Haris Ashley
Vanderbilt University Medical Center (VUMC) is an out-of-network participant in several insurance plans, although some insurance carriers include Vanderbilt in their individual plans. Accepted insurance plans vary across different Vanderbilt facilities, and it is recommended that patients verify their coverage with their insurance company. Some of the insurance plans accepted by Vanderbilt Medical Group include Aetna, Cigna, and UnitedHealthcare.
| Characteristics | Values |
|---|---|
| Insurance accepted by Vanderbilt Medical Group | Aetna, Cigna, UnitedHealthcare Group, and more |
| Insurance accepted by Vanderbilt University Medical Center and its affiliates | Several insurance carriers include Vanderbilt in their individual plans |
| Exclusions | Blue Cross Blue Shield Tennessee Medicare Advantage – Blue Advantage, UnitedHealthcare COMPASS (Individual Exchange Plan), UnitedHealthcare Complete (C-SNP) |
| International coverage | Aetna |
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What You'll Learn
Vanderbilt University Medical Center's insurance plans
Vanderbilt University Medical Center (VUMC) is an out-of-network participant in several insurance plans. However, it is important to note that VUMC may be included in some individual plans offered by certain insurance carriers. To confirm coverage, it is recommended that patients verify their insurance plan's specifics with their provider.
Vanderbilt Medical Group, including the Monroe Carell Jr. Children's Hospital at Vanderbilt, does not accept all insurance plans. Notably, Blue Cross Blue Shield Tennessee Medicare Advantage – Blue Advantage is excluded from coverage at VUMC, MCJCHV, and VWCH facilities. Similarly, UnitedHealthcare COMPASS (Individual Exchange Plan) and UnitedHealthcare Complete (C-SNP) are not accepted at VWCH, VBH, and VTHH facilities.
Vanderbilt University Medical Center offers a range of insurance plans for its employees and patients. These plans vary depending on the specific facility and location. For example, the Vanderbilt Bedford Hospital accepts insurance plans such as Aetna, including Aetna Behavioral Health, Aetna Medicare Advantage, and Aetna Select VHAN. It also accepts Cigna products, including PPO, POS, and HMO plans, as well as Cigna Behavioral Health and Cigna-HealthSpring Medicare Advantage.
Additionally, the Vanderbilt Bedford Hospital works with UnitedHealthcare Group, UnitedHealthcare Medicare Complete/AARP, and UnitedHealthcare – HCA employees (with authorization). It is important to note that some plans may have exclusions or require prior authorization for certain services. For instance, adult services under Amerigroup TennCare and UnitedHealthcare Community Plan may require prior authorization.
When it comes to international coverage, Vanderbilt University Medical Center provides travel insurance through Aetna. This insurance requires individuals to pay for services upfront and then submit a claim form to Aetna for reimbursement. In the case of foreign emergency or urgent care, claims are paid at the Aetna in-network level of coverage. Non-emergency claims, on the other hand, are reimbursed at the out-of-network level, provided they are deemed medically necessary.
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Aetna insurance at Vanderbilt
Aetna is listed as one of the insurance providers that cover services at Vanderbilt University Medical Center and its affiliates. However, it is important to note that Vanderbilt may not participate in all products offered by an insurance carrier. Therefore, it is recommended that individuals contact their insurance company to verify their coverage for care delivered at a Vanderbilt facility or physician practice.
For fully benefits-eligible employees at Vanderbilt University, Aetna automatically issues health insurance cards for the Choice CDHP health plan option at the employee-only coverage tier. This plan provides 100% coverage for preventive care and screenings, with no deductible or co-pay required, as long as the service meets the guidelines for preventive care and is not for diagnosis screenings. The Choice CDHP plan also allows individuals to see providers and specialists without a referral and offers a choice of in-network and out-of-network providers.
Aetna also provides coverage for Vanderbilt University employees and patients who are travelling internationally. In case of foreign emergency or urgent care, claims are paid at the Aetna in-network level of coverage. For foreign non-emergency claims, they are paid at the out-of-network level as long as they were medically necessary.
In summary, Aetna insurance is accepted at Vanderbilt University Medical Center and its affiliates, but it is always advisable to verify coverage details with the insurance provider and the specific Vanderbilt facility you plan to visit.
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Cigna insurance at Vanderbilt
Cigna Health Insurance is one of the many insurance plans accepted by the Vanderbilt University Medical Center (VUMC). In 2017, Vanderbilt announced an agreement with Cigna for VUMC's full participation in Cigna Connect, an Affordable Care Act (ACA)-compliant exchange-based individual insurance plan option. This agreement allows individuals who enroll in Cigna Connect to be seen as in-network by Vanderbilt's physicians and receive care at their maximum benefit level.
Vanderbilt University Medical Center and its affiliates are out-of-network participants in some insurance plans, and they may not participate in all products offered by an insurance carrier. Therefore, it is recommended that patients verify their coverage with their insurance company before seeking treatment at a Vanderbilt facility or physician practice.
In addition to Cigna, Vanderbilt also accepts insurance plans such as Aetna, BlueCross BlueShield, UnitedHealthcare, and more. It is important to note that there are specific exclusions for certain facilities, such as the Monroe Carell Jr. Children's Hospital at Vanderbilt, under some insurance plans.
Vanderbilt University also offers its own health insurance plan, known as the Vanderbilt Group Health Plan, which is available to its employees and their dependents. The university also has a spousal coverage fee to encourage spouses to consider the coverage offered by their employers, with a $100 monthly surcharge for those who choose the Vanderbilt University plan.
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UnitedHealthcare insurance at Vanderbilt
Vanderbilt University Medical Center (VUMC) and its affiliates are out-of-network participants in several insurance plans, including UnitedHealthcare. However, it is important to note that Vanderbilt may not participate in all products offered by an insurance carrier. Therefore, it is recommended to verify your specific UnitedHealthcare insurance coverage for care delivered at a Vanderbilt facility or physician practice.
UnitedHealthcare is listed as an excluded insurance provider for several Vanderbilt entities, including the Monroe Carell Jr. Children's Hospital at Vanderbilt. Specifically, UnitedHealthcare COMPASS (Individual Exchange Plan) and UnitedHealthcare Complete (C-SNP) are excluded insurance plans for VWCH, VBH, and VTHH facilities.
On the other hand, for Vanderbilt students, UnitedHealthcare (UHC) will be the carrier for the Student Health Insurance Plan (SHIP) starting August 12, 2024. This plan is available to all undergraduate, graduate, and professional students, with the Student Health Center (SHC) serving as the primary care provider (PCP). Students can utilize UnitedHealthcare's Provider Search Tool to locate in-network providers and ensure they receive the best benefit coverage.
In summary, while UnitedHealthcare is listed as an excluded insurance provider for certain Vanderbilt entities, it is also the designated carrier for the student health insurance plan offered by Vanderbilt University. It is always advisable to consult with your insurance company and Vanderbilt facilities directly to confirm coverage details and ensure a clear understanding of your specific insurance plan's inclusions and exclusions.
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Insurance plans for Vanderbilt employees
Vanderbilt University Medical Center (VUMC) is an out-of-network participant in several insurance plans. However, it is important to note that VUMC may not be included in all products offered by an insurance carrier. Therefore, it is recommended to verify coverage with the insurance company before seeking treatment at a Vanderbilt facility.
- Aetna: This includes Aetna Behavioral Health, Aetna Medicare Advantage, and Aetna National Advantage Program. Aetna also provides coverage for Vanderbilt employees travelling internationally, although a claim form must be submitted for reimbursement.
- Cigna: Including Cigna Behavioral Health, Cigna Connect (Nashville market members only), and Cigna SureFit (with certain authorizations).
- UnitedHealthcare: Including UnitedHealthcare Group, UnitedHealthcare Medicare Complete/AARP, and UnitedHealthcare Options PPO.
- Blue Cross Blue Shield Tennessee Medicare Advantage: VUMC is excluded from this plan.
- UnitedHealthcare COMPASS: VUMC is excluded from this individual exchange plan.
- CHIPRA (Children's Health Insurance Program Reauthorization Act): Allows special enrollment rights for qualified Vanderbilt Group Health Plan members.
- Spousal Coverage: Vanderbilt offers a spousal coverage fee to encourage spouses to consider the coverage offered by their own employers. A $100 per month fee is charged if the Vanderbilt University plan is preferred.
It is important to note that insurance plan acceptance may vary depending on the specific Vanderbilt facility or location. Therefore, it is always recommended to verify coverage with the insurance company and confirm the accepted plans at the specific Vanderbilt location.
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Frequently asked questions
Vanderbilt Medical Group is an in-network participant in several local and national health insurance plans. Some of the accepted insurance providers include:
A:
- Aetna (Excluding First Health, except Medical Mutual of Ohio)
- Cigna (Includes PPO, POS, and HMO products)
- UnitedHealthcare Group
Vanderbilt University Medical Center and its affiliates are out-of-network participants in Blue Cross Blue Shield Tennessee Medicare Advantage insurance plans.
Vanderbilt Health recommends Aetna for international travel as it covers foreign emergency/urgent care claims at the in-network level of coverage.
