Boston Children’s Hospital and physicians are participating with the list of insurance plans below. Participation in these plans is not a guarantee of payment or coverage. Many insurance companies require a referral or prior-authorization for coverage of services. If you would like to verify coverage or have questions regarding out of pocket expenses we recommend that you call the member services number on your insurance card or contact your employee benefits program for more information. If you have a question as to whether Boston Children’s Hospital and its physicians participate in your insurance plan please contact 617-355-3397.
YOUR FINANCIAL RESPONSIBILITY: If you are enrolled in a tiered, high deductible or limited network your out of pocket expense will vary based on the provider and/or place of service (i.e. main campus vs. satellites), and provider of service. We recommend that you call your insurance carrier or your benefits office to determine your liability/out of pocket financial responsibility.
BEHAVIORAL HEALTH COVERAGE: Behavioral Health Benefits should always be verified with your health insurance company. Coverage of services can vary based on a variety of factors.
- AETNA CHOICE POINT OF SERVICE (POS)
- AETNA MANAGE CHOICE
- AETNA OPEN ACCESS MANAGE CARE
- AETNA OPEN CHOICE PPO
- AETNA HEALTH NETWORK
- AETNA NETWORK OPTION PLANS
- AENTA INDEMNITY PLANS
- AETNA TRANSPLANT NETWORK
- AETNA BEHAVIORAL HEALTH
- AETNA US HEALTHCARE HMO
- AETNA US HEALTHCARE PPO & INDEMNITY
- AETNA BETTER HEALTH
- INTERNATIONAL AETNA GLOBAL BENEFITS
- INTERNATIONAL AETNA
The BlueCard program is a national program that enables members of a Blue Cross Blue Shield plan to get health care service benefits while traveling or living in another Blue plan’s service area. Benefits vary from plan to plan and state to state. Always check benefits and eligibility before rendering services. BlueCard members have a suitcase logo on their ID card.
- BLUE CROSS MA PPO & INDEMNITY
- BLUE CROSS MA HMO & BLUE CHOICE (POS)
- BLUE CROSS MEDEX
- BLUE CROSS BLUE SHIELD - FEDERAL
- BLUE OPTIONS - HMO BLUE NEW ENGLAND OPTIONS
- BLUE OPTIONS - PREFERRED BLUE PPO OPTIONS
- BLUE BENEFIT ADMINISTRATORS
- BLUE SELECT OPTIONS HMO & PPO
- BLUE CROSS OUT-OF-STATE
- BCBS BEHAVIORAL HEALTH
PLEASE NOTE – Boston Children’s Hospital and physicians DO NOT participate in the following plans:
- BCBS MEDICAID PLANS
- BEACON - MASSHEALTH (MBHP)
- BEACON - FALLON HEALTH
- BEACON - GIC
- BEACON - NEIGHBORHOOD HEALTH PLANS
Cigna’s LocalPlus Network plan will no longer be available at Boston Children’s effective January 1, 2018.
- CIGNA CARELINK
- CIGNA OPEN ACCESS PLUS
- CIGNA NETWORK OPEN ACCESS & OPEN ACCESS PLUS
- CIGNA HMO OPEN ACCESS & POS OPEN ACCESS
- CIGNA LOCALPLUS ® HMO, POS, and HMO POS
- CIGNA NETWORK & NETWORK POS, PPO or EPO
- CIGNA LOCALPLUS® NETWORK FOCUS NETWORK
- CIGNA OPEN ACCESS PLUS NETWORK
- CIGNA NETWORKS IN THE US: PPO & AOP
- CIGNA HEALTH PLAN-PPO & INDEMNITY
- CIGNA MVP
- CIGNA LIFESOURCE
- CIGNA GREAT WEST LIFE
- INTERNATIONAL CIGNA
- CIGNA BEHAVIORAL HEALTH
- LIFESOURCE
PPO MAINE FEDERAL EXCHANGE – MAINE COVERAGE ONLY
- Community Advantage – Gold & Silver (ME)
- Community Value – Silver (ME)
- Community Value Plus Silver
- Community Choice Silver
- Community Preferred Silver
- Community Preferred Plus Silver
- Community Option Bronze
- Community Plus Bronze
- Community Option Bronze
- Community Plus Bronze
- Community Option HSA Bronze
- Community Safe Harbor Catastrophic
- Community Premier Platinum
- Community Balance Silver
- SELECT CARE
- HARRINGTON ADVANTAGE-PPO
- FALLON ADVANTAGE PLAN- THE CITY OF WORCESTER – SELECT CARE TIER 2
- FALLON HARRINGTON ADVANTAGE - PPO
- FALLON CONNECTOR OPTIONS – SELECT CARE
- FALLON TIERED CHOICE – TIER 3
- FALLON PREFERRED CARE-PPO
- FALLON – COMMUNITY CARE
PLEASE NOTE – Boston Children’s Hospital and physicians DO NOT participate in the following plans:
- DIRECT CARE (CITY OF WORCHESTER-DIRECT)
- STEWARD COMMUNITY CARE
- HARRINGTON HHCS 2 ACA
- THE CITY OF WORCESTER ADVANTAG – DIRECT PLAN
- FALLON MEDICARE – NO PRODUCTS
HARVARD PILGRIM HEALTH CARE (HPHC)
- HPHC-HMO
- HPHC-PPO
- HPHC CHOICE PLUS PASSPORT
- HARVARD PILGRIM OPTIONS-PPO
- HPHC STUDENT INSURANCE PL-PPO
- HEALTH PLANS INC-PPO
- HPHC NH HEALTHY KIDS
- HPHC CHOICE NET - HMO
- HPHC CHOICE NET - PPO
- HPHC PRIMARY CHOICE (GIC)
- HPHC INDEPENDENCE PLAN (POS)
- HPHC FOCUS NETWORK – Authorized Access
- HPHC HOSPITAL PREFER-HMO
- HPHC HOSPITAL PREFER-PPO
- HPHC SOUTHCOAST
- HPHC NH ELEVATE HEALTH – Authorized Access
- HPHC ELEVATE HEALTH OPTIONS
PLEASE NOTE – Boston Children’s Hospital and physicians DO NOT participate in the following plans:
- HPHC LAWRENCE GENERAL
- HPHC SIGNATURE HEALTHCARE
- HPHC DARTMOUTH HITCHCOCK
- HPHC BIDMC SELECT
- HPHC BMC SELECT-HMO
- HPHC BMC TIERED-HMO
- CHOICE CARE NETWORK - PPO
PLEASE NOTE - Boston Children's Hospital and physicians DO NOT participate in the following plans:
- HUMANA HMO
MASSHEALTH – ACCOUNTABLE CARE ORGANIZATION (ACOs)
- BE HEALTHY PARTNERSHIP / BAYSTATE HEALTHCARE ALLIANCE - may require plan prior to approval
- BERKSHIRE FALLON HEALTH COLLABORATIVE - may require plan prior to approval
- COMMUNITY CARE COOPERATIVE (C3)
- FALLON 365 CARE - may require plan prior approval
- MASS GENERAL BRIGHAM
- MY CARE FAMILY
- STEWARD HEALTH CHOICE
- TUFTS HEALTH TOGETHER WITH ATRIUS HEALTH
- TUFTS HEALTH TOGETHER WITH BIDCO
- TUFTS HEALTH TOGETHER WITH BOSTON CHILDREN’S ACO
- TUFTS HEALTH TOGETHER WITH CHA
- WELLFORCE CARE PLAN
- WELLSENSE COMMUNITY ALLIANCE
- WELLSENSE MERCY ALLIANCE
- WELLSENSE SIGNATURE ALLIANCE
- WELLSENSE SOUTHCOAST ALLIANCE
- MASSHEALTH-LIMITED
- MASSHEALTH-NON-PCC
- MASSHEALTH-PCC
- MASS BEHAVIORAL HEALTH PLAN (MBHP)
- MASSHEALTH STANDARD
- MASSHEALTH COMMONWEALTH
- MASSHEALTH CARE PLUS
- MASSHEALTH FAMILY ASSIST
- MASSHEALTH SMALL BUSINESS EMPLOYEE PREMIUM
- CHILDREN’S MEDICAL SECURITY PLAN
- New Hampshire
- Vermont
- Maine
- AETNA BETTER HEALTH
- AMERIHEALTH CARITAS NEW HAMPSHIRE
All Others please refer to 617-355-3397
MULTIPLAN/PHCS
Covers out of network benefits for patients.
NEIGHBORHOOD HEALTH PLAN (NHP) MASSACHUSETTS
- NHP CARE (GIC MEMBERS)
- NHP COMMERCIAL
- NHP PRIME HMO
- NHP MASSHEALTH
- NHP COMMONWEALTH CHOICE
- NHP COMMONWEALTH CARE - QHP
PLEASE NOTE – Boston Children’s Hospital and physicians DO NOT participate in the following plans:
- RHODE ISLAND NHP
TUFTS HEALTH PLAN - NETWORK HEALTH
TUFTS HEALTH PLAN TOGETHER – MASSHEALTH PLAN
- Care Plus
- Commonwealth Care
TUFTS HEALTH PLAN DIRECT – CONNECTORCARE (QHP)
- Subsidized - PLAN TYPE 1-3 (CC1 CC2 & CC3)
- Nonsubsidized – PLATINUIM, GOLD, SILVER, BRONZE, AND CATASTROPHIC
- Gold silver & bronze out of pocket expense
- TUFTS HEALTH PLAN - HMO
- TUFTS BENEFIT ADMIN - PPO
- LIBERTY
- NAVIGATOR
- CARELINK-TUFTS
- TUFTS HEALTH PLAN - POS
- TUFTS NAVIGATOR (GIC)
- TUFTS YOUR CHOICE - HMO
- TUFTS YOUR CHOICE - PPO
- TUFTS STEWARD - DPO
- TUFTS UNIFORM SERVICE
- TUFTS STEWARD - EPO
PLEASE NOTE – Boston Children’s Hospital and physicians DO NOT participate in the following plans:
- TUFTS SPIRIT PLANS
- TUFTS SELECT NETWORK PLANS
- TUFTS STEWARD COMMUNITY CHOICE PLANS
- TUFTS ADVANTAGE HMO SELECT
- TUFTS GIC SELECT PRODUCTS (GIC)
- TUFTS SPIRIT PRODUCTS
- TUFTS STEWARD COMMUNITY CHOICE
- UNICARE – GIC
- UNICARE – COMMUNITY CHOICE (GIC)
- UNICARE – INDEMNITY PLANS (GIC)
- UNICARE – PLUS (GIC
- UNICARE – CLASSIC (PPO & HMO)
- AMERICHOICE
- UNITED PASSPORT
- UNITED HEALTHCARE - HMO, PPO, POS
- OXFORD HEALTH PLANS
- OPTUM TRANSPLANT
- UNITED BEHAVIORAL HEALTH
- INTL UNITED HEALTHCARE
- UNITED HEALTHCARE COMMUNITY PLAN
Patients may contact their carriers for specific benefit information.