Our Participating Plans

Please note, the information provided here is as we understand it at this time.  You should always verify your benefits with your plan before making appointments.   

Understanding your insurance:

INSURANCE PLAN NAME VS. NETWORK...  Please have your insurance cards available when you call to make your appointment.  It has become more complicated than it used to be to determine if we participate in your plan.  Even if we have a contract with a payor, there could be some exceptions, depending on the network being utilized.  We may need to ask you for some information from your card.  While it is your responsibility to make sure you go to a participating provider, we will help as much as possible to figure this out, but the best way to verify that we are in network is for you to check directly with your plan.

Hint:   If you are shopping on healthcare.gov, after you select a plan on the Marketplace, you will have the option to click on the Provider Directory to search for us as a provider.  Just click on 'quick link' to get the the provider search.

REFERRALS:  If your plan requires that you get a referral,  you are responsible for requesting the referral from your primary care physician and for making sure that we receive the referral prior to your visit.  

Please scroll down to find information about...

  • Affordable Health Care/MarketPlace plans available for our area in 2020.  
  • A list of plans that we accept.  Exclusions and referral requirements are noted in red.
  • Medicare and Medicare Supplement information

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Plans available on the Marketplace in 2020:   
This is a list of plans offered through the MarketPlace for 202, and our participation status in those plans.  

Cigna Connect is offered both on and off the marketplace.  We do participate in all of the Cigna Connect plans.

Ambetter offers several options both on and off the Marketplace.  We do not participate in any version of the AmBetter plans and they will not provide benefits in our office.

WellFirst offers several options both on and off the Marketplace.  We do not participate in any version of the WellFirst plans and they will not provide benefits in our office. & REFERRAL REQUIREMENTS

We do accept these plans:

  • AARP Medicare Complete Choice PPO  we are not contracted, but the plan provides out-of-network benefits.  Excludes AARP Medicare Complete HMO. You will have no benefits with the HMO plan in our office.
  • Aetna PPO
  • Aetna HMO  requires referral 
  • Aetna Coventry Gold Advantage (Medicare plan)   requires referral 
  • Aetna Coventry Advantra HMO  (Medicare plan)   requires referral 
  • Aetna Coventry Advantra PPO (Medicare plan)
  • Anthem BCBS; Our Participating Networks include:  Blue Access, Blue Access Choice, Blue Preferred, Traditional.  excludes:  Pathway;  Pathyway X;  Direct Access;  Federal Preferred HMO;  Multi-State;  Anthem Mercy Health  
  • Baxter Regional Health Plan PPO
  • Beech Street PPO
  • Best Doctors Inc
  • BCBSMI UAW  Retiree Medical Benefits Trust Medicare Advantage PPO  (No contract is required, so if you have this plan, you can see us, or any doctor who participates with traditional Medicare.)  excludes BCBS UAW HMO. You will have no benefits with the HMO plan in our office.
  • Carpenters  processed by Meritain  
  • Cigna GWH Plans   requires referral
  • Cigna HMO    requires referral 
  • Cigna Open Access, Open Access Plus (OAP), Choice Fund OA Plus with CareLink
  • Cigna PPO, Choice Fund PPO, Surefit
  • Cigna POS
  • Cigna Connect Network   referral is recommended for best patient benefit, but not required.  
  • Coventry Gold Advantage (Medicare plan)   requires referral 
  • Coventry Advantra HMO  (Medicare plan)   requires referral 
  • Coventry Advantra PPO (Medicare plan)
  • Coventry    excludes Carelink, Select and Focused Care HPN
  • Coventry HMO   requires referral  
  • Coventry PPO
  • Coventry POS  
  • Coventry CMR   
  • District 9
  • First Health Coventry National
  • Golden Rule
  • Healthlink HMO/POS
  • Healthlink PPO
  • HFN Inc.
  • Humana Choice Care
  • IBEW processed by Cigna
  • Indiana Roofers processed by HealthLink
  • Liberty Healthshare
  • Medicare (traditional) and Rail Road Medicare
  • Medicare Complete PPO  (by UHC)  excludes any Medicare Complete HMO plan.  You will have no benefits with the HMO plan in our office. 
  • Medicare Supplement plans.. If your secondary insurance card has the words 'Medicare Supplement' on it... you will be covered.  It is designed to be used with your traditional Medicare card. 
  • MultiPlan
  • NALC processed by Cigna
  • Painters processed by HealthLink
  • PHCS (Private Healthcare Systems)
  • Plumbers processed by Meritain
  • Sheet Metal processed by Meritain
  • UFCW processed by Meritain
  • UMR 
  • Union Pacific Railroad
  • United HealthCare Group Medicare Advantage PPO  (No contract is required, so if you have this plan, you can see us, or any doctor who participates with traditional Medicare.)  excludes United HealthCare Group Medicare Advantage HMO.  You will have no benefits with the HMO plan in our office.
  • United HealthCare  All Savers
  • United HealthCare Choice and Choice Plus
  • United HealthCare Charter   requires referral
  • United HealthCare Compass   requires referral
  • United HealthCare Core
  • United HealthCare Navigate   requires referral
  • USA Managed Care Organization

Please note, the information provided here is as we understand it at this time.  You should always verify your benefits with your plan before making appointments.   


About Medicare and Medicare Supplement Plans:

If you have traditional Medicare as primary insurance, and your secondary insurance card has "Medicare Supplement" written on it, then you have a  Medicare Supplement plan.   It is designed to work with Medicare .  If Medicare approves your charges, then the supplement plan will also cover your charges. Deductibles may still apply.

 excepted MEDICARE PLANS     
 
EXCLUSIONS (no coverage) & REFERRAL REQUIREMENTS

  • AARP Medicare Complete Choice PPO  we are not contracted, but the plan provides out-of-network benefits.  Excludes AARP Medicare Complete HMO. You will have no benefits with the HMO plan in our office.
  • Aetna Coventry Gold Advantage (Medicare plan)   requires referral 
  • Aetna Coventry Advantra HMO  (Medicare plan)   requires referral 
  • Aetna Coventry Advantra PPO (Medicare plan)
  • BCBSMI UAW  Retiree Medical Benefits Trust Medicare Advantage PPO  (No contract is required, so if you have this plan, you can see us, or any doctor who participates with traditional Medicare.)  excludes BCBS UAW HMO. You will have no benefits with the HMO plan in our office.
  • Coventry Gold Advantage (Medicare plan)   requires referral 
  • Coventry Advantra HMO  (Medicare plan)   requires referral 
  • Coventry Advantra PPO (Medicare plan)
  • Medicare (traditional) and Rail Road Medicare
  • Medicare Complete PPO  (by UHC)  excludes any Medicare Complete HMO plan.  You will have no benefits with the HMO plan in our office. 
  • Medicare Supplement plans.. If your secondary insurance card has the words 'Medicare Supplement' on it... you will be covered.  It is designed to be used with your traditional Medicare card. 
  • United HealthCare Group Medicare Advantage PPO  (No contract is required, so if you have this plan, you can see us, or any doctor who participates with traditional Medicare.)  excludes United HealthCare Group Medicare Advantage HMO.  You will have no benefits with the HMO plan in our office.

 


This is a list of plans that we DO NOT participate in that patients frequently ask about. This is not a complete list of non-par plans. 

Essense
Exclusive Choise
SSM,  SSM CoreSource
Mercy Anthem
Medicaid or any Medicaid HMO/PPO Plans|
TriCare/Champus (other than TriCare for Life Medicare Supplement)

Copyright © 2019 Laura Wagner, MD. All Rights Reserved.
14377 Woodlake Dr. #111 • Chesterfield, MO 63017
314-434-1111