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 open enrollment ends on March 31, 2014. 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
Basic Health Plan
Beechstreet
Cigna
Community Health Plan of Washington
Coordinated Care
CorVel
Coventry/Firsthealth
First Choice Health Network
Greatwest Healthcare
Group Health Cooperative
Healthy Options
Health Management Network
Holland American Cruise Lines
Humana
Interplan
Interlink Transplant Services
Labor & Industries
Lifewise

Medicaid
Medicaid Out of State
Molina Healthcare
Multiplan/PHCS
New West Medicare
OptumHealth
PacifiCare
PPONext
Premera Blue Cross
Premera Blue Cross (Medicare Advantage)
Premera Blue Cross (Health Exchange)
Regence Blue Shield
Regence Blue Shield (Medicare Advantage)
Regence Blue Shield (Health Exchange)
Soundpath Health
Three Rivers Provider Network
Tricare Prime Standard and Extra
United Healthcare (UHC)
Uniform Medical Plan
Veteran's Administration

 


Aetna: All Aetna programs are accepted.
• Aetna's Aexcel Network is comprised of select number of specialties.  As of January 1 2013, Swedish is designated for cardiology, gastroenterology, general surgery, obstetrics and gynecology, & orthopedics.  Other Swedish groups are considered non-Aexcel providers

Amerigroup: The Basic Health Plan and Healthy Options are accepted.

Asuris: Contracted through Regence Blue Shield.

Basic Health Plan: Swedish accepts Amerigroup, Molina, Coordinated Care, United Healthcare and, for specialty providers only, Community Health Plan of Washington as providers for the Washington State Basic Health Plan.

Beechstreet: Swedish is contracted with the Beechstreet network and accepts most Third Party Administrators using this network. (Contract is not direct – it is through First Choice Health Network).

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 for specialty care only, including OBGYN.  Swedish is not contracted for primary care. Swedish does not accept the Washington Health Program or the GAU/Direct Line/Medical Care Services program.  Minor and James Medical accepts all CHPW products for specialty care only.

Coordinated Care: The Basic Health Plan and Healthy Options 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 is accepted.  Options, Alliant Plus, 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: Swedish accepts Molina, Coordinated Care, Amerigroup, United Healthcare, and, for specialty providers only, Community Health Plan of Washington as providers for the Medicaid replacement plans Healthy Options and Children’s Health Program (CHIP). 

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.

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.

Medicaid: 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.

Molina Healthcare: Swedish accepts Molina Healthcare.  Patients assigned to an Independent Physician Organization (IPO) may require special authorizations.

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.

PPONext (Concentra): Swedish accepts this PPO through our contract with the Beechstreet Network.

Premera Blue Cross: In 2014, Swedish is not contracted with Premera’s Heritage Signature, Heritage Prime, or LifeWise’s Connect network (with the exception of Swedish Edmonds).

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 Real Value.

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 Prime Standard and Extra: Swedish accepts Tricare plans.  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 and the Basic Health Plan. 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 Administration (VA) Federal Program: Veterans Administration recipients are required by the VA to receive care within the Veterans Administration.  However, if a fee service authorization is issued by the VA (or in event of an emergency) Swedish can treat VA patients and bill the VA.

Accepted 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)
• Managed Health Network (MHN)
• Wellpoint Behavioral Health.

Swedish does not contract with, but will still bill:

• ValueOptions
• Optum Health

 

 

2014 Health Insurance Exchange Plans

Health Benefit Exchange Plan

In-Network for Swedish?

Bridgespan Health

Swedish is not contracted witih Bridgespan at this time.

Community Health Plan of Washington - "Community HealthEssentials"

Yes, all locations are in-network.

Coordinated Care "Ambetter"

Yes, all locations are in-network.

Group Health Cooperative

Only Swedish Pine Lake Primary Care is in-network.

LifeWise Healthplan of Washington (using the LifeWise Connect Network)

Only Swedish Edmonds is in-network.*

Swedish remains in-network with most other LifeWise networks, including LifeWise Preferred.

Molina Healthcare "Marketplace"

Yes, all locations are in-network.

Premera Blue Cross (using the Premera Heritage Signature Network)

Only Swedish Edmonds is in-network.*

Swedish remains in-network with most other Premera networks, including: Premera Heritage, Premera Foundation, Premera Global, and Premera Medicare Advantage. 


* Premera and LifeWise are offering plans on the Health Benefit Exchange that utilize newly created medical networks that are different than the networks offered on many other plans. Swedish is out-of-network with some newly created networks, including: Premera Heritage Signature, Premera Heritage Prime, and LifeWise Connect.

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. NOTE: Regence plans not sold through the exchange do include Swedish.

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 (using the LifeWise Connect Network): Swedish is not contracted with the LifeWise Connect network (LifeWise is a subsidiary of Premera). An authorization from LifeWise is required for persons to be seen, otherwise the services be applied to an out of network benefit. Swedish Edmonds is participating with the LifeWise Connect network.

Molina: Swedish accepts the Molina Marketplace Exchange plan.

Premera Blue Cross (using the Premera Heritage Signature Network): Swedish is not contracted with the Premera Heritage Signature network. An authorization from Premera is required for persons to be seen, otherwise the services be applied to an out of network benefit. Swedish Edmonds is participating with the Premera Heritage Signature network. In addition, Swedish is not contracted with Premera’s Heritage Prime network (with the exception of Swedish Edmonds). If you mostly receive care at our Swedish Edmonds campus, then you can also choose a plan from Premera, but this is for “in network” coverage at Swedish Edmonds only.

 

 

2014 Medicare Advantage Plans

For plans accepted by Swedish Medical Group and more information, click here.

Amerigroup: Swedish accepts Amerigroup Medicare Advantage.

Community Health Plan of Washington: Swedish accepts Community Health Plan of Washington Medicare Advantage for specialty care only.

Group Health Cooperative: Swedish is not contracted with Group Health Cooperative Medicare Advantage Clear Care HMO. Swedish accepts Clear Care PPO with an authorization from GHC. SMG Pine Lake accepts all GHC products. 

Humana: Swedish accepts all Humana Medicare Advantage plans. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group.

Molina: Swedish accepts all Molina Medicare Advantage plans. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group.

Premera Blue Cross: Swedish accepts all Premera Medicare Advantage plans.

Regence Blue Shield: Swedish accepts Regence MedAdvantage PPO. Swedish is not contracted with Regence BlueAdvantage HMO. The Minor and James ambulatory surgery center is not contracted.

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.

United Healthcare: Swedish accepts all United Healthcare Medicare Advantage plans. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group.

 

 

Updated on November 13, 2013

 

 

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.