Insurance Confusion Abounds
As if the changes in healthcare are not confusing enough, there are new plans being rolled out with all sorts of names. Some have our office listed as a participating in-network provider when we are not or will not be. Most of these are ACO plans (Accountable Care Organization) even when they don’t say they are.
An ACO is a network of doctors and hospitals who share responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. Examples of these organizations are Banner Health Network, AZ Care Network and Honor Health Accountable Care Organization. We do not feel this system will benefit our patients in the long run and have chosen not to participate in ACOs. Plus, even if we made a decision to join an ACO, the law states we, as a primary care physician (PCP), can only participate in one ACO. This would mean we would have to lose all of our patients who are in other ACOs. In fact, there are so many doctors who feel the way that we do, that the insurance plans do not have enough physicians on their plans to see all of their patients. What they are doing to counteract this is leaving all contracted doctors in the system until they can get enough doctors to join an ACO, like Banner Health Network. That explains why we may still be listed as providers even though we are not on certain plans. Once the insurance companies do get enough doctors on their new ACO plans, they will change the status of the old physicians, like us, to out-of-network. When this happens, you will be assigned to a new PCP who is contracted with an ACO.
We wish there were key words or some easy way to notify you of what your insurance company provides, but sadly, this is a very complicated system that cannot be easily understood. The following is a list of the insurance plans we currently take and those we do not accept. We do offer competitive self-pay rates, which are usually less expensive than the contracted rates with in network physicians.
- Aetna HMO/PPO
- AZ Foundation for Medical Care
- Banner Aetna (Product Names: MultiPlan, Banner Health Network Multi Tier, Open Access, Managed Plus)***These are the only Banner Aetna plans we are contracted with and we are a Tier 2 provider. Effective 1/1/2018
- Blue Cross Blue Shield HMO/PPO
- Cigna/Great West
- MultiPlan/PHCS/Beech Street
- United Health Care
- All AHCCCS (Including UHC Community Plan and HealthNet AHCCCS)
- Aetna Attribution
- Aetna Leap-Banner Health Network
- Aetna Whole Health-Banner Health Network
- AZFMC Compass Coop/Meritus Mutual/CCMHN
- Banner Aetna (Product Name: Banner Health Network) ***We are Tier 2 provider with other Banner Aetna product names. See contracted list above.
- BCBS of Arizona Blue Alliance
- BCBS Select Network-Banner Health Network
- CCN Cigna Local Plus Plans
- Cigna Connect Network
- Coventry Health Care/First Health
- HealthNet Excel Care
- HealthNet Ambetter (Formerly known as Community Care)
- Mayo Health Plan
- One Health
- Plan Pioneer CMS ACO
- UHC (Compass Plus)
- UHC (Navigate)
- University of Arizona Health Plans