Insurance Plans
Revised 04/21/2008Accountable Health Plan - All physicians contracted
Aetna TRS - All physicians contracted
Aetna PPO & HMO - All physicians contracted
Aetna Plans that do NOT require a Referral:
Aetna - Erika Travel Insurance, LTD - Student Health Plan
Aetna HealthFund Plan
Aetna QPOS requires PCP selection but does NOT require a referral
Aetna Open Access-HMO Plan
Aetna Open Access - Elect Choice (EPO) Plan
Aetna Managed Choice (POS) Plan-Requires PCP but does NOT require referral
Aetna USAccess
Aetna Choice POS and Aetna Choice POS II
Aetna Open access Managed Choice (POS) Plan
Aetna Open Choice (PPO) Plan
Aetna Traditional Choice Indemnity Plan
Aetna Medicare "Open" PFFS Plan Only
Aetna Plans that Require a Referral:
Aetna HMO - Requires Referral from PCP
Aetna Elect Choice (EPO) - Requires Referral from PCP
Aetna Medicare - NOT PARTICIPATING
Affiliated PPO - Not in Texas as of 1/1/2007
AmCare - Not Participating
ARIA/Mediview - ARIA Employees (Covenant) must have numeric Referral
Assurant (Fortis) PPO (PHCS) - PHCS PPO Only - NOT PHCS Open Access or POS
Assured - All physicians contracted
Beechstreet - All physicians contracted
Benefit Planners - All physicians contracted
BlueChoice Solutions - Not Participating - Patient will be billed as out-of-network by BCBS
BCBS - All Physicians contracted - Dr. Farady's panel closed to NPs 6/1/08
Blue Choice - All Physicians contracted - Dr. Farady's panel closed to NPs 6/1/08
BCBS Par Plan - All Physicians contracted - Dr. Farady's panel closed to NPs 6/1/08
BCBS POS - Needs Referral - All physicians contracted - Dr. Farady's panel closed to NPs 6/1/08
BCBS TRS - All Physicians contracted - Dr. Farady's panel closed to NPs 6/1/08
Blue Cross PPO - All Physicians contracted - Dr. Farady's panel closed to NPs 6/1/08
CCN - All physicians contracted
CHIPS-Triage Schedules - Seton Needs Ref; Panel Closed to NPs however,NPs Triaged for UC
Cigna PPO & HMO - Through SPHN (Seton) - All physicians contracted
Cigna POS - All physicians contracted
Cigna POS Open Access & Plus or POS-OA, EPO - All physicians contracted
Cigna HMO,Cigna Flexcare/-HMO - All physicians contracted
Cigna Healthcare of TX, Cigna Select-"C" on card - All physicians contracted
Cigna Indemnity - All physicians contracted
COBRA - Make sure it is insurance we are contracted with. Benefits must be verified.
Covenant Mgt Sys - Requires Referral - All physicians contracted
First Health - All physicians participating thru SPHN
Guardian - All physicians contracted
GEHA - All physicians contracted
Great West - NOT CONTRACTED
Health Select - Needs Blue Link Referral - DR. SPECIFIC - All physicians contracted
HealthSelect Traditional - All physicians contracted
Healthy Equations - Needs Referral: ARC - All physicians contracted
HealthSmart PPO - All physicians contracted through SPHN
HMO Blue - Dr. BUSHORE TAKING NEW PATIENTS - NEEDS Dr Specific REFERRAL; Not Participating: Farady, Kaiser & Jackson; Dr. Curry's Panel closed to new patients
Humana Military HMO - Must have out-of network referral faxed over first, physician specific
Humana Military PPO - Out-of-Network. Patient will pay greater portion of cost share.
Humana Medicare Advantage - All physicians participating - no referral
Humana ChoiceCare - All physicians contracted
Humana Emphesys - All physicians contracted
Humana PPO, Humana ASO, Humana Open Access - All physicians contracted
Humana Freedom - All physicians contracted
Humana HMO - All physicians contracted
Humana Preferred PPO and Humana Preferred POS-Open Access - All physicians contracted
John Alden PPO (PHCS) - All physicians contracted with PPO ONLY-NOT OPEN ACCESS/POS
Medcorp - All physicians contracted
Medicaid - See "NHIC"-Triage schedules/No Star plans; No Medicaid for Jackson, Kaiser or Bushore
Medicaid Star Plans - Do not take - We are NOT contracted with Superior or Amerigroup
Medicare - All physicians contracted - Check secondary insurance
Medicare-Humana Advantage - All physicians contracted
Medicare-Railroad - All physicians contracted
Medical Control - All physicians contracted
Mega Life PPO - All physicians contracted
Multiplan/PHCS - All physicians contracted through SPHN
National Healthcare Alliance - All physicians contracted
NHIC - MUST GO TO TRIAGE NURSE TO SCHEDULE-UC NP ONLY
NHIC (Medicaid) - Dr. Jackson, Dr. Kaiser, and Dr. Bushore not contracted
NHIC (Medicaid) - Needs current month's card (letter) at every visit
NHIC-(Superior) - Not on Superior-out of network referral through triage
One Health Plan - Not Participating
PacifiCare HMO - All physicians contracted - Merged with UHC
PHCS POS/Open Access - Not participating
PHCS-PPO - ASO - All Physicians contracted-No Scott & White PHCS
PHCS HMO Plans - Requires referral - All physicians contracted
Preferred Network PPO - All physicians contracted
Project Access/I Care - Scheduled through Triage Nurse
Pronet - All physicians contracted
Railroad Medicare - All physicians contracted
Scott & White Plan - Not contracted-Not even if PHCS
SPHN - All physicians contracted
Seton Health Plan (HMO) - All physicians contracted
SHP - Diocese - All physicians contracted
Seton Chips - Triage Schedules-Limited New Patients
Star Plans - No NHIC Star Plans
Sterling (Medicare) - All physicians contracted
Superior Medicaid - Not Contracted -Triage Schedules - Out-of-network referral
TML PPO - All physicians contracted
Tx True Choice PPO - All physicians contracted through SPHN
TriCare - Is Now HUMANA MILITARY-See HUMANA MILITARY
TRS Care - All physicians Contracted
Unicare - Not Participating
United HealthCare - Global referral - All physicians contracted
USA Managed Care - All physicians contracted through SPHN
UT Select-BCBS - All physicians contracted BUT if change to HMO Blue see "HMO Blue"
UT-HMO Blue - Bushore accepting NPs. Curry EPs only.
Zenith - All physicians contracted - is AMD
