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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.

Aetna Commercial

  • HMO
  • Elect Choice (EPO)
  • Aetna Select / Select Open Access
  • Aetna Open Access Elect Choice (EPO)
  • Quality Point-of-Service (QPOS)
  • Managed Choice (POS)
  • Choice POS & POS II
  • Open Access Managed Choice POS
  • Open Choice (PPO)
  • Aetna Affordable Health Choices
  • Aetna Health Network Only
  • Aetna Health Network Option
  • Aetna HealthFund
  • Aetna Premier Care Network (APCN) /Plus
  • Savings Plus of Ohio-HNO
  • Ohio HealthNetworkOption
  • Ohio Open Choice PPO
  • Aetna with Innovation Health – Aetna Select, POS, PPO
  • National Advantage Program (NAP)
  • GEHA

Aetna Medicare Advantage

  • Aetna Medicare HMO & PPO
  • Aetna Medicare ESA PPO
  • Aetna Medicare Premier 1 & 2 PPO
  • Aetna Medicare Premier Plus PPO
  • Aetna Medicare Value Plan PPO
  • Aetna Medicare Premier HMO
  • Aetna Medicare Value Plan HMO
  • Aetna Medicare Advantra PPO
  • Aetna Medicare Advantra ESA PPO
  • Aetna Medicare Advantra Silver
  • PPO

Aetna Other Government

  • Aetna Medicare HMO Dual SNP (DSNP)

Anthem BCBS Commercial

  • Blue Access PPO
  • Balanced Blue Access PPO
  • Blue Access Options PPO (OH I &II) (prefix VXA,XDV, YKY)
  • Blue HMO
  • Blue Preferred HMO, POS, EPO
  • Blue Preferred Plus POS
  • Blue Traditional
  • National PPO (Blue Card PPO)
  • Bronze Blue Access PPO & PPO Plus
  • Gold Blue Access PPO
  • Lumenos Plans
  • Ohio Med Plan
  • Platinum Blue Access PPO
  • Silver Blue Access PPO & PPO Plus
  • Anthem Federal Employee Plan

Anthem Medicare Advantage

  • Anthem Senior Adv. PPO, HMO
  • Anthem MediBlue Preferred HMO
  • Blue Medicare Advantage PPO
  • Anthem MediBlue Access PPO
  • Anthem MediBlue Access Basic (Regional PPO)
  • Anthem MediBlue Access Core (Regional PPO)
  • Anthem MediBlue Access Plus (PPO)
  • Anthem MediBlue Dual Advantage
  • Anthem MediBlue Essential HMO
  • Anthem MediBlue Extra HMO
  • Anthem MediBlue Plus HMO
  • Medicare Select

Behavioral Health Systems

  • Behavioral Health Only

Beech Street - PPO

Bright Health Medicare Advantage

  • Bright Advantage HMO
  • Bright Advantage Flex PPO

Buckeye Community Plan

  • Medicaid
  • AllWell Medicare Advantage
  • Ambetter (Exchange HMO)
  • MyCare Ohio

CareSource

  • Medicare
  • Medicaid
  • MyCare Ohio, D-SNP
  • Marketplace (Exchange)

Cigna Behavioral Health

  • Behavioral Health Only

Cigna Healthcare of Ohio

  • HMO, PPO
  • Choice Fund PPO
  • Gatekeeper PPO
  • International
  • Open Access Plus
  • Choice Fund OA Plus

Cigna Medicare Advantage

ClaimDoc

Communicare Medicare Advantage

  • I-SNP Plan

Devoted Health Medicare Advantage

HealthSmart PPO

First Health/CCN/Coventry

  • PPO

Health Design Plus

  • UH Choice Network –
    Cleveland Metropolitan School

Health Ohio Network PPO

Healthstar PPO/PPO Next

Horizon Health- Behavioral Health Only

Humana

  • Commercial PPO, HMO, POS, EPO
  • Medicare PPO, HMO
  • Medicare Network PFFS

Marymount BH Services

  • Behavioral Health Only

Medical Mutual of Ohio

  • SuperMed PPO
  • SuperMed Classic
  • SuperMed HMO
  • SuperMed Preferred
  • SuperMed Traditional
  • Ohio Med
  • MedFlex
  • MMO Exchange/Individual
    • NE Ohio HMO
  • Medicare Advantage HMO & PPO

Molina

  • Medicaid
  • Marketplace Exchange

Northcoast HealthCare

  • Home Health/Home Infusion

Ohio Bureau of Workers' Comp

  • All BWC MCO's

Ohio Health Choice Plan/Ohio

Health Choice Plus – PPO

PHS/Direct Care America - PPO

PHCS/MultiPlan - PPO & POS

SummaCare

  • HMO, PPO, POS
  • Medicare Advantage
  • Apex PPO, EPO and POS

United Behavioral Health (Optum)

  • Behavioral Health Only

United Healthcare

  • Commercial Plans
    • Core Essential – EPO & POS
    • Choice HMO & EPO
    • Choice Plus POS
    • Nexus – ACI, EPO, POS, HMO
    • Heritage POS River Valley – Choice
    • UHC Doctors Plan/ Plus – HMO, EPO, POS
    • PPO
    • UHC Charter / Charter Plus
    • Select – HMO, EPO
    • Select Plus POS
    • Navigate / Navigate Plus
    • All Savers
  • Government Plans
    • UHC Medicare PPO & HMO
    • AARP Medicare Complete Plans
    • UHC Medicaid
    • UHC MyCare Ohio (UHC Connected Care)
    • UHC Dual Complete – HMO SNP & HMO-POS SNP

Valor Medicare Advantage (I-SNP Plan)

Beacon Health (Value Options)

  • Behavioral Health Only

Veterans Community Care Network (VA CCN) – through Optum/UHC

  • Please note – Providers must have an approved referral from the VA prior to rendering Service Connected Care.

Non-Contracted Insurance Plans

Anthem Medicare Advantage

  • Anthem MediBlue Prime Select (HMO) – exclusive to Cleveland Clinic

Blue Cross Blue Shield

  • Blue High Performance Network – exclusive to Cleveland Clinic

Medical Mutual

  • Mercy Health Network Plans – exclusive to Mercy Health providers
    • Mercy Health Employee Plans - SuperMed EPO
      • Note – Mercy offers a PPOplan that allows members to access providers outside of Mercy’s network using Tier 2 benefits
    • Individual Networks- Mercy Health HMO
  • MetroHealth Network plans – exclusive to MetroHealth
    • CLE-Care HMO
    • SkyCare – MetroHealth employee plan exclusive the Metro facilities, employees have no out of network benefits
      • Note – Metro offers a SkyCare Plus plan that allows members to access providers outside of Metro’s network using Tier 2 benefits
  • Lake Health Chamber HMO
  • Ohio Health HMO, ProMedica HMO, Dayton HMO

Molina

  • Molina Dual Options MyCare Ohio

Paramount

  • Medicare & Medicaid

SummaCare Exchange

  • New Health Connect – Summa employee health plan
  • New Health Connect – Mercy Canton employee health plan
  • SCConnect – Marketplace plan (offered in Summit, Stark, Portage and Medina Counties

Oscar health plans

  • Includes Cleveland Clinic plan

Humana Medicare Advantage

  • Humana Cleveland Clinic Preferred (HMO) & Humana Cleveland Clinic (HMO SNP-DE) – both plans are exclusive to Cleveland Clinic

Other Plans:

Southwest does not accept or recognize a discount, unless the medical plan can access one of the PPO networks SWG participates in. These networks may include Cigna, PHCS, or First Health for limited or JUST physician services. Please continue to check member ID cards and verify eligibility. These may be considered self-pay/no insurance patients

  • Healthcare Sharing Ministry Plans - These are discount plans and not considered insurance.
    • MediShare
    • Harmony Healthshare
    • Liberty Healthshare – if a member presents or calls to schedule a service under this plan, please refer them to Financial Clearance at 440-816-4701.
      • Use “LIBERTY HEALTH SHARE” Iplan
  • Referenced Based Pricing Plans
    • Lucent Health (example)

*Please note this is not a complete list of non-contracted insurance plans, these are the most common plans.