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Insurance Plans

Virginia Mason accepts many health insurance plans; please see the information below regarding acceptance of various plans. Contact your health insurance plan for information on covered services before your appointment.

Enrollment for health insurance through the state's Health Benefit Exchange began Oct. 1, 2013. You can find enrollment information through the Washington Healthplanfinder. Learn about the Health Benefit Exchange and Medicaid Expansion.



Aetna -
All Aetna programs (includes a PPO plan) are accepted.

Amerigroup - Virginia Mason is not contracted for this Basic Health or Healthy Options program. Virginia Mason will accept insurance-approved referrals for specialty care (referrals that are initiated by a non-Virginia Mason Primary Care Provider, and approved by Amerigroup). All BHP and Healthy Options patients MUST have insurance approved referrals for all services, otherwise services may be denied.

Basic Health Plan (BHP) and Healthy Options (HO) Programs - Virginia Mason is not contracted for Basic Health or Healthy Options programs. However, Virginia Mason will accept insurance-approved referrals for specialty care. Referrals are accepted if they are initiated by the non-Virginia Mason Primary Care Provider (PCP) and approved by the insurance. All BHP and Healthy Options patients MUST have insurance approved referrals for all services, otherwise services may be denied.

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CHAMPUS/CHAMPVA (Federal Program) - CHAMPUS/CHAMPVA does not have a contracted provider network. Virginia Mason is not currently accepting this program.

CIGNA (including Seafarers Welfare Plan) - A Preferred Provider Organization (PPO) and Managed Care (HMO), most products are accepted. Acceptance does not include discount card programs.

Community Health Plans of Washington (CHPW) - Healthy Options, Basic Health & Basic Health Plus - Virginia Mason is not contracted with this program, however will accept insurance-approved referrals for specialty care \(referrals that are initiated by the patient’s non-Virginia Mason Primary Care Provider, and approved by CHPW). All BHP and Healthy Options patients MUST have insurance-approved referrals for all services, otherwise services may be denied.

Coordinated Care Corporation (CCC) - Virginia Mason is not contracted for this Basic Health or Healthy Options program. Virginia Mason will accept insurance-approved referrals for specialty care (referrals that are initiated by the patient’s non-Virginia Mason Primary Care Provider, and approved by CCC). All BHP and Healthy Options patients MUST have insurance approved referrals for all services, otherwise services may be denied.

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Coventry (formerly First Health) - A Preferred Provider Organization (PPO) - Most products are accepted. Acceptance does not include discount card programs.

First Choice Health Network - A Preferred Provider Organization (PPO), most products are accepted. Acceptance does not include discount card programs.

Great West Healthcare (now owned by Cigna) - A Preferred Provider Organization (PPO) - Most products are accepted. Acceptance does not include discount card programs.

Group Health Cooperative (includes Kaiser, Options and Alliant programs) - HMO and Point-of-Service plans are accepted.

Humana (ChoiceCare) - a Preferred Provider Organization (PPO) - Most products are accepted. Acceptance does not include discount card programs.

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Interplan Health Group (formerly NorthwestOne) - A Preferred Provider Organization (PPO) - Most products are accepted. Acceptance does not include discount card programs.

Labor and Industry (L&I) - L&I is accepted.

Lower Elwha Klallam Tribe (via Contract Health Services) - Lower Elwha Klallam Tribe via Contract Health Services is accepted. To be seen at Virginia Mason and receive coverage from Lower Elwha Klallam Tribe via Contract Health Services, an approved referral is required. Services may not be covered without an approved referral.

 Medicaid - Medicaid is accepted for primary care and specialty care for already established primary care patients (established in primary care is defined as seen in general internal medicine, family practice or pediatrics within the last three years). 

  • Non-established patients are accepted for specialty care with direction from their community provider.
  • Medicaid is not accepted for new patients and primary care services.
  • Medicaid is also not accepted if patients who are not established and are self-directing for specialty care.

Note:  Virginia Mason is currently not available for psychiatry and behavioral health services. Please contact a Community Health Center for these services.

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Medicaid Out-of-State (Alaska, Montana, Idaho, etc.) - Virginia Mason 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.

Molina Healthcare - Virginia Mason is not contracted for this Basic Health or Healthy Options program. Virginia Mason will accept insurance-approved referrals for specialty care (referrals that are initiated by a non-Virginia Mason Primary Care Provider, and approved by Molina). All BHP and Healthy Options patients MUST have insurance-approved referrals for all services, otherwise services may be denied.  
 
Multiplan - A Preferred Provider Organization (PPO) - Most products are accepted. Acceptance does not include discount card programs.
 
PacifiCare - (PacifiCare is now owned by United Healthcare, but continues to run as a separate program at this time). Virginia Mason accepts all PacifiCare programs (includes a PPO plan).
 
PPONext - (Formerly Preferred Health Network and now owned by Beech Street) A Preferred Provider Organization (PPO) - Virginia Mason accepts most PPONext products. Acceptance does not include discount card programs.

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Premera Blue Cross - Virginia Mason accepts all Premera Blue Cross programs, including Blue Cross/Blue Shield out-of-state.

Private Health Care Systems (PHCS) - (Recently purchased by Multiplan, but continues to run as a separate organization at this time) A Preferred Provider Organization (PPO), Virginia Mason accepts most PHCS products. Acceptance does not include discount card programs.

Regence Blue Shield - Virginia Mason accepts all Regence Blue Shield programs, including Blue Cross/Blue Shield out-of-state.

TriCare Standard and Extra - Virginia Mason is not contracted with TriCare Standard and Extra, but will bill the programs as a courtesy. TriCare Standard and Extra members/patients may be considered as out-of-network should they elect to receive care within Virginia Mason.

TriCare for Life - Virginia Mason is not contracted with TriCare, but will bill the programs as a courtesy. TriCare for Life is a secondary to Medicare.

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TriCare Prime - Virginia Mason is not contracted with TriCare Prime. Virginia Mason will accept approved TriCare Prime specialty care referrals. The referral must be initiated by the TriCare Prime primary care manager (or other TriCare Prime referring provider) and approved by TriCare Prime prior to scheduling specialty care (unless urgent/emergent).

United Healthcare (UHC) - Virginia Mason accepts all United Healthcare products (Acceptance does not include discount card programs).
 
United Healthcare Community Plan (UHC-CP) - Effective March 1, 2013, Virginia Mason is contracted with UHC-CP Healthy Options and Basic Health Plan programs for established Virginia Mason patients and children of established Virginia Mason patients. UHC-CP is a Health Maintenance Organization (HMO). Persons covered under this program are required to select contracted Primary Care Providers (PCPs).

As of this date, UHC-CP members who are established Virginia Mason patients and children of established Virginia Mason patients may select a Virginia Mason Primary Care Provider (PCP). Primary care includes family practice, general internal medicine and pediatrics.

Virginia Mason will accept specialty care referrals for UHC-CP members who are not established and do not have a Virginia Mason PCP.

Uniformed Medical Plan Preferred Provider Organization (PPO) - Virginia Mason accepts all Uniformed Medical Plan products.

Under the PPO program, insurance-approved referrals for specialty care is not required. However, certain services may require insurance prior-authorization. Contact your insurance provider with any prior-authorization and benefit related questions.

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Uniformed Services Family Health Plan (USFHP) - USFHP is a TriCare program administered by Pacific Medical Centers. Virginia Mason is contracted with USFHP for specialty care referrals and hospital services.

  • USFHP Patients MUST have a Pacific Medical Centers-initiated and USFHP-approved referral in order to receive specialty care services within Virginia Mason. This is a requirement of the USFHP program.
  • The referral is required for ALL services and must be in place prior to services occurring. 
  • If there is not a Pacific Medical Centers-initiated, USFHP authorized referral in place prior to services occurring, the services will be denied.

Veterans Administration (VA) Federal Program - Veterans Administration recipients are required by the VA to receive care within the Veterans Administration. Virginia Mason is NOT currently working with this program.

  • However, if there is an urgent/emergent situation (e.g. patient presents in the ED), we will accept and bill the program.
  • Virginia Mason will also provide mammogram services to VA patients, as the VA does not have mammography capability. A referral is not required for mammograms.

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Medicare Programs

Medicare - Medicare is available to persons 65 and older and/or disabled persons who may be under 65, but qualify due to their disability. Virginia Mason accepts Medicare.

Medigap and plans identified as Medicare Supplement Plans - Supplements to Medicare: Virginia Mason continues to accept all Medigap and Medicare supplement plans (usually identified as benefit levels A through L).

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Medicare Advantage Programs

Virginia Mason is not contracted with most Medicare Advantage programs, however, will accept those non-contracted as described in the information listed below. This list includes programs that we are aware of and is not all inclusive. Other plans not listed will apply in the same manner.

Aetna Medicare Open (Medicare Advantage PFFS) - Not contracted – Accepting for already established patients and specialty care referrals. 

Aetna Golden Choice (Medicare Advantage PPO) - Not contracted – Accepting for already established patients and specialty care referrals.

ASURIS - Contracted via Regence Medicare Advantage

Blue Cross/Blue Shield Medicare Advantage out-of-state plans - Contracted via Regence Medicare Advantage

Cigna Medicare Access, Access Plus, Access Plan One and Access Plan Three - Not contracted – Accepting for already established patients and specialty care referrals.

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Community HealthFirst, HealthFirst MA Plan and Medicare Advantage Premium - Not contracted – Accepting for already established patients and specialty care referrals.

Columbia Community Care - Not contracted – Accepting for already established patients and specialty care referrals.

Coventry Advantra Freedom - As of Dec. 31, 2009 this program is no longer offered in Washington State. Not contracted – Accepting for already established patients and specialty care referrals.

Desert Medicare Advantage - Not contracted – Accepting for already established patients and specialty care referrals.

Essence Advantage (HMO) - Not contracted – Accepting for already established patients and specialty care referrals. Must have an insurance-approved referral to be seen for specialty care. May not select a Virginia Mason primary care provider.

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Evercare IH and Evercare Premier by United Healthcare (HMO) - Not contracted – Accepting for already established patients and specialty care referrals. Must have an insurance-approved referral to be seen for specialty care. May not select a Virginia Mason primary care provider.

First Seniority Freedom Plan - Not contracted – Accepting for already established patients and specialty care referrals.

Group Health Clear Care Medicare (HMO) - Contracted - Vital, Clear Care Basic, Clear Care Essential, Clear Care Optimal and Clear Care Sound - Contracted for specialty care only. A Group Health Clear Care Medicare approved referral is required for persons to be seen within Virginia Mason.

Group Health Clear Care Medicare PPO - Contracted - Prestige and Elite - Service areas are Yakima, Franklin, Benton, Jefferson and Clallam. PCP selection and referral is not required.

HealthMarkets Care Assured Plans - Not contracted – Accepting for already established patients and specialty care referrals.

Health Net Pearl Plan - Not contracted – Accepting for already established patients and specialty care referrals.

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Humana Choice (PPO) Medicare, Humana Gold Medicare - Not contracted - Accepting for already established patients and specialty care referrals.

Humana Prime Choice PPO – Virginia Mason is contracted with Humana Prime Choice PPO for all services (effective Feb. 1, 2013)

Mennonite Mutual Aid Association (Team Care advantage) - Not contracted – Accepting for already established patients and specialty care referrals.

Molina Medicare Options (HMO) - Not contracted – Accepting for already established patients and specialty care referrals. Must have an insurance-approved referral to be seen for specialty care. May not select a Virginia Mason primary care provider.

MVP Care (formerly USA Care by Preferred Care) - Not contracted – Accepting for already established patients and specialty care referrals.

New West Medicare - Not contracted – Accepting for already established patient specialty care referrals.

ODS - Not contracted – Accepting for already established patient specialty care referrals.

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Partners Apex Plus King County (HMO)
Partners Charter and Charter Plus (HMO)
Partners Sound Plus and Apex King County (HMO)
Partners Summit Plus (HMO-POS)

Not contracted – Accepting for already established patient specialty care referrals.

Preferred Care Partners - Not contracted – Accepting for already established patients and specialty care referrals.

Pyramid (Today's Option) - Not contracted – Accepting for already established patients and specialty care referrals.

Regence Medicare Advantage - Contracted - Virginia Mason is contracted with Regence Medicare Advantage for all services. Contract also includes Asuris and BC/BS out-of-state. 

SecurityChoice Plus and Classic (PFFS) - Not contracted – Accepting for already established patients and specialty care referrals.

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Sierra Health and Life Insurance Company (Sierra Optima Choice) - Not contracted – Accepting for already established patient specialty care referrals.

SoundPath Health (HMO) - formerly Puget Sound Health Partners - Not contracted – Accepting for already established patient specialty care referrals. HMO – MUST have an insurance-approved referral to be seen for specialty care. May not select a Virginia Mason PCP.

Today's Options, Value and Premier powered by CCRx - Not contracted – Accepting for already established patient specialty care referrals.

True Value Medicare - Not contracted – Accepting for already established patient specialty care referrals.

Unicare (SecurityChoice) - Not contracted – Accepting for already established patient specialty care referrals.

United Healthcare Medicare Select - Not Contracted – (Not accepting as persons under this program are required to utilize contracted hospitals; Virginia Mason is not a contracted hospital).

United Healthcare Community Plan (Dual SNPs)(HMO) - Not contracted – Accepting for already established patient specialty care referrals. (HMO – MUST have an insurance-approved referral to be seen for specialty care). May not select a Virginia Mason PCP.

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United Healthcare AARP MedicareComplete
United Healthcare MedicareComplete 
United Healthcare Medicare Advantage PPO

 

Contracted – For HMO, a referral is not required for Network members. The wording “Network” will show after the PCP name and/or clinic selection if a network member. This information will be in the lower left corner of the ID card.

  • If the ID card does not indicate "Network" a referral is required if the PCP is a non-Virginia Mason PCP. 
  • If PPO – no referral required, but there may be prior-authorization requirements.

United Healthcare Medicare Supplement - Contract not required - Supplement program to Medicare, which is like a Medigap program. Medicare Supplement and Medigap programs continue to be accepted for all services covered under Medicare.

USA Care by Preferred Care - Not contracted – Accepting for already established patients and specialty care referrals.

WellCare (Concert, Serenade, Sonata, Melody) - Not contracted – Accepting for already established patients and specialty care referrals.

Windsor Sterling Programs - Not contracted – Accepting for already established patients and specialty care referrals.

Windsor Sterling Basic (HMO) 
Windsor Sterling Basic Plus (HMO)

Windsor Sterling Select

Not contracted – Accepting for already established patient specialty care referrals. (HMO – MUST have an insurance approved referral to be seen for specialty care)

Not contracted – (Not accepting as persons under this program are required to utilize contracted hospitals, Virginia Mason is not contracted)

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Behavioral Health Networks

Below outlines contracted behavioral health networks separately contracted for the Virginia Mason Psychiatry and Psychology department.

CIGNA Behavioral Health
Magellan
PacifiCare Behavioral Health, Inc.
United Behavioral Health
ValueOptions

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Optical Networks

Virginia Mason is not contracted with any optical networks.

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