Our Participating Plans

Scroll down to find some useful information about insurance and a list of plans we are in, including:

  • MarketPlace (HealthCare.Gov) plans available in our area for 2024
  • Medicare plans that we accept
  • Commercial plans that we accept. 

Here's some things you need to know about your insurance coverage in our office.

  • We are listed as a specialist with insurance plans.
  • We have listed the plans that we participate in. The list of non-par plans does not represent every plan that we are not in, but only those more commonly seen in or area. If you don't see your plan on the list, you should check with insurance company to see if you have restrictions on where you can get care.

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.  See the Referral tab under Insurance.

IN-NETWORK versus OUT-OF-NETWORK participation status.   This is important!

  • When a provider is contracted with an insurance, they are considered in-network, or a  participating provider
  • When a provider is not contracted with an insurance, they are considered out-of-network, or a non-participating provider. This means you will have zero benefits or limited benefits for services provided. It is your responsibility to check with your insurance company for details and limitations for out-of-network services.

PLAN TYPES:   Know your plan. This is really important too!
It is your responsibility to verify your out-of-network benefits with your plan.  *

PPOs - Preferred Provider Organizations:   If we participate - ok.   If we do not participate - it's still ok.
The plan prefers that you use an in-network provider, but they will pay for out-of-network services. Be prepared to pay more for out-of network services. No referrals required. Please verify coverage with your insurance.

POS - Point of Service:  If we participate - ok.   If we do not participate - no benefits. 
You will need to get care from a provider within the network. You will need a referral from your primary care doctor to see a specialist within your network.  

HMOs - Health Maintenance Organizations:   If we participate - ok.  If we do not participate - no benefits.
You will probably be limited to using in-network providers if you expect to have any benefits. And you will probably need a referral to see a specialist.

EPOs - Exclusive Provider Organizations:  If we participate - ok.   If we do not participate - no benefits. 
They want you to exclusively use in-network providers.   

If a plan offers multiple plan types, we have listed the plan types of the insurance to help you determine if we are in-network, or participating.

We have also listed the plans in black and red to show you our participation status in each plan.
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MARKETPLACE PLANS (HealthCare.gov)     2024 
black = we participate    blue = non-par with out of network benefits *   red = non-par (no benefits)    

UnitedHealthcare - Bronze, Silver and Gold 
Aetna CVS offers multiple options.  
Ambetter offers several options on and off the Marketplace.   
Anthem Pathway X offers several options, including Bronze, Silver and Gold.  These plans are offered both on and off the Marketplace.   
Medica offers multiple options.  
Oscar Insurance Company offers multiple options.  
 

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MEDICARE HEALTH PLANS   
black = we participate    blue  = non-par with out of network benefits    red = non-par (no benefits)   

AARP Medicare Advantage from UHC ST: Walgreens PPO NON PAR-with out-of-network benefits *
AARP Medicare Advantage from UHC ST: Walgreens HMO-POS  
Aetna Medicare Gold Advantage HMO
Aetna Medicare SmartSaver Elite HMO 
Aetna Medicare Elite PPO
Aetna Medicare  SmartFit PPO
Aetna Medicare Option 1 HMO-POS,  Option 2 HMO  includes group plans 
Aetna Medicare Discover Value Plus HMO
Aetna Medicare PPO and Premier PPO
Aetna Medicare Assure HMO D-SNP    
Aetna Medicare UnityPoint Health Prime HMO  
Aetna Medicare Prime HMO-POS  
Anthem Medicare Advantage PPO -  NON-PAR - Has out of network benefits *
Anthem Medicare Advantage HMO  
Essense Advantage HMO, Select HMO, Plus HMO 
Essence Advantage Choice PPO and Choice Plus PPO
Humana Gold Plus - any HMO plan
Humana Choice - any PPO and PFFS plan - NON-PAR - There our out of network benefits.*
Medicare (traditional)
RailRoad Medicare
United HealthCare Medicare Advantage PPO - NON-PAR - plan has out of network benefits *
United HealthCare GROUP Medicare Advantage PPO, NON-PAR - plan has out of network benefits *

United HealthCare GROUP Medicare Advantage HMO 
United HealthCare Dual Complete HMO-POS D-SNP 
United HealthCare SNP Plans - including Complete Care, Dual Complete, Care Advantage, Nursing Home Plan

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COMMERCIAL HEALTH PLANS   
black = we participate    blue  = non-par with out of network benefits   red = non-par (no benefits)   

Allsavers (UHC)
Ambetter
Aetna
Aetna Carelink
Aetna CVS Health
Aetna HMO
Anthem Blue Access and Blue Access Choice
Anthem Blue Preferred HMO      referral required
Anthem Blue Preferred PPO
Anthem FEP (Federal)
Anthem Alliance network
Anthem Mercy - If the network listed is Blue Access or Blue Access Choice, we are par.

Anthem Mercy - If the network listed is Alliance, we are non-par. Note: The network is not the same as the plan name.
Anthem Pathway or Pathway X
Anthem Direct Access
Anthem Multi-State
Baxter Regional Health
Beech Street
Best Doctors, Inc. PPO
Champus/Champva

Cigna HealthCare of St., Louis HMO   referral required
Cigna Local Plus      check insurance card regarding referral
Cigna Open Access Plus
Cigna HMO 
Cigna PPO 
Coventry Commercial, National, HMO, PPO, POS
Coventry CMR, self insured ASO, OPM administered
Coventry Select and Carelink
Essence HMO
Exclusive Choice
First Health
Golden Rule
Healthlink HMO   requires referral
Healthlink PPO, POS, HMO-OA
HFN.Inc.
Humana Commercial Products - we participate in CHOICE CARE only
Humana Medicare Supplement
IBEW  (processed by Cigna)
Medicaid or any Medicaid HMO or PPO product
Mercy Anthem - Blue Access Choice - If the network is listed as Blue Access Choice, we are par)
Mercy Anthem - Alliance - If the network is listed as Alliance, we are non-par)
Medica
Meritain

Multiplan
NALC  (processed by Cigna) 
Oscar Insurance Co
Painters  
PHCS Private Healthcare Systems
Plumbers & Pipefitters  
Sheet Metals 
Solidarity HealthShare
SSM & SSM CoreSource
Tricare for Life Medicare Supplement
Tricare, all other
UFCW 
UHSS
UMR
Union Pacific RailRoad
United HealthCare: Choice & Choice Plus, Allsavers, Core
United HealthCare Compass, Navigate, Charter   referral required
Wellfirst

 

 

 



 

 

 

 

 

Copyright © 2024 Laura Wagner, MD. All Rights Reserved.
14377 Woodlake Dr. #111 • Chesterfield, MO 63017
314-434-1111