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:

2015 Medicare Advantage Plans

Medicare Advantage (Medicare Part C) information

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, 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
2015 Exchange Plans
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
2015 Medicare Advantage
   Plans

Molina Healthcare
Moda Health Plan
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 Health (an affiliate of Regence). An authorization from BridgeSpan is required for patients 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. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group in order to come to Swedish. 

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): All GWHC products are accepted.

Group Health Cooperative (GHC): 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. 

Swedish is not contracted with the Group Health Cooperative Exchange plan. An authorization from GHC is required for patients to be seen. Swedish Medical Group 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. 

  • In 2015, Swedish is considered out-of-network with Humana Community HMO Medicare Advantage plan. All other Humana plans will continue to be accepted.

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, Swedish OB/GYN Specialists-Edmonds, 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 patients to be seen, otherwise the services will be applied to an out-of-network benefit.

  • Effective Jan. 1, 2015, Swedish is in-network with all LifeWise networks and plans. Including the LifeWise Connect network and the LifeWise plans offered through the Exchange.

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.

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

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 CareSwedish OB/GYN Specialists-Edmonds, 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 patients to be seen, otherwise the services be applied to an out-of-network benefit.

  • Premera Blue Cross (uses the Premera Heritage Signature network): Effective Jan. 1, 2015, Swedish is in-network with all Premera networks and plans. Including the Premera Heritage Signature network and the Premera plans offered on the Exchange.

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.

  • In 2015, Swedish is considered out-of-network with Regence ActiveCare and Regence Medicare Advantage BlueAdvantage HMO.

Soundpath Health: 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 the 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
 

2015 Medicare Advantage Plans

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 HMO plans. Swedish accepts Group Health Cooperative Medicare Advantage PPO plans with an authorization from GHC. SMG Pine Lake accepts all GHC products.  

Humana: Swedish accepts all Humana Medicare Advantage plans with the exception of Humana Community HMO. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group in order to come to Swedish.

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

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.

Soundpath Health: 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 in order to come to Swedish.
 

2015 Health Benefit Exchange Plans

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

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: Swedish is not contracted with the Group Health Cooperative (GHC) Exchange plan. An authorization from GHC is required for patients to be seen. Swedish Medical Group Pine Lake clinic accepts all GHC products.

LifeWise (uses the LifeWise Connect network): Effective Jan. 1, 2015, Swedish is in-network with all LifeWise networks and plans. Including the LifeWise Connect network and the LifeWise plans offered on the Exchange.

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

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

Premera Blue Cross (uses the Premera Heritage Signature network): Effective Jan. 1, 2015, Swedish is in-network with all Premera networks and plans. Including the Premera Heritage Signature network and the Premera plans offered on the Exchange.

Health Insurance Questions?  We’re Happy to Help.

Get in touch with the Swedish Customer Service Line at 206-701-7771 between 8 a.m.-6 p.m. Mondays through Fridays (except some holidays.)


Free Help Sessions

Drop in enrollment sessions are being held at Swedish to assist those signing up for a new plan (or renewing one) through the Health Benefit Exchange.

  • Wednesday, Dec. 3, 11 a.m.-6 p.m., Swedish Mill Creek
  • Tuesday, Dec. 17, 11 a.m.-6p.m., Swedish Cherry Hill

If you can't attend, then make an appointment to come in for assistance. Call Swedish at 206-386-6996 between 8:30 a.m. and 4:30 p.m. Monday through Friday.