Review the list of insurance plans that are participating (PAR) with CHOP Primary Care, Harborview/Smithville.

A

• Aetna
  • Choice POS, Choice POS II, Elect Choice
  • Open Access, Health Fund, Health Network, Health Network Option
  • HMO, Managed Choice, Open Choice PPO, QPOS, Select
  • Open Access Aetna Select, US Access, Traditional Choice
  • Chickering Group, Signature Administrators
  • CHOP Preferred Plan- CHOP Employee Plan (POS & CDHP)
  • Savings Plus Managed Choice
• America’s Choice Network
• AmeriHealth (HMO, POS, and PPO for PA, NJ, and DE members)
• AmeriHealth HMO (CHOP Employee Plan)
• AmeriHealth 65
• AmeriHealth Administrators
• Atlanticare AtlantiCare - CHOP Home Care does not participate 

B

• Blue Cross Blue Shield
  • Some Blue Cross Blue Shield plans with Blue Card access may participate with CHOP and its affiliated providers. Contact your BCBS plan to find out if your plan considers the specific CHOP provider to be in-network.
• Blue Cross of California – for Crozer Keystone Health System Employee Plan

C

• Centivo
• CHAMP Va CHAMP Va - CHOP Home Care does not participate
• Cigna (HMO, PPO, POS)
• Cigna LifeSource Transplant Network (pediatric liver program, pediatric heart program, pediatric blood and marrow transplant program)
• Coventry (HMO, HMO Open Access, PPO, POS) - PA, NJ, and DE
• Crozer Keystone Health System Plan — Blue Cross of California

D

• Devon Health Services

E

• Employers Health Network

F

• First Health

G

• Geisinger Health Plans, except St. Luke’s Hospital Employee Priority Care Plus Plan
• Golden Rule

H

• HealthAmerica
• HealthPartners of Minnesota
• H.E.R.E.I.U. Welfare Fund - CHOP Home Care does not participate
• Highmark
• Horizon Blue Cross Blue Shield - All commercial plans
  • CHOP Home Care does not participate with any Horizon Blue Cross Blue Shield plan
• Horizon NJ Health – does not include CHOP Home Care
• Humana ChoiceCare
• Humana Military Services (TRICARE East) - CHOP Home Care does not participate

I

• Independence Blue Cross
• Independence Administrators
• InterGroup
• InterLink Networks

J

• Jefferson Health Plans

K

• Keystone Health Plan East
  • HMO and POS

L

• LifeTrac Networks

M

• Mail Handlers Benefit Plan
• MAMSI Life and Health
• Medical Assistance of NJ
  • CHOP Home Care does not participate
• MultiPlan

N

• NJ Carpenter Fund

O

• OneNet (Alliance)
• Optum Health Networks (Transplant, CHD, Neonatology, Cancer)
• Oxford (Liberty and Freedom networks participate)

P

• PennCare - Personal Choice
• Personal Choice
• Populytics
  • Valley Preferred
• Preferred Care
• Preferred Healthcare/Pennsylvania’s Preferred Health Networks (PPHN)
• Premier Network (by Devon Health Services)
• Private Health Care Systems or PHCS
• Provider Network of America (PNOA) 

Q

• QualCare

T

• TRICARE East (Humana Military Services) - CHOP Home Care does not participate
• Three Rivers Provider Network

U

• United Healthcare 
  • Empire - CHOP Home Care does not participate with this plan
• UPMC, all commercial plans
• US Family Services (Saint Vincent’s Catholic Medical Center) - CHOP Home Care does not participate

An important message regarding insurance, billing and patient financial responsibility

We would like to let you know that the CHOP Care Network of New Jersey and the CHOP physicians who work here are in network with the health plans listed above. If your plan is not listed you will be considered out of network.

• NOT IN NETWORK: Your professional services will be provided on an out-of-network basis. You may have financial responsibility applicable to out-of-network services and may be responsible for costs in excess of your copayment, deductible and coinsurance and those allowed under your plan.
• You may request an estimate of the cost for your scheduled services. This estimate will include the professional fee for your CHOP Care Network providers, absent any unforeseen medical circumstances that may arise. We will provide this by CPT code. You may call 267-426-1467.
• You may be asked to sign a form selecting CHOP and CHOP physicians, knowing that CHOP and CHOP physicians are not in your health plan. This must be signed prior to the appointment.
• IN-NETWORK: You will not be expected to pay any professional fee amounts for Covered Services that are more than your in-network copayment, deductible and coinsurance amounts for covered professional services. If during the course of your visit services are provided that are not covered by your health plan you will be financially responsible for these services.

There is the possibility that other services may be performed during your scheduled procedure or visit with a CHOP Provider. It is also possible that your CHOP Provider may recommend, coordinate or refer you for other services in connection with services provided at the time of your visit to CHOP Care Network. These may include laboratory services or X-rays. We will try to refer this work to providers in your health plan network but this may not always be possible. Please check with your health plan to find in-network providers.

If your plan is self-funded or not a health benefits plan (for example auto, disability, workers compensation, long term care plan) certain services may be provided on an out-of-network basis. The billing limitations described in this letter may not apply and you may have financial responsibility more than allowed in your plan.

We encourage you to contact your health plan directly for more information about your plan, healthcare costs and providers who participate in your health plan.

We know that you have healthcare choices and we appreciate you choosing Children’s Hospital of Philadelphia for your healthcare needs.