Insurance Information and Tips
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I am a "medical" provider for most insurance/managed care
plans marketed in the Middle Tennessee area as well as a few
"vision" plans which cover examinations for glasses or contact
lenses (see sidebar at right for important details about "vision
coverage"). The list below identifies the plans utilized most
frequently by our patients. Some of these plans require that you obtain
a written referral from a primary care physician (pediatrician, family
practitioner, internist) for a specialist visit to be covered. Many
larger plans have Web pages which can provide helpful information
which may not be available in "sign-up" materials.
Most plans will require you to pay for some part of the visit, either a "co-pay" (commonly in the $ 5 - 20 range) or "deductible" which must be paid before any insurance payments are made. Even after the deductible has been met, many plans require that a percentage of the remaining balance be paid by the patient (20% is a fairly common liability). You should expect to pay any co-pay or deductible amounts at the time of the visit. We file insurance with participating companies and bill for percentage balances remaining after the claim has been processed. |
Vision Coverage Most insurance plans in this area separate eye exams for "refractive" diagnoses from general medical coverage, similar to dental coverage plans. If the company offers vision examination and glasses as a benefit, it may be through a limited number of providers who have been contracted separately for this particular service. Click here for further details. |
|
Company/Plan |
? Primary Care Referral ? |
Web Page |
| ACORDIA NATIONAL | No | http://www.acordia.com/index_flash.html |
| ADMINITRON | Some plans | Not Listed |
| AETNA PPO | No | http://www.aetnaushc.com/ |
| AETNA HMO | Yes | http://www.aetnaushc.com/ |
| AFTRA HEALTH FUND | No | http://www.aftrahr.com/spd/contact.html |
| ALLMERICA | No | http://www.allmerica.com/ |
| AON SELECT | No | http://www.aon.com/home.asp |
| BLUE CROSS/BLUE SHIELD TN | Some plans | http://www.bcbst.com/ |
| BLUECARE | Yes | http://www.state.tn.us/tenncare/ |
| CENTRAL STATES | No |
Not Listed |
| CIGNA HMO | Yes | http://www.cigna.com/consumer/services/healthcare/index.html |
| CIGNA PPO |
No |
http://www.cigna.com/consumer/services/healthcare/index.html |
| CNA | No | |
| COLE VISION | No | |
| COLUMBIA HEALTHCARE NETWORK | Yes |
Not Listed |
| CORESOURCE | Some Plans | http://www.coresource.com/ |
| EYEMED | No | http://www.eyemedvisioncare.com/ |
| FEDERAL EMPLOYEE PROGRAM (FEP-BCBS) | No | http://www.fepblue.org/ |
| FIRST HEALTH | Some Plans | http://www.firsthealth.com/ |
| FORTIS BENEFITS | Some Plans | http://www.fortisbenefits.us.fortis.com/ |
| GALLAGHER BENEFIT ADMIN | No | http://www.gallagher-abow.com/ |
| GREAT WEST | Yes | http://www.gwla.com/ |
| HEALTH NET HMO | Yes | Not Listed |
| HEALTH NET PPO | No | Not Listed |
| HEALTHSOURCE-HMO | Yes | |
| HMO BLUE | Yes | |
| HUMANA / EMPLOYERS HEALTH | No | http://www.humana.com/ |
| JOHN ALDEN | No | http://www.nstarmc.com/health.htm |
| JOHN HANCOCK | No | http://www.unicare.com/ |
| MAILHANDLERS | Some Plans |
Not Listed |
| MEDICARE / EQUICOR | No | http://www.cignamedicare.com/ |
| METLIFE | Some Plans | http://www.metlife.com/ |
| MUTUAL OF OMAHA | No | http://www.mutualofomaha.com/pers_ins/health_AFNxxxxx_main.html |
| NES - VISION | No |
Not Listed |
| NEW ENGLAND | No |
Not Listed |
| NEW YORK LIFE | No | http://www.newyorklife.com/ |
| ONE HEALTH PLAN HMO | Yes | http://www.onehealthplan.com/ |
| PRIVATE HEALTHCARE SYSTEMS (PHCS) | Some Plans | http://www.phcs.com/ |
| PITTMAN & ASSOCIATES | Some Plans |
Not Listed |
| PRINCIPAL FINANCIAL GROUP | Some Plans | |
| PROVIDENT | Some Plans |
Not Listed |
| PRUDENTIAL HMO | Yes | http://www.aetnaushc.com/pruhealthcare/ |
| PRUDENTIAL PPO | No | http://www.aetnaushc.com/pruhealthcare/ |
| SIGNATURE HEALTH ALLIANCE | Some Plans | http://www.signaturehealth.com/ |
| STARMARK | No | http://www.starmarkinc.com/ |
| STATE FARM | No | http://www.statefarm.com/insuranc/health/health.htm |
| THE GUARDIAN | No | http://www.glic.com/home_set.html |
| TRICARE/CHAMPUS | Yes | http://www.tricare.osd.mil/ |
| TRUSTMARK | No | http://www.trustmarkinsurance.com/ |
| UNICARE | Some Plans | http://www.unicare.com/ |
| UNITED HEALTHCARE | No | http://www.unitedhealthcare.com/ |
| WAUSAU | No | http://www.wausau.com/ |
| WILLIAM C BEELER | Some Plans |
Not Listed |
| WILLIS CORROON | Some Plans | |
| XANTUS | Yes |