Swedish Edmonds Health Insurance Plans
Swedish Medical Center is included in many health insurance plans. Since insurance plan coverage can change, it's always a good idea to check with your health insurance company for specific information about your plan's choice of hospitals.
Please bring your current insurance card with you each time you come to the hospital for services.
Keep in mind that medical professionals providing services at Swedish/Edmonds may or may not be contracted with the same insurance plans as the hospital.
Medical insurance policies vary on which services are covered. If you have a question about what your insurance will cover for a service or procedure or how a claim was paid, please contact your insurance company or review your benefits handbook.
For personal injury claims covered by motor vehicle insurance or a homeowner’s policy, please provide complete and accurate information for us to submit a claim. We bill third-party carriers as a courtesy; however, the patient remains responsible for the entire balance.
Professional Contract List for SMG, MJM, Pet C/T and First Hill Diagnostic Imaging:
Aetna: All Aetna programs are accepted, with this exception:
• Aetna's Aexcel Network is comprised of select number of specialties. As of 1/1/12, Swedish is designated for cardiology, general surgery, neurology, & orthopedics. Other Swedish groups are considered non-Aexcel providers
Amerigroup: Swedish Medical Group is contracted with Amerigroup effective 11/1/12 for HO and BHP. MJM will be contracted shortly.
Asuris: Contracted through Regence Blue Shield.
Basic Health Plan: Swedish accepts Amerigroup, Molina, Coordinated Care and, for specialty providers only, Community Health Plan of Washington as providers for the Washington State Basic Health Plan.
Beechstreet: Swedish is contracted with the Beechstreet network and accepts most Third Party Administrators using this network. (Contract is not direct – it is through First Choice Health Network).
Cigna: (including Greatwest Health, Seafarers Welfare Plan, NALC, and Masters Mates and Pilots) – All Cigna programs are accepted. Acceptance does not include discount card programs.
Community Health Plan of Washington: Swedish accepts CHPW for specialty care only, including OBGYN. Swedish is not contracted for primary care. Swedish does not accept the Washington Health Plan or the GAU/Direct Line/Medical Care Services program. Minor and James Medical accepts all CHPW products.
Coordinated Care Corportation(CCC): The Basic Health Plan and Healthy Options are accepted.
CorVel: Swedish is contracted with this disability management PPO.
Coventry/Firsthealth: Most products are accepted.
Essence Advantage: Contracted through 12/31/2012
First Choice Health Network: All products are accepted.
Greatwest Healthcare (now owned by Cigna): All GWHC products are accepted.
Group Health Cooperative: Options PPO is accepted. Options, Options Select, Alliant Plus, Alliant Select are accepted with an authorization from GHC, otherwise they will be applied to an out of network benefit. Other GHC products are not accepted. SMG Pinelake accepts all GHC products.
Healthy Options: Swedish accepts Amerigroup, Molina, Coordinated Care, Amerigroup (SMG) and, for specialty providers only, Community Health Plan of Washington as providers for the Medicaid replacement plans Healthy Options and Children’s Health Program (CHIP).
Health Management Network (HMN): Swedish is contracted with this PPO.
Holland American Cruise Lines: Swedish is contracted with Holland America for services related to the Maritime Medical Act.
Humana: All Humana programs are accepted, including Medicare replacements (Choice and Gold) and commercial plans through the Choicecare Network. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group.
Humana Veterans Healthcare Services: Swedish is contracted for specialty services under this demonstration project. Services must be authorized by the VA.
Interplan (now Healthsmart): Most products are accepted.
Interlink Transplant Services: transplant related services only.
Labor and Industry: L&I is accepted, including self insured L&I carriers.
Medicaid: Swedish is contracted with Washington State Medicaid, although zip codes residential zip code restrictions may apply at some primary care locations.
Medicaid Out of State: Swedish 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: Swedish accepts Molina Healthcare. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations.
Multiplan/PHCS: Swedish accepts most plans using the PHCS/Multiplan network.
New West Medicare: Not contracted.
OptumHealth: transplant related services only. Optum is a division of United Healthcare.
PacifiCare (now UnitedHealthcare West): Swedish accepts all commercial and Medicare replacement programs.
PPONext (Concentra): Swedish accepts this PPO through our contract with the Beechstreet Network.
Premera Blue Cross: Swedish accepts all Premera Blue Cross Programs, including BlueCross/BlueShield out of state and Lifewise.
Private Healthcare Systems (PHCS)/Multiplan: Swedish accepts most plans using the PHCS/Multiplan network.
Regence Blue Shield: Swedish accepts all Regence Blue Shield plans including Blue Cross/Blue Shield out of state and Asuris. With the exception of Regence Real Value.
Soundpath Health (formally Puget Sound Health Partners): Swedish is contracted with Soundpath. Patients assigned to an Independent Physician Organization (IPO) may require special authorizations from that group in order to come to Swedish.
Sterling/Windsor: Contracted for the Medicare Advantage plan.
Three Rivers Provider Network: Swedish is not contracted with TRPN, but will bill as a courtesy.
Tricare Prime Standard and Extra: Swedish accepts Tricare plans. Zip code restrictions may apply for primary care locations. Tricare for Life is billed secondary to Medicare and does not require a contract.
United Healthcare (UHC): Swedish accepts most United Healthcare products. Including plans branded through Oxford Healthcare, AARP Medicare Complete, Goldenrule and plans fka PacifiCare, Secure Horizons, and Evercare. Swedish DOES NOT accept United Healthcare Community Plan Basic Health or Healthy Options.
Uniform Medical Plan (now part of Regence Blue Shield): Swedish is contracted.
Veteran’s Administration (VA) Federal Program: Veterans Administration recipients are required by the VA to receive care within the Veterans Administration. However, if a fee service authorization is issued by the VA (or in event of an emergency) Swedish can treat VA patients and bill the VA.
Windsor/Sterling: Contracted for the Medicare Advantage plan.
Accepted Behavioral Health Networks: Some plans use other companies for Mental Health and Chemical Dependency claims. Swedish is contracted with these plans:
- Aetna Health Management
- Cigna Behavioral Health
- Cenpatico (Coordinatedcare)
- Managed Health Network (MHN)
- Wellpoint Behavioral Health
Swedish does not contract with, but will still bill:
- Optum Health