How to Make Sure Your Health Plan Includes Swedish

How to Make Sure Your Health Plan Includes Swedish

With the Affordable Care Act, and all the changes taking place in health insurance, it can get a little confusing about how to choose a new plan — or if you even need to choose one. So we’d like to explain your choices, and let you know what to do to continue to receive care at Swedish with the best possible insurance benefits.

Do I need to choose a new health insurance plan?

If I need a new plan, when do I have to choose it?

How do I make sure my care at Swedish is covered?

Who are the insurance companies that include Swedish?

What if my insurance company doesn’t include Swedish?

Why isn’t Swedish included in some of the new plans?

Why is it important to choose a plan that includes Swedish?
If you’re a current Swedish patient, be sure to read this section.

What if I want to receive care at Minor & James Medical (a Swedish health partner)?

What if I have more questions?

 


Do I need to choose a new health insurance plan?

If you fall into one of these groups, you may need to choose a new health insurance plan:

  1. You don’t currently have health insurance
  2.  You have an individual plan, but your insurance company is ending that plan
  3. You’re insured under your spouse’s plan provided by his or her employer, but spouses won’t be covered in the future

If you currently have a health insurance plan through your work (known as a group plan), or if you’re on Medicare, there will likely be no major changes to your coverage, and you shouldn’t need to take any action.

If you have more questions, please give our Customer Service Line a call at 206-701-7771 between 8 a.m. and 6 p.m. Mondays through Fridays.

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If I need a new plan, when do I have to choose it?

For Those Who Currently Have An Individual Plan

The Affordable Care Act (ACA) says that all insurance plans need to meet certain minimum requirements. For instance, health plans are required to cover you even if you have a medical condition at the time you sign up for coverage. Also, preventative care, prescription drugs, maternity care, and more now have to be covered on all plans.

If you currently have an individual health plan and it’s being ended because it doesn’t meet all the requirements of the ACA, most insurance companies are asking you to choose a new plan by the third week of January 2014. If your insurance company doesn’t hear from you, they will — in most cases — move you to a new plan that meets the ACA requirements automatically.

You should call your insurance company to see what their deadline is, and to learn about the type of plan they will move you to automatically.

For Those Who Don’t Currently Have Health Insurance

With the Affordable Care Act (ACA), everyone is required to have health insurance or risk paying a tax penalty. Fortunately, if you don’t have health insurance because you can’t afford it, you may be eligible for subsidized insurance where the Federal government pays for part of the costs.

If you’re uninsured and getting new coverage, or if you were on your spouse’s company plan but are being dropped from that coverage, you can purchase a plan directly from a health insurance company, or you can go through Washington State’s Health Benefit Exchange. This exchange, which you’ll find at www.wahealthplanfinder.org was set up to make it easy for people to shop and apply for health coverage online. You can also go online to see if you qualify for a lower-cost, subsidized plan.

You can enroll in a new plan by Dec. 31, 2013 and coverage will start on January 1, 2014. You can also purchase coverage between January 1 and March 31, 2014 and your enrollment will start the following month. The new Affordable Care Act requires that everyone have a health plan by this March 31, 2014 deadline or risk paying a tax penalty.

If you have more questions, please give our Customer Service Line a call at 206-701-7771 between 8 a.m. and 6 p.m. Mondays through Fridays.

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How do I make sure my care at Swedish is covered?

For Those Who Currently Have an Individual Plan

If your current individual plan includes Swedish, then it’s highly likely that the new plan your insurance company will automatically move you to (as well as other plans they offer), should also include Swedish.

To be absolutely certain, you should contact your insurance company.  You can also get in touch with Swedish at 206-701-7771 and we can give you the information for most health insurance companies that include Swedish in their provider networks.

For Those Planning to Purchase a New Plan Through the Washington Health Benefit Exchange

If you’re planning to purchase a plan at www.wahealthplanfinder.org,  you should note that not all plans offered include Swedish in their networks.

When a healthcare provider is “in network” it means the insurance company will cover a higher amount of the charges. When a provider is “out of network” you can still go to this provider, but you will be required to pay a larger percentage of the bill.

When you enroll in a new plan through the Washington Health Benefit Exchange and the www.wahealthplanfinder.org website, there are three plans that include Swedish in their networks:

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Coordinated Care (Ambetter Plans)

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Molina Healthcare

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Community Health Plan of Washington

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. Please note the Swedish Cancer Institute at the Swedish Edmonds campus is not considered to be "in network", so patients receiving cancer treatment at Swedish Edmonds will not be covered under Premera.

If you are currently a patient of the Swedish Cancer Institute please make certain the plan you choose through the Healthcare Exchange includes Swedish. If the plan does not include Swedish, you are at risk of paying high out-of-pocket expenses.  

If you have more questions, please give our Customer Service Line a call at 206-701-7771 between 8 a.m. and 6 p.m. Mondays through Fridays.

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Who are the insurance companies that include Swedish?

For Those Who Currently Have an Individual Plan

Most insurance companies who offer individual plan coverage in Washington State include Swedish in their provider networks. For example, plans from Regence, Premera, LifeWise, United Healthcare and several other companies have Swedish “in network.” For a full list click here

To be absolutely certain that a plan you’re considering includes Swedish, you should contact your insurance company. You can also get in touch with Swedish at 206-701-7771, and we can give you the information for those health plans that include Swedish in their network.

For Those Planning to Purchase a New Plan Through the Washington Health Benefit Exchange

When you enroll in a new plan through the Washington Health Benefit Exchange and the www.wahealthplanfinder.org website, there are three plans that include Swedish in their networks:

coordinatedcare.jpg

Coordinated Care (Ambetter Plans)

molina-(1).jpg

Molina Healthcare

communityhealthplan-(1).jpg

Community Health Plan of Washington

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.

If you’re not familiar with these companies, you should know that all of these organizations have a long track record of caring for Washington families. Coordinated Care is a subsidiary of Centene Corporation, a Fortune 500 company founded in 1984 that operates health plans in 19 states. Molina Healthcare is another Fortune 500 company, and was founded by an emergency room physician in 1980. It now provides healthcare to 1.8 million people throughout the U.S. Community Health Plan of Washington was founded more than 20 years ago, and is the only health plan in the state founded by local community health centers. They currently serve more than 300,000 individuals and families in Washington.

If you have more questions, please give our Customer Service Line a call at 206-701-7771 between 8 a.m. and 6 p.m. Mondays through Fridays.

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What if my insurance company doesn’t include Swedish?

You can still receive care at Swedish – that’s always an option. But, if you choose a plan where Swedish is not “in network,” then you’ll pay a higher co-insurance (the percentage of the bill you pay, versus the portion the insurance company pays), and there may not be a limit to your total out-of-pocket cost for care received at Swedish. Generally, it makes the most sense to switch to a plan that does have Swedish “in network” for your convenience and to receive the best benefits.

If you have more questions, please give our Customer Service Line a call at 206-701-7771 between 8 a.m. and 6 p.m. Mondays through Fridays.

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Why isn’t Swedish included in some of the new plans?

Swedish negotiates with each company separately, and it sometimes takes time to work out agreements between two organizations. We simply were not able to do that with some of the health plans being offered on the Washington Health Benefit Exchange and www.wahealthplanfinder.org.

For instance, BridgeSpan plans (offered by Regence) and plans from LifeWise and Premera don’t include Swedish at this time. However, if you are a patient of Swedish Edmonds, the Premera plans on the Washington Health Insurance Exchange do consider that Swedish campus only to be “in network.”

Rest assured, our goal is to significantly add to the number of health insurance plans we partner with, so it’s quite possible that a plan that doesn’t include Swedish now, may in the future.

If you have more questions, please give our Customer Service Line a call at 206-701-7771 between 8 a.m. and 6 p.m. Mondays through Fridays.

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Why is it important to choose a plan that includes Swedish?

If you’ve been receiving care at Swedish, it makes good sense to continue your care here, so the same physicians, care teams, technology, and medical records are readily available to you.

An equally important reason to choose a plan that includes Swedish in its network, is that there will be a limit to the maximum amount you’ll be required to pay each year for your care here. For instance, once you’ve paid a certain amount in co-pays, co-insurance, and deductibles (that amount varies depending on the plan you choose), your insurance will take over and pay 100% of your bills — there will be no more out-of-pocket costs to you.

However, if you go with an insurance plan that does not include Swedish in its network, there is no limitation on your out-of-pocket expenses each year. For people with serious chronic conditions, like cancer or heart disease, the out-of-pocket costs could easily be many thousands of dollars.

Even if you’re in perfect health, choosing a health plan that includes Swedish is a smart idea. When Swedish is in your health plan’s network, you’re making literally thousands of the area’s top physicians and the latest medical technology available to you.

There’s also the convenience you’ll enjoy of being able to see a primary care physician at one of more than 20 Swedish and Minor & James clinics throughout the region. Swedish also has five hospitals and two care centers with emergency rooms in the Puget Sound area, including locations in Seattle, Ballard, Edmonds, Mill Creek, Issaquah, and Redmond.

Swedish has been taking care of Seattle-area families for 103 years. And there’s nothing we’d like more than to continue to serve you and your family.

If you have more questions, please give our Customer Service Line a call at 206-701-7771 between 8 a.m. and 6 p.m. Mondays through Fridays.

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What if I want to receive care at Minor & James Medical (a Swedish health partner)?

All of the information provided above applies to those seeking care at Minor & James Medical. If you have questions, please give the Swedish Customer Service Line a call at 206-701-7771 between 8 a.m. and 6 p.m. Mondays through Fridays.

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What if I have more questions?

If you still aren’t 100 percent clear on all these changes (and we’d hardly blame you!), we’d be happy to answer your questions.

Please give our Customer Service Line a call at 206-701-7771 between 8 a.m. and 6 p.m. Mondays through Fridays.

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.