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COMMERCIAL INSURANCE PLANS (updated 10/1/2013)

We have contracted with the following insurance plans and are "in-network" providers.  Please see the note below regarding other plans.

Aetna (All commercial Aetna plans)

BeechStreet

BlueChoice of SC(formerly Companion -this is NOT standard BCBS PPO)

Carolina Care Plan (now SuperMed)

CCN

Cigna (all Cigna NC, SC, and national plans)

FirstHealth

GE Health Care Preferred (Humana)

Golden Rule (plans that utilize the UHC provider network)

Great West (PPO and POS plans)

Humana

Kanawha

Mail Handler's

Medcost (All plans)

MultiPlan, Inc.

OneNet (by UnitedHealthCare)

ppoNEXT (now BeechStreet)

Premier Health PPO

Primary Physician Care

Private Healthcare Systems (PHCS)

Provider Select

SuperMed Network

Tricare (all Tricare plans - Prime, Standard, Tricare for Life, etc.)

United HealthCare (UHC) (All commercial UHC plans EXCEPT Core and Navigate-see information below)

USA Managed Care

Wellpath  and SouthCare PPO

 

MEDICARE INSURANCE PLANS

You will receive an in-network benefit level if you have one of the following Medicare or Medicare Advantage plans:

Medicare Part B (original Medicare with or without a supplement)

AARP

Aetna Medicare

BCBS SC MEDICARE (SC only - we are out of network with the NC BCBS Medicare plan)

Care Improvement Plus

Guardian Healthcare

Humana Medicare

MVP Health Care

Railroad Medicare

SecureHorizons

Sterling Health Plans

UnitedHealthcare Medicare

Universal Health Medicare

Windsor Health Plans

Notes regarding Medicare Advantage Plans: We will file your insurance claim for any Medicare Advantage plan, but you are responsible for knowing your coverage limitations if we are outside your Medicare Advantage network. Please call for status if you have questions or a plan that is not listed. 

Notes regarding original Medicare Part B Coverage: If you have original Medicare Part B and a secondary or supplementary insurance, we will file your claim with both of your insurance plans. There is a difference between supplement and secondary insurance. Medicare Supplement insurance is a policy that is purchased to pay either the Medicare deductible or Medicare co-insurance or both and often has a prescription drug benefit. Secondary insurance is typically a retirement benefit that sometimes, but often will not cover the Medicare deductible and/or coinsurance, but generally has a drug benefit. Again, it is up to the patient to understand his or her insurance and its coverage limitations.  The 2011 Medicare annual deductible is $162.00 and coinsurance remains at 20%.

 


 

If the health insurance plan that you have is not listed above, then it is possible that it is administered through a company such as Medcost, PHCS, or other listed third party administrator where we have an in-network contract.  Please call us if you are unsure.

 

Let us know if you have an insurance plan that you would like us to participate in as a preferred in-network provider.  With the exception of BCBS PPO plans (non-Medicare), we don't know of any commercial plans where we are not preferred providers. Please note that we are not contracted with any Workers Comp, Medicaid or official ACA plans.

 

Currently, the only insurance plan in our market that will not negotiate in good faith:

BlueCross BlueShield PPO (BCBS Commercial PPO Plans)

For the time being, we have opted out of the BCBS PPO network.  If you have a BCBS plan other than BlueChoice (Companion) or BlueCross SC Medicare, please click here for more information.

 

BlueCross BlueShield of SC is a private company with over $2.5 billion in annual revenues and over $1 billion in reserves.  Yet they pay physicians far less than government healthcare plans for our military (Tricare) and our Medicare senior citizen recipients as well as all other commercial insurance plans in SC and surrounding states. Some might say that BCBS SC subscriber premiums pay for abnormally high corporate executive compensation and reserves instead of medical care.

 

 

 

 

 

 

** AFFORDABLE CARE ACT PLANS (a.k.a. "Obamacare") Effective 1/1/2014:

 

Our doctors are NOT in-network with any of the official Affordable Care Act plans. By design, these plans are "narrow network" plans with a limited provider network.

 

If you have chosen a plan in the state or federal health exchanges, it is important to call your doctors and hospitals to verify that they participate in your particular plan.  

 

We are happy to see any patient who has one of these plans at our standard self-pay rates, but the patient will be required to make payment in full at the time of service and no insurance claims will be filed by us for the visit. 

 

 

 

 

 

 

** UNITED HEALTHCARE "Core" and "Navigate" Plans - Effective 1/1/2014:

 

United HealthCare (UHC) has started marketing two new plans in SC/NC that will be available 1/1/2014 targeted at small businesses.  Core (high deductible plans) and Navigate (HMO gatekeeper plans that require referrals to see any specialist). UHC has communicated that by design, these plans are intended to have a very limited doctor network and they have excluded the majority of their UHC network doctors from these plans.  It appears that these plans were designed to compete with the ACA ("Affordable Care Act" - a.k.a. "Obamacare") plans. If you choose this healthcare plan, be advised that "UHC Providers" are not automatically included in these plans.  We are happy to see any patient who has one of these plans at our standard UHC network rates, but the patient needs to understand that they will be responsible for full payment at the time of service and claims on these plans will be processed out of network.  If you would like Fort Mill Dermatology to be included in these new insurance plans, please contact UHC to let them know. It would be helpful to inform them that we have one of the few board-certified Pediatric Dermatologists in the state. By email: http://www.uhc.com/contact_us.htm By phone: call the customer service number on the back of your insurance card. NOTE THAT WE ARE CONTRACTED WITH ALL OTHER UHC PLANS, BOTH COMMERCIAL AND MEDICARE ADVANTAGE.

 

 

 

 

 

 

 

 

 

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