Insurance Plans Accepted
Managed Care Contracts
In an effort to better serve our patients and physicians, Southwest General has pursued contracts with many Managed Care Organizations (MCOs). We strive to develop contracts with companies who not only provide good medical coverage to their subscribers, but also who provide fair reimbursement and equitable contract terms. In addition to accepting traditional Medicare and Medicaid, Southwest has arranged special “managed care” contracts with the following entities:
Southwest General accepts all Medicare Private Fee For Service (PFFS) plans.
Please see the Non-Contracted Listing for exceptions.
Verify Eligibility – patient’s benefits can be Out of Network, Tiered or Exclusive to another Hospital System all based on Benefit Design.
This list is meant to be a basic guide and not provide detailed information. Periodic updates to this list may occur.
Aetna Commercial
Please see non-contracted list for exceptions
- All Aetna Commercial plans*
- Aetna Meritain
- Individual Exchange
- GEHA
- Aetna EHP +
Aetna Medicare Advantage
Please see non-contracted list for exceptions
- All Aetna Medicare Advantage plans*
Aetna Other Government
- Aetna Medicare HMO Dual SNP (DSNP)
AmeriHealth Caritas - Medicaid
Anthem BCBS Commercial
Please see non-contracted list for exceptions
- All Anthem BCSC Commercial plans*
- Traditional, Blue Access, Federal
- Blue Access (OH I &II)
Anthem Medicare Advantage
Please see non-contracted list for exceptions
- All Anthem Medicare Advantage plans*
Anthem Medicaid
Anthem NextGen MyCare Ohio
Beech Street - PPO
Behavioral Health Systems
- Behavioral Health Only
Buckeye Community Plan
- Medicaid
- AllWell Medicare Advantage
- Ambetter (Exchange HMO)
- NextGen MyCare Ohio
CareSource
- Medicare Advantage
- Medicaid
- NextGen MyCare Ohio
- Dual D-SNP Hospital only
- Marketplace (Exchange) Hospital only
Carelon Behavioral Health (Beacon Health) (Value Options)
- Behavioral Health Only
Cigna Evernorth Behavioral Health
- Behavioral Health Only
Cigna Healthcare
Please see non-contracted list for exceptions
- All Cigna Commercial Plans*
Cigna Medicare Advantage - HealthSpring
ClaimDoc
Clarity Health
Communicare Medicare I-SNP, C-SNP
Devoted Health Medicare
- Medicare Advantage
First Health/CCN/Coventry PPO
HealthSmart PPO
Health Ohio Network PPO
Horizon Health- Behavioral Health Only
Humana Health Horizons
- Medicaid
Humana Behavioral Health
Medical Mutual of Ohio
Please see non-contracted list for exceptions
- All MMO Commercial plans*
- MMO Exchange NE Ohio HMO
MMO Medicare Advantage
Molina
- Medicaid
- NextGen MyCare Ohio
- Marketplace Exchange
Northcoast HealthCare
- Home Health
Ohio Bureau of Workers' Comp
- All BWC MCO's
Ohio Health Choice/OHC Plus
Paramount Elite Medicare - SGMG only
PHS/Direct Care America - PPO
PHCS/MultiPlan - PPO & POS
SummaCare
Please see non-contracted list for exceptions
- Commercial
- Medicare Advantage
TheraMatrix Physical Therapy Network
TriCare: Humana TriCare
- Prior auth required
United Behavioral Health (Optum)
- Behavioral Health Only
United Healthcare Commercial
Please see non-contracted list for exceptions
- All United Healthcare Commercial
- GEHA / UMR
- UHC Nexus ACO - TIER 2
United Healthcare Medicare Advantage
- United Healthcare GEHA Medicare ADV
- UHC MyCare Ohio (UHC Connected Care)
- UHC Dual Complete – HMO SNP
United Healthcare Medicaid
- UHC Community Plan
Veterans (VA)
- Please note – Providers may need approved referral from the VA prior to rendering care
Wellcare Medicare Advantage
Non-Contracted Insurance Plans
Non-Contracted or “Out-of-network” (OON) means providers and facilities that have not signed a contract with a health plan to provide services. Out-of-network providers may be allowed to bill for the difference between what the plan pays and the full amount charged for a service. This is called “balance billing.” “Surprise billing” is an unexpected balance bill. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
All SWG Patients are protected under the No Surprise Billing Act (NSA) that went into effect 1/1/22. In short, patients will be billed no more than their in-network patient out-of-pocket amounts according to their benefit plans. Any and all additional reimbursement must come from the payer’s OON payment rate OR a further negotiated single case agreement. Southwest General DOES NOT BALANCE BILL patients and will work with all plans to be compliant with the NSA regulations. More information about the NSA can be found on our website under Financial Tools. If you have questions about an OON provider, please call or email Managed Care.
*Please note - this is not a complete list of non-contracted insurance plans, these are the most common plans.
Common OON Plans
Aetna
- Aetna Premier Care Network PLUS – exclusive to Cleveland Clinic
- Aetna EHP – Cleveland Clinic, no OON benefits
- MetroHealth Network
Anthem Pathway (Exchange)
Anthem Medicare Advantage
- Anthem MediBlue Prime Select (HMO) – exclusive to Cleveland Clinic
- Anthem High Performance Network—exclusive to Cleveland Clinic
CIGNA Open Access Plus Pathwell Pharmacy Benefit
Humana Medicare Advantage including Humana HMO D-SNP
Medical Mutual
- Mercy Health, MetroHealth Skycare, CLE-Care HMO, Ohio Health HMO, Promedica HMO, Dayton HMO
Molina
- Molina Dual Options MyCare Ohio
- Medicare Complete HMO D-SNP
Oscar health plans
- Includes Cleveland Clinic plan
Paramount Elite Medicare Advantage - Hospital
SummaCare
- New Health Connect – Summa & Mercy Canton/CCF employee health plans
- SC Connect – Marketplace plan (offered in Summit, Stark, Portage & Medina Counties)
United Healthcare Exchange
Other Non Contracted/ OON “Plans” not subject to NSA:
Reference Based Plans-- These plans typically have NO NETWORK even possible and have “Acceptance Language” on the card that says we would accept a low percentage of Medicare (e.g. 120% of Medicare) for the services. These are not recognized by SWG as Contracted Plans and therefore do not accept or recognize a discount, unless the medical plan can access a contracted wrap PPO network specific for Facilities, (common examples: Cigna, PHCS, or First Health).
Example Referenced Based Pricing Plans (not complete, just some common ones)
- Lucent Health
- CommuniCare Health Benefits (not the CommuniCare SNFs in our area)
- The Health Plan
- ClearChain
- Sana
- Sidecar Health
- Imagine360
Healthshare Programs- Healthshare Programs are NOT insurance. They are predatory and profit seeking companies that more and more patients are presenting with. They may or MAY NOT pay anything towards the patient’s bill.
Example Healthcare Sharing Plans -
- MediShare
- Harmony Healthshare
- Liberty Healthshare
- Christian Healthshare Ministries (CHM)