Is Valley Medical Center in Your Health Plan?

Valley Medical Center and its clinics contract with more than two dozen health plans, listed below.*

 

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If we are contracted with your insurance company, we will bill you after your insurance company has processed your claim. Our billing statement lists relevant charges and clearly notes any payments we received from your insurance company. 

If you do not have insurance coverage, you will need to make financial arrangements prior to receiving services at VMC; Please read about our Financial Assistance program options.

Notice to Medicare Beneficiaries
To our Medicare population, please review your Medicare benefits carefully. You are responsible to know your Medicare benefits and non-covered services. You will be financially responsible for any non-covered services. An example of a Medicare non-covered service would be any self-administered drugs provided to you during a hospital outpatient hospital visit. If you have Medicare supplemental insurance, VMC will also submit a bill to them for all services, including the non-covered Medicare charges. If no drug coverage exists, or the non-covered services are also denied by your supplemental Medicare plan, payment for those drugs will be your personal financial responsibility.

For a more complete explanation, please review the flyer, "Medicare--Am I Covered?"

Pre-authorization

Some procedures may require pre-authorization from your insurance company or making other financial arrangements in advance. Please review Pre-authorization Requirements and read our Guidelines for Preparing for Your Stay at VMC.

 Billing

Know your rights under the Balance Billing Protection Act

This notice applies to commercial plans (fully insured commercial, PEBB, SEBB and opted-in self-funded employer-sponsored) that are enrolled into the Balance Billing Protection Act (BBPA) for specific services.  The BBPA does not apply to Medicare or Medicaid, which have other protections for enrollees. To confirm this notice applies to your health plan please contact your insurance carrier.


Beginning January 1, 2020, Washington state law protects you from ‘surprise billing’ or ‘balance billing’ if you receive emergency care or are treated at an in-network hospital or outpatient surgical facility by an out-of-network provider.

What is ‘surprise billing’ or ‘balance billing’ and when does it happen?

Under your health plan, you’re responsible for certain cost-sharing amounts. This includes copayments, coinsurance and deductibles. You may have additional costs or be responsible for the entire bill if you see a provider or go to a facility that is not in your plan’s provider network.

Some providers and facilities have not signed a contract with your insurer. They are called ‘out-of- network’ providers or facilities. They can bill you the difference between what your insurer pays and the amount the provider or facility bills. This is called ‘surprise billing’ or ‘balance billing.’

Insurers are required to tell you, via their websites or on request, which providers, hospitals and facilities are in their networks. And hospitals, surgical facilities and providers must tell you which provider networks they participate in on their website or on request.

 

When you CANNOT be balance billed:

Emergency Services

The most you can be billed for emergency services is your plan’s in-network cost-sharing amount even if you receive services at an out-of-network hospital in Washington, Oregon or Idaho or from an out-of- network provider that works at the hospital. The provider and facility cannot balance bill you for emergency services.

Certain services at an In-Network Hospital or Outpatient Surgical Facility

When you receive surgery, anesthesia, pathology, radiology, laboratory, or hospitalist services from an out-of-network provider while you are at an in-network hospital or outpatient surgical facility, the most you can be billed is your in-network cost-sharing amount. These providers cannot balance bill you.


In situations when balance billing is not allowed, the following protections also apply:

  • Your insurer will pay out-of-network providers and facilities directly. You are only responsible for paying your in-network cost-sharing.
  • Your insurer must:
    • Base your cost-sharing responsibility on what it would pay an in-network provider or facility in your area and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or certain out-of-network services (described above) toward your deductible and out-of-pocket limit.
     
  • Your provider, hospital, or facility must refund any amount you overpay within 30 business days.
  • A provider, hospital, or outpatient surgical facility cannot ask you to limit or give up these rights.

 

If you receive services from an out-of-network provider, hospital or facility in any OTHER situation, you may still be balance billed, or you may be responsible for the entire bill.

This law does not apply to all health plans. If you get your health insurance from your employer, the law might not protect you. Be sure to check your plan documents or contact your insurer for more information.

If you believe you’ve been wrongly billed, file a complaint with the Washington state Office of the Insurance Commissioner at www.insurance.wa.gov or call 1-800-562-6900.

 

 

Please see the column Health Carrier Networks below to see if  Valley is contracted with your network in regards to the Balance Billing Protection Act. 

 

Health Plan Health Carrier Networks Does Valley Medical Center's
hospital participate?
Does Valley Medical Center's
clinic network participate?
Aetna Health (including First Health/Conventry, excluding Aexcel and Aetna Whole Health) Open Choice, Managed Choice, Elect Choice, Aetna Premier Care Network,  all w & w/o Aetna Managed Pharmacy Network Yes Yes
Choice Care   Yes Yes
CIGNA (including former Great West and One Health plans) WA PPO-PPA Direct Network, WA OAP Direct Network, WA PPO-PPA Direct Network w/National Pharmacy Network, WA OAP Direct w/National   Pharmacy Network, Cigna LocalPlus of WA Network, Cigna Local Plus of WA w/National Pharmacy Network Yes Yes
DSHS-Medicaid-Apple Health   Yes Yes
DSHS Family Planning Only   Covers only contraception services in clinic; excludes all other medical services; excludes infants. Covers only contraception services in clinic; excludes all other medical services; excludes infants.

(DSHS) Medicaid Managed Care Plans

   Amerigroup

   Community Health Plan of Washington

   Coordinated Care (Centene)

   Molina Health Care

   United Healthcare Community Health Plan
 

 

Yes

Yes 

Yes

Yes

Yes

 

Yes

No

Yes

Yes

Yes

Exchange Products

   Molina MarketPlace

   Premera Heritage Signature

   Regence Bridgespan – Real Value and UW Medicine EPO only

 

 

Yes

Yes

Yes

 

Yes
 
Yes
 
Yes

Federal Employees: Aetna Health, Alliance Health Plan, AWPU Health Plan, Blue Cross and Blue Shield, GEHA Benefit Plan, Mail Handlers, and PacifiCare   Yes Yes
First Choice Health Network First Choice Health Network Yes Yes
Kaiser Foundation Health Plan  Core (HMO), Medicare Advantage HMO, Sound Choice, Custom Networks No No
Kaiser Foundation Health Plan  Elect PPO, Options POS, Omni PPO Yes as out-of-network benefit. Yes as out-of-network benefit.
Kaiser Foundation Health Plan Access PPO Yes Yes
Health Care Authority/Uniform Medical Plan   Yes Yes
Labor & Industries   Yes Yes
Managed Health Network   Yes Yes
March Vision   Yes Yes
Medicare   Yes Yes

Medicare Managed Care Plans

   Aetna Medicare Advantage

   Amerigroup Medicare Advantage

   Humana / Honor / Choice Care PPO/HMO
   (Medicare Managed Care Plan)

   Molina Medicare Options Plus     

   Premera Medicare Advantage –

   UnitedHealthcare Medicare Managed Care Plan

   Regence Blue Advantage HMO

   Regence Medicare Advantage PPO

   CHPW

PacificSource Medicare

WellCare Medicare HMO & PPO

 



Yes

Yes

Yes


Yes

Yes

Yes


Yes

Yes

Yes

Yes

Yes



Yes

Yes

Yes


Yes

Yes

Yes


Yes

Yes

No

Yes

Yes

Premera Blue Cross Global, Heritage, Heritage and Dental Choice, Heritage Prime, Heritage Signature, Heritage Signature and Dental Choice, Individual Signature, LifeWise Assurance Co., LifeWise Health Plan of WA Preferred Yes Yes
Premera Blue Cross      LifeWise Primary No No
Private Health Care Systems / Multiplan   Yes Yes
Regence Blue Shield Participating, Preferred, Individual & Family Network, Real Value, UW Medicine Yes Yes
Tricare   Yes Yes
Triwest   Yes Yes
United Health Care/United Health Networks Charter, Choice, Options, Signature Value, Select Yes Yes
United Health Care/United Health Networks      Navigate, Core Yes No

 * The contracted health plans listed above are subject to change.