an Independent Practice Association (IPA) may require a special authorization from that group in order to come to Swedish.

Premera Blue Cross: Swedish is in-network with all Premera Medicare Advantage plans.

Regence Blue Shield: Swedish is in-network with Regence MedAdvantage PPO. Swedish is out-of-network with Regence BlueAdvantage HMO.

Soundpath Health: Swedish is in-network with Soundpath Health. Patients assigned to an Independent Practice Association (IPA) may require a special authorization from that group in order to come to Swedish.

United Healthcare: Swedish is in-network with all United Healthcare Medicare Advantage plans. Patients assigned to an Independent Practice Association (IPA) may require a special authorization from that group in order to come to Swedish.


2017 Health Benefit Exchange Plans

BridgeSpan Health: Swedish is in-network with the BridgeSpanProvidence-Swedish Health network plan. Swedish is out-of-network will all other BridgeSpan plans.

Community Health Plan of Washington (uses the First Choice Health network): Swedish is in-network with the Community Health Plan of Washington Exchange plan which uses the First Choice Health network.

Coordinated Care: Swedish is in-network with the Coordinated Ambetter Exchange plan.

Group Health Cooperative (GHC): Swedish is out-of-network with all GHC Exchange plans, unless an authorization has been obtained from GHC to come to Swedish. Swedish Medical Group Pine Lake accepts all GHC products.

LifeWise Health Plan of Washington: Swedish is considered out-of-network for all LifeWise plans offered on the Exchange. Learn more

Molina: Swedish is in-network with the Molina Marketplace Exchange plan.

Premera Blue Cross: Swedish is considered out-of-network for all Premera plans offered on the Exchange. Learn more.

Regence Blue Shield: Swedish is in-network with the Regence Providence-Swedish Health network plan. Swedish is out-of-network will all other Regence plans offered on the Exchange.