Managed Care

HMOs, PPOs, POSs, EPOs

In Southwest Virginia there are literally dozens of different health plans to choose from!

HCA facilities throughout our region provide a link for the entire Southwestern Virginia corridor. This health care partnership includes over 600 primary care physicians and specialists and provides a support network for virtually any health care service you may require. This network includes: Alleghany Regional Hospital, Clinch Valley Medical Center, Lewis-Gale Medical Center, Montgomery Regional Hospital and Pulaski Community Hospital.

HCA Hospitals - Southwest Virginia participate in all major insurance and managed care programs, as well as form alliances to offer special direct programs to employers in the region.

As your health care partner, HCA Hospitals - Southwest Virginia wants to help you know more about available health plans. There are three basic types of health plans:  Indemnity plans, Preferred Provider Organization (PPO) plans, and Health Maintenance Organization (HMO) plans.

Health Plans - What to Look For

The three types of health plans differ in three major areas:

• How freely you can choose your doctor,  hospital, or other provider.
• To what extent the plan manages utilization of the medical services.
• How much of the costs the plan pays and how much you pay.

I. Indemnity plans are the traditional form of health insurance. There are no restrictions on which doctor, hospital, or other provider you may see. Typically, the insurer pays the provider directly, or in some cases, pays you first and you pay the provider. Most indemnity plans cover a specific percentage of customary and reasonable expenses after a deductible. You are responsible for the balance.

II. A Preferred Provider Organization (PPO) plan encourages you to choose doctors, hospitals, and other providers that participate in the plan. They do this by increasing the portion of the bill they pay if you stay "in network." You may choose to go "out-of-network" at any time, but if you do, you'll have to pay a higher percentage of the provider's bill. Other than physician office visits and emergency care, services must usually be authorized by the PPO before you receive them. Some PPOs have a primary care physician who is responsible for coordinating your medical care.

III. A Health Maintenance Organization (HMO) plan requires that you select a primary care physician (PCP) within the HMO provider network. Your PCP is responsible for meeting your health care needs, either by taking care of you directly or by referring you to other providers (such as specialists). As long as you see your PCP or have an authorized referral to another provider, your out-of-pocket cost is usually a relatively small copayment per visit. But if you chose to go to another provider without a referral--whether or not the providers are in the HMO network--you'll have to pay 100% of the provider's bills. The exceptions are true emergency situations for which you are covered by the plan.

An Exclusive Provider Organization (EPO) plan is very similar to an HMO. With an EPO, you must select a primary care physician or physician gatekeeper who will be responsible for meeting your health care needs. In most EPO plans, as with an HMO, if you choose to go out-of- network, you'll have to pay 100% of the provider's bills.

Point of Service (POS) plan. This is a variation of the HMO and EPO plans and is often described as an open-ended HMO. As with an HMO, you must pick a primary care physician within the network. You pay least when you receive services from your PCP or through an authorized referral to another provider. But unlike an HMO, you may opt out of the network. If you opt out you'll be responsible for paying a portion of the provider's bills.

When you choose a health insurance plan that includes one of our hospitals as a preferred provider, you'll find we meet all your important health care needs.

Primary care physicians -- More and more area residents are having an easier time finding a primary care physician because of the growing number of physicians in the Southwest Virginia Network.

Convenience -- As part of the HCA health care system, physicians and hospital care are closer than you think! HCA facilities provide essential health care services to area residents at many convenient locations throughout Southwest Virginia.

Renowned specialist physicians -- HCA hospitals represent a medical staff of over 600 physicians who are not only recognized for their expertise in primary care (family medicine, obstetrics/gynecology, and pediatrics), but also for specialty care, including cardiovascular, oncology, orthopedic, rehabilitation, neurosciences, and behavioral services, as well as occupational health.

High quality, cost efficient care -- HCA's comprehensive range of services and its commitment to quality and cost-effectiveness have made it a predominant managed care provider in the region. Our hospitals have instituted programs for increased cost- effectiveness and quality in virtually every area of health care.

By calling the Business Development Department at (540) 772-2890, we can help you match your health plan to your health needs.

The following is a list of the many insurance and managed care companies with whom we are contracted:

Medical/Surgical Managed Care Contracts

4-MOST
Aetna
Anthem BC/BS
Anthem - Health Keepers
Champus-Tricare
Cigna
First Health/CCN
Healthcare Savings - Patient's Choice
John Deere Health Plan, Inc.
MAMSI/MDIPA/Alliance/Optimum Choice
Multiplan
One Health Plan
Private Healthcare Systems(PHCS)
Southern Health
United Healthcare
Virginia Premier

Behavioral Health Managed Care Contracts

Blue Ridge Behavioral Healthcare
CHAMPUS/TRICARE
CIGNA Behavioral Healthcare
First Health
Horizon Behavioral Service
Magellan
MAMSI/MDIPA/Alliance/Optimum Choice
Managed Health Network
Medical Control
Menniger Health Systems
One Health Plan
Preferred Mental Health Management Inc.
Private HealthCare Systems (PHCS)
Sentara Mental Health
United Behavioral Health
Value Options