Is Valley in Your Health Plan?
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Unraveling the Medicare mazeVMC的GoldenCare健康和保健计划为老年人提供信息丰富的研讨会，帮助您选择最佳的医疗保险计划和补充保险. |
If we are contracted with your insurance company, 你的保险公司处理完你的索赔后，我们会给你开账单. 我们的账单清单列出了相关费用，并清楚地说明了我们从你们的保险公司收到的任何付款.
If you do not have insurance coverage, you will need to make financial arrangements prior to receiving services at VMC; Please read about our Financial Assistance program options.
Notice to Medicare Beneficiaries
对于我们的医疗保险人群，请仔细审查您的医疗保险福利. 您有责任了解您的医疗保险福利和非保险服务. You will be financially responsible for any non-covered services. 医疗保险非覆盖服务的一个例子是在医院门诊期间提供给您的任何自行服用的药物. If you have Medicare supplemental insurance, VMC will also submit a bill to them for all services, including the non-covered Medicare charges. If no drug coverage exists, 或者你的补充医疗保险计划也拒绝提供不包括在内的服务, 这些药物的费用将由您个人承担.
For a more complete explanation, please review the flyer, "Medicare--Am I Covered?"
Pre-authorization
有些程序可能需要您的保险公司的预先授权或提前做出其他财务安排. Please review Pre-authorization Requirements and read our Guidelines for Preparing for Your Stay at VMC.
Billing
- About VMC hospital bills
- About VMC clinic bills
- About bills from contracted providers (e.g. 其他医生、x光/成像、麻醉学、救护公司、实验室等.)
- Special Note: 有关心理健康服务的提供和覆盖范围的详细信息，请致电1.800.469.3979.
Know your rights under the Balance Billing Protection Act
| 本通知适用于商业计划(全保商业计划), PEBB, SEBB和自筹资金的雇主赞助的选择)，他们被登记在余额账单保护法(BBPA)中，提供特定的服务. BBPA不适用于医疗保险或医疗补助，这两种保险对参保人有其他保护. 要确认此通知适用于您的健康计划，请与您的保险公司联系. |
Beginning January 1, 2020, 如果你在网络内的医院接受紧急护理或在网络外的门诊手术机构接受治疗，华盛顿州法律保护你不受“意外账单”或“余额账单”的影响.
什么是“意外账单”或“余额账单”，什么时候发生?
根据你的健康计划，你要承担一定的费用分摊额. This includes copayments, coinsurance and deductibles. 如果你去看医疗服务提供者或去不属于你的计划的医疗服务提供者网络的机构，你可能会有额外的费用或要为整个账单负责.
一些供应商和设施没有与你的保险公司签署合同. They are called ‘out-of- network’ providers or facilities. 他们可以根据你的保险公司支付的金额和供应商或机构支付的金额之间的差额向你开出账单. This is called ‘surprise billing’ or ‘balance billing.’
Insurers are required to tell you, via their websites or on request, which providers, hospitals and facilities are in their networks. And hospitals, 手术机构和提供者必须在他们的网站上或根据要求告诉你他们参与了哪些提供者网络.
When you CANNOT be balance billed:
Emergency Services
即使你在华盛顿的网络外医院接受急救服务，你最多也只能为你的计划支付网络内费用分摊额, 俄勒冈州或爱达荷州，或者医院外的医疗机构. 提供商和设施无法为您结清紧急服务账单.
网络内医院或门诊外科设施的某些服务
When you receive surgery, anesthesia, pathology, radiology, laboratory, 或者，当你在网络内医院或门诊外科机构时，由网络外提供者提供的住院医生服务, the most you can be billed is your in-network cost-sharing amount. These providers cannot balance bill you.
在不允许余额结算的情况下，还适用以下保护:
- 您的保险公司将直接支付网络外的供应商和设施. You are only responsible for paying your in-network cost-sharing.
- Your insurer must:
- 将你的费用分摊责任建立在支付给你所在地区的网络内供应商或设施的费用上，并在你的福利解释中显示这个金额.
- 将您为紧急服务或某些网络外服务(如上所述)支付的任何金额计入您的免赔额和自付限额.
- 您的供应商、医院或设施必须在30个工作日内退还您多付的任何金额.
- A provider, hospital, 门诊手术机构不能要求你限制或放弃这些权利.
If you receive services from an out-of-network provider, hospital or facility in any OTHER situation, you may still be balance billed, or you may be responsible for the entire bill.
This law does not apply to all health plans. 如果你从雇主那里获得健康保险，法律可能不会保护你. 请务必检查您的计划文件或与您的保险公司联系以获取更多信息.
If you believe you’ve been wrongly billed, 向华盛顿州保险专员办公室提出投诉 www.insurance.wa.gov or call 1-800-562-6900.
请参阅下面的健康运营商网络一栏，了解Valley是否与您的网络一起参与《正规手机网赌软件》.
| Health Plan | Health Carrier Networks | Does Valley Medical Center's hospital participate? |
Does Valley Medical Center's clinic network participate? |
| 6 Degrees Health | No - Not Contracted | No - Not Contracted |
| Aetna Health(包括First Health/ convtry，不包括Aetna Whole Health) | Open Choice, Managed Choice, Elect Choice, Aetna Premier Care Network, Aexcel等 & w/o Aetna Managed Pharmacy Network | Yes | Yes |
| Centivo | Cigna PPO Network, Embright Network | Yes | Yes |
| CIGNA (including former Great West and One Health plans) | WA PPO-PPA Direct Network, WA OAP Direct Network, WA PPO-PPA Direct Network w/National Pharmacy Network, WA OAP Direct w/National Pharmacy Network, Cigna LocalPlus of WA Network, Cigna Local Plus of WA w/National Pharmacy Network | Yes | Yes |
| Cigna Behavior Health Services | EverNorth | No | No |
| DSHS-Medicaid-Apple Health | Yes | Yes |
| DSHS Family Planning Only | Covers only contraception services in clinic; excludes all other medical services; excludes infants. | Covers only contraception services in clinic; excludes all other medical services; excludes infants. |
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(DSHS) Medicaid Managed Care Plans |
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| Community Health Plan of Washington | Yes | No | |
| Coordinated Care (Centene) | Yes | Yes | |
| Molina Health Care | Yes | Yes | |
| United Healthcare Community Health Plan |
Yes | Yes | |
| Wellpoint Apple Health (Formerly Amerigroup) | Yes | Yes | |
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Exchange Products |
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| Molina Healthcare of Washington | Molina Choice, Constant Care and Core Care, Cascade Standard | Yes | Yes |
| Premera Heritage Signature | Preferred, Cascade | Yes | Yes |
| BridgeSpan Health Company | Bronze Care on Demand, Bronze Essential, Bronze HDHP, Cascade | Yes | Yes |
| United HealthCare | Bronze Value, Gold Value, Silver Advantage, Cascade | Yes | Yes |
| Regence Blue Shield | 个人和家庭网络，Cascade，按需护理青铜，Bronze Essential, 2000年金牌 | Yes | Yes |
| Regence Blue Shield | Cascade Care East Side Health Network | No | No |
| Pacific Source (Accessed through First Choice Health Benefit) | Navigator, Cascade | Yes | Yes |
| Community Health Network | Cascade, Cascade Select | Yes | No Primary Care, Yes Specialty Care with referral |
| Coordinated Care (Ambetter) | Cascade Select, Cascade, Clear, Essential, Secure | No | No |
| Kaiser Foundation Health Plan of the Northwest | Cascade, WA Bronze, WA Gold, WA Silver | No | No |
| Federal Employees: Aetna Health, Alliance Health Plan, AWPU Health Plan, Blue Cross and Blue Shield, GEHA Benefit Plan, Mail Handlers, and PacifiCare | Yes | Yes |
| First Choice Health Network | First Choice Health Network | Yes | Yes |
| Kaiser Foundation Health Plan | Access PPO and Options Federal plans | Yes | Yes |
| Kaiser Foundation Health Plan | Summit PPO Network | Tier 2 Benefit | Tier 2 Benefit |
| Kaiser Foundation Health Plan | 核心/HMO, Medicare Advantage, Elect PPO, Core Select和Connect/Virtual Plus | No | No |
| Labor & Industries | Yes | Yes |
| March Vision | Yes | Yes |
| Medicare | Yes | Yes |
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Medicare Managed Care Plans |
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| Aetna Medicare Advantage | Yes | Yes | |
| Medicare Wellpoint Medadvantage (Formerly Amerigroup) |
Yes | Yes | |
| Humana / Honor / Choice Care PPO/HMO |
Humana Medicare, Honor/Choice Care/PPO/HMO, Optum Care Network | Yes | Yes |
| Molina Medicare Complete Care | Select; D-SNP | Yes | Yes |
| Molina Medicare Choice Care | No | No | |
| Premera Medicare Advantage | Yes | Yes | |
| UnitedHealthcare Medicare MedAdvantage |
Yes | Yes | |
| Medicare Managed Care Plan Optum Care Network |
Yes | Yes | |
| Regence Blue Advantage HMO | Yes | Yes | |
| Regence Medicare Advantage PPO | Yes | Yes | |
| CHPW | Yes | No | |
| PacificSource Medicare | Yes | Yes | |
| WellCare Medicare HMO & PPO | Yes | Yes | |
| PEBB | State of Washington & other municipalities and government agencies | Yes | Yes |
| Premera Blue Cross | Global, Heritage, Heritage and Dental Choice, Heritage Prime, Heritage Signature, Heritage Signature and Dental Choice, Individual Signature, LifeWise Assurance Co., LifeWise Health Plan of WA Preferred |
Yes | Yes |
| Premera Blue Cross | LifeWise Primary, LifeWise Cascade Care | No | No |
| Private Health Care Systems / Multiplan | Yes | Yes |
| Regence Blue Shield | Participating, Preferred, Individual & 家庭网络，真实价值，UW医学AHN，高性能网络(HPN) | Yes | Yes |
| SEBB | school districts state wide | Yes | Yes |
| Tricare | Yes | Yes |
| Triwest | Yes | Yes |
| Uniform Medical Plan | Yes | Yes |
| United Health Care/United Health Networks | Charter, Choice, Options, Signature Value, Select | Yes | Yes |
| United Health Care/United Health Networks | Navigate, Core | Yes | No |
* The contracted health plans listed above are subject to change.