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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.

This list is meant to be a basic guide and not provide detailed information.Periodic updates to this list may occur. If you have any questions or require additional information please contact Michelle at x6779

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 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
  • GEHA
  • National Advantage Program (NAP)

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)
  • 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

Beacon Health (Value Options)

  • Behavioral Health Only

Beech Street - PPO

Behavioral Health Systems

  • Behavioral Health Only

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

Clarity Health

Communicare Medicare I-SNP

Devoted Health Medicare

  • Medicare Advantage

HealthSmart PPO

First Health/CCN/Coventry PPO

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

Medical Mutual of Ohio

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

MMO Medicare Advantage

Molina

  • Medicaid
  • Marketplace Exchange

Northcoast HealthCare

  • Home Health/Home Infusion

Ohio Bureau of Workers' Comp

  • All BWC MCO's

Ohio Health Choice/Ohio Health Choice Plus

PHS/Direct Care America - PPO

PHCS/MultiPlan - PPO & POS

SummaCare

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

TheraMatrix Physical Therapy Network

TriCare: Humana TriCare

  • Prior auth may be required

UH Choice (UHHS Plan)

United Behavioral Health (Optum)

  • Behavioral Health Only

United Healthcare

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

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.

Wellcare Medicare Advantage

Veterans (VA)

  • Please note – Providers may need approved referral from the VA prior to rendering care

Non-Contracted Insurance Plans

Non-Contracted or “Out-of-network” (OON) means providers and facilities that haven’t 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 (should be registered under the correct I Plan)

Aetna

  • Aetna Premier Care Network PLUS – exclusive to Cleveland Clinic

Anthem Medicare Advantage

  • Anthem MediBlue Prime Select (HMO) – exclusive to Cleveland Clinic
  • Anthem High Performance Network—exclusive to Cleveland Clinic

Medical Mutual

  • 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
  • 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 & Mercy Canton/CCF employee health plans
  • SCConnect – Marketplace plan (offered in Summit, Stark, Portage & 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 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 (common examples: Cigna, PHCS, or First Health). Please continue to check member ID cards and verify eligibility and register encounters under the “MISC COMMERCIAL INS” IPlan

Example Referenced Based Pricing Plans (not complete, just some common ones)

  • Lucent Health
  • CommuniCare Health Benefits (not the CommuniCare SNFs in our area)
  • Valenz (Secure One Preferred)
  • The Health Plan
  • ClearChain

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.

Patients who present with only a Healthshare card should be registered as SELF PAY and may be eligible for additional financial assistance through Financial Clearance. If you are unsure if it’s a healthshare program, you can register it under MISC COMMERCIAL INS.
Example Healthcare Sharing Plans
-

  • MediShare
  • Harmony Healthshare
  • Liberty Healthshare AT THIS TIME: Use “LIBERTY HEALTH SHARE” IPlan
  • Christian Healthshare Ministries (CHM)

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