There are 3 important terms a patient needs to be familiar with regarding managed care plans. First, the Payer is the actual insurance company that collects premiums and pays claims. Secondly, the re-pricer is the managed care plan that processes claims, applies discounts, certifies procedures referrals, and hospitalizations. Thirdly, the plan type such as HMO,PPO,EPO,POS describes how the plan works in terms of reimbursement, referrals, and choosing a primary care physician. For example GenAM-PHCS-PPO is a plan paid by General American Insurance company, managed by PHCS (Private Health Care Systems), and is of a PPO variety.

          I am enrolled in numerous managed care plans. The easiest way to find out if I am enrolled
in your plan is to call our office. Alternately, you can check your provider book, or call the insurance company. The following is a list of plans which I do not contract with.

          Mar 01, 2006: I am now in CIGNA Network for the PPO product

Non Contracted Plans:

Humana HMO( I am in Humana PPO)

Unicare HMO ( I am in Unicare PPO & POS )

Blue Cross HMO ( HMO Illinois ) ( I am in Blue Cross PPO )