Jane Dotson
Valley Medical Center offers a range of insurance options for its patients. The center works with several insurance providers, including Aetna, Cigna, Horizon Blue Cross Blue Shield, and United HealthCare. Patients are advised to consult their insurance providers to confirm their specific coverage and network status. Additionally, Valley Medical Center provides billing and payment procedures information, with separate billing for contracted providers such as surgeons, radiologists, and anesthesiologists. The center also offers financial assistance programs for those without insurance coverage. Understanding insurance coverage and billing processes is essential for patients seeking medical services at Valley Medical Center.
| Characteristics | Values |
|---|---|
| Insurance plans accepted by Valley Medical Group | Aetna, Amerihealth Braven Health, Cigna, Clover Centivo, Horizon Blue Cross Blue Shield of NJ, Horizon NJ Health, Mohawk Valley Health Plan, Great-West Healthcare, Oxford Health Plans, United HealthCare, Veterans Administration Community Care Network, Beech Street Community Care Network, Consumer Health Network, Devon Health Services, First Health, Health Care Payors Coalition, MagnaCare, Multiplan, NJ Urology Group, Qualcare |
| Insurance plans accepted by The Valley Hospital | TRICARE |
| Other | It is the patient's responsibility to check with their insurance provider to determine a healthcare provider's network status |
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What You'll Learn
Valley Medical Center billing and payment procedures
Billing and insurance procedures can be confusing, and Valley Medical Center (VMC) outlines several scenarios on its website to help patients understand their financial obligations.
VMC will send a statement showing any personal financial amount owed after your insurance company has responded with its payment or coverage information. Insured patients who do not have 100% insurance coverage will be offered financial options for remaining balances after insurance payments. VMC also states that you may receive informational statements while your insurance company processes your claim, but you will not be required to make a payment until your portion of the services is determined and sent to you in the form of a bill.
If your visit to VMC is the result of a motor vehicle or non-work-related accident, you will be required to provide all automobile insurance or other third-party liability information within 15 days. VMC will pursue payment for your care from that source before billing your healthcare insurance. Most healthcare insurance policies require that all third parties are billed before they will process your claims.
VMC also provides information regarding billing for work-related incidents. VMC will bill the Washington State Department of Labor & Industry, or other Employer Self Insured Workman’s Compensation programs, and provide information about your accident and health status within the legally required time frames so that you can receive any time loss payments or other benefits.
It is important to note that many doctors, ambulance companies, and labs are separate businesses with their own billing and account procedures, and they may not participate in the same healthcare insurance contracts or offer the same financial options as VMC. If you receive a bill from one of these providers, you should contact them directly. Physician fees, for example, are billed separately and are not included in the hospital bill.
Regarding insurance coverage, it is each patient's responsibility to check with their insurance provider to determine a healthcare provider's network status. Valley Medical Group (VMG) providers accept insurance plans such as Horizon BCBS, Cigna (including Medicare), and United HealthCare, among others. The Valley Hospital and VMG contract separately with insurers, so it is important to verify that your healthcare provider is in-network.
Finally, VMC offers several payment options, including online payment through the VMG patient portal or QuickPay Portal, and provides contact information for any questions or assistance regarding statements or bills received.
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Insurance plans accepted by Valley Medical Group
Valley Medical Group accepts most major health insurance plans, including personal checks and credit cards. The specific insurance plans that are accepted by Valley Medical Group include:
- Horizon BCBS (VPS, Inc./PC is Tier 1 in Omnia. Includes Commercial and Medicare LOB. Includes Medicaid)
- Aetna (excluding Aetna Better Health Medicaid HMO)
- Amerihealth Braven Health (Except Braven Medicare Plus (HMO))
- Cigna (including Medicare)
- Clover Centivo
- Horizon Blue Cross Blue Shield of NJ
- Horizon NJ Health
- Mohawk Valley Health Plan (non-HMO plans only via Valley's CIGNA contract)
- Great-West Healthcare (now part of CIGNA)
- Oxford Health Plans
- United HealthCare (including United HealthCare Community Plan)
- Veterans Administration Community Care Network (CCN)
- Beech Street Community Care Network
- Consumer Health Network (CHN)
- Devon Health Services
- First Health
- Health Care Payors Coalition
- MagnaCare
- Multiplan NJ Urology Group (administered by HealthScope)
- Qualcare
It is important to note that Valley Medical Group's accepted insurance plans are different from those accepted by The Valley Hospital. Additionally, insurance plan coverage may change, so patients are advised to confirm with their carrier or provider's office before seeking treatment.
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Insurance claims and pre-authorisation
The Valley Health System includes Valley Hospital and Valley Medical Group, which contract separately with insurers. The Valley Medical Group accepts insurance plans from several providers, including:
- Horizon BCBS (VPS, Inc./PC is Tier 1 in Omnia)
- Aetna (excluding Aetna Better Health Medicaid HMO)
- Amerihealth Braven Health (excluding Braven Medicare Plus (HMO))
- Cigna (including Medicare)
- United HealthCare (including United HealthCare Community Plan)
- Veterans Administration Community Care Network (CCN)
- Oxford Health Plans
The Valley Hospital also accepts insurance from the above providers, but it is important to check with your insurance provider to determine if a specific healthcare provider is included in their network.
During the pre-authorisation process, the insurance company may suggest lower-cost alternatives to the requested treatment or medication. If the requested treatment or medication is not pre-authorised, the patient may have to pay more out of pocket. Patients can help tackle issues with pre-authorisation by being aware of their rights and knowing what treatments and medications their insurance covers.
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Patient rights and protections against surprise billing
Surprise billing, or receiving an unexpected bill from an out-of-network provider or facility, can cost patients thousands of dollars. In the US, the No Surprises Act, which came into effect on January 1, 2022, protects patients with health insurance from surprise billing under certain circumstances. The Act supplements state surprise billing laws, creating a "floor" for consumer protections against surprise bills from out-of-network providers.
The No Surprises Act bans surprise bills for most emergency services, even if they are received out-of-network and without prior authorization. It also bans out-of-network cost-sharing for most emergency and some non-emergency services, meaning patients cannot be charged more than in-network cost-sharing for these services. In addition, the Act bans out-of-network charges and balance bills for certain additional services, such as anesthesiology or radiology, provided by out-of-network providers as part of a patient's visit to an in-network facility.
Under the No Surprises Act, healthcare providers and facilities must give patients an easy-to-understand notice explaining the applicable billing protections and who to contact if they have concerns. Patients who are uninsured or choose not to use their health insurance for a service can often get a good faith estimate of the cost of their care upfront. If a patient disagrees with their bill, they may be able to dispute the charges.
If a patient has health insurance and their health plan denies all or part of a claim for service, they can appeal that decision. The plan documents will contain information on the review process and how to request a review.
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Valley Medical Center's relationship with insurance providers
Valley Medical Center (VMC) maintains a relationship with several insurance providers. VMC is a part of the Valley Health System, which includes The Valley Hospital and Valley Medical Group, which contract separately with insurers. As such, the insurance plans accepted by Valley Medical Group are different from those accepted by The Valley Hospital.
VMC has a contract with UW Medicine, which has a contract with Aetna for Medicare Advantage and Commercial services until May 31, 2025, unless renewed. VMC also accepts insurance from those with TRICARE®, a registered trademark of the Department of Defense, Defense Health Agency.
VMC also accepts insurance from those covered by the Washington State Department of Labor & Industry, or other Employer Self Insured Workman’s Compensation programs. VMC will provide information about a patient's accident and health status within the legally required time frames so that they can receive any time loss payments or other benefits associated with work-related incidents.
VMC also works with several contracted providers, including surgeons, radiologists, anesthesiologists, and pathologists, who will bill patients separately.
VMC also provides a financial assistance program for those without insurance coverage.
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Frequently asked questions
Valley Medical Group accepts insurance plans from providers including Horizon BCBS, Aetna, Amerihealth, Cigna, and United HealthCare.
Valley Medical Center accepts insurance from a variety of providers. It is the patient's responsibility to check with their insurance provider to determine whether their healthcare provider's network status.
You can contact Valley Health's Payer Contracting team at [email protected] or 540-536-6140.
You can contact The Valley Health System's Managed Care Department directly at 702-894-5700.
You can contact Hospital Patient Financial Services at 1.855.826.1540 or 425.690.3578, option 5.
