Yale doctors and providers participate in most managed care plans in our region. The plans in which we participate are listed alphabetically by company name.
Most YMG providers participate with all of the contracted managed care carriers listed below, however there are some exceptions, which are listed at the bottom of this page.
| Commercial, HMO & PPO |
Referral
Required
to see
Specialist |
Member
Eligibility |
Pre Certification
and Referrals |
Aetna/US Healthcare www.aetna.com |
| Aetna Affordable Health Choices (PPO) |
NO |
888-772-9682 |
888-772-9682 |
| Aetna Health Fund |
NO |
Call # on ID Card |
Call # on ID Card |
| Aetna Select |
YES |
888-632-3862 |
800-632-3862 #3 |
| Choice POS |
NO |
800-624-0756 |
800-624-0756 #3 |
| Choice POS II |
NO |
888-632-3862 |
800-632-3862 #3 |
| Elect Choice (EPO) |
YES |
888-632-3862 |
800-632-3862 #3 |
| HMO |
YES |
800-624-0756 |
800-624-0756 #3 |
| Managed Choice |
NO |
888-632-3862 |
800-632-3862 #3 |
| Open Access Aetna Select |
NO |
888-632-3862 |
800-632-3862 #3 |
| Open Access Elect Choice |
NO |
888-632-3862 |
800-632-3862 #3 |
| Open Access HMO |
NO |
800-624-0756 |
800-624-0756 #3 |
| Open Access Managed Choice POS |
NO |
888-632-3862 |
800-632-3862 #3 |
| Open Choice PPO & NAP |
NO |
888-632-3862 |
800-632-3862 #3 |
| Quality Point of Service (QPOS) |
NO |
800-624-0756 |
800-624-0756 #3 |
| Traditional Choice (Indemnity) |
NO |
888-632-3862 |
800-632-3862 #3 |
US Access HMO |
NO |
800-624-0756 |
800-624-0756 #3 |
| Commercial, HMO & PPO |
Referral
Required
to see
Specialist |
Member
Eligibility |
Pre Certification
and Referrals |
| Anthem Blue Cross/Blue Shield www.anthem.com |
| Bluecare HMOs: |
| BlueCare |
NO |
800-922-3242 |
800-238-2227 |
| BlueCare Plus |
YES |
800-922-3242 |
800-238-2227 |
| BlueCare Plus Access 10 |
YES |
800-922-3242 |
800-238-2227 |
| BlueCare Plus Basic Health Plan |
YES |
800-922-3242 |
800-238-2227 |
| BlueCare Plus Direct |
YES |
800-922-3242 |
800-238-2227 |
| BlueCare Plus POS |
YES |
800-922-3242 |
800-238-2227 |
| BlueCare POS |
NO |
800-922-3242 |
800-238-2227 |
| Blue Options: |
| Century Preferred |
NO |
800-922-3242 |
800-238-2227 |
| Century Preferred Direct PPO |
NO |
800-922-3242 |
800-238-2227 |
| New
England Health Plans (formerly HMO Blue New England): |
| Blue Choice New England |
YES |
800-676-2583 |
800-676-2583 |
| HMO Blue New England |
YES |
800-676-2583 |
800-676-2583 |
| Small Employer Plan Comprehensive: |
Call to verify |
Call # on ID card |
Call # on ID card |
| State of CT Employees: |
| State Preferred (PPO) |
NO |
800-922-2232 |
800-238-2227 |
| State BlueCare POS |
NO |
800-922-2232 |
800-238-2227 |
| State BlueCare POE |
NO |
800-922-2232 |
800-238-2227 |
| State BlueCare POE Plus |
YES |
800-922-2232 |
800-238-2227 |
| Federal Employee Program: |
| Federal Employee Plan (Basic Option) |
NO |
800-438-5356 |
800-860-2156 |
| Federal Employee Plan (Standard Option) |
NO |
800-438-5356 |
800-860-2156 |
| Anthem Other: |
| Anthem PPO (Anthem Employees) |
NO |
800-922-3242 |
800-238-2227 |
| BlueCare/BlueCard PPO |
Call to verify |
800-676-2583 |
800-676-2583 |
| Century
(90,94,96, 9D, 9T, 98) |
NO |
800-922-3242 |
800-238-2227 |
| National Accounts (includes Teamsters) |
NO |
800-233-6183 |
800-238-2227 |
| Commercial, HMO & PPO |
Referral
Required
to see
Specialist |
Member
Eligibility |
Pre Certification
and Referrals |
| Cigna Health Care www.cigna.com |
| HMO, Network, POS |
YES |
800-882-4462 |
800-882-4462 |
| PPO, EPO, Indemnity, Open Access |
NO |
800-882-4462 |
800-882-4462 |
| ConnectiCare www.connecticare.com |
| Connecticare PPO |
NO |
800-562-6834 #1 |
800-562-6834 #2 |
| HMO-Open Access |
NO |
800-562-6834 #1 |
800-562-6834 #2 |
| HMO-Personal Care Plan |
YES |
800-562-6834 #1 |
800-562-6834 #2 |
| POS Open Access Plan |
NO |
800-562-6834 #1 |
800-562-6834 #2 |
| POS-Personal Care plan |
YES |
800-562-6834 #1 |
800-562-6834 #2 |
| Great-West HealthCare (formerly One Health Plan) |
Varies by employer |
Call # on ID Card |
Call # on ID Card |
| Health
Net www.healthnet.com |
| Charter HMO and Charter POS |
NO* |
800-438-7886
Auto 800-622-7708 |
800-438-7886
Auto Referral 800-622-7708 |
| Passport HMO and Passport POS |
NO |
800-438-7886
Auto 800-622-7708 |
800-438-7886
Auto Referral 800-622-7708 |
| HMC PPO (Health Management Center) |
Varies by Employer |
Call # on ID Card |
Call # on ID Card |
| Multiplan - participating as of 2/15/04 |
Varies by Employer |
Call # on ID Card |
Call # on ID Card |
| Commercial, HMO & PPO |
Referral
Required
to see
Specialist |
Member
Eligibility |
Pre Certification
and Referrals |
| Oxford Health Plans www.oxfordhealth.com |
| Freedom Plan Access |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Freedom Plan Classic |
YES |
800-666-1353 |
Fax # 800-303-9902 |
| Freedom Plan Direct |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Freedom Plan Laurel |
YES |
800-666-1353 |
Fax # 800-303-9902 |
| Freedom Plan Laurel Select |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Freedom Plan POS |
YES |
800-666-1353 |
Fax # 800-303-9902 |
| Freedom Plan Value Option |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Freedom Plans PPO |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Freedom Plan HMO Laurel |
YES |
800-666-1353 |
Fax # 800-303-9902 |
| HMO |
YES |
800-666-1353 |
Fax # 800-303-9902 |
| HMO Freedom |
YES |
800-666-1353 |
Fax # 800-303-9902 |
| HMO Laurel |
YES |
800-666-1353 |
Fax # 800-303-9902 |
| HMO Laurel Select |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| HMO Liberty |
YES |
800-666-1353 |
Fax # 800-303-9902 |
| HMO Select |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| HMO Select-Freedom Network |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| HMO Select-Liberty Network |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Liberty Plan Access |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Liberty Plan Classic |
YES |
800-666-1353 |
Fax # 800-303-9902 |
| Liberty Plan Select PPO |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Oxford HSA Direct |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Oxford HSA Exclusive |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Oxford My plan |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Oxford Exclusive Plan Metro |
NO |
800-666-1353 |
Fax # 800-303-9902 |
| Commercial, HMO & PPO |
Referral
Required
to see
Specialist |
Member
Eligibility |
Pre Certification
and Referrals |
| PHCS (Private Healthcare Systems) |
Varies by Employer |
Call # on ID Card |
Call # on ID Card |
| Tricare www.healthnetfederalservices.com |
| Tricare Extra |
NO |
1-877-874-2273 |
1-877-874-2273 |
| Tricare Prime |
YES |
1-877-874-2273 |
1-877-874-2273 |
| Tricare Prime POS |
NO |
1-877-874-2273 |
1-877-874-2273 |
| Tricare Prime Remote |
YES (for family, not ADSM) |
1-877-874-2273 |
1-877-874-2273 |
| Tricare Standard |
NO |
1-877-874-2273 |
1-877-874-2273 |
| United Healthcare www.unitedhealthcareonline.com |
| |
NO |
800-822-3806 |
877-842-3210 |
| Yale Health Plan |
| |
YES |
203-432-0246 |
203-432-0246 |
| Medicaid Managed Care |
| Blue Care Family Plan |
YES |
800-828-2239 |
800-828-2239 |
| Community Health Network |
YES |
800-440-5071 |
800-440-5071 |
| Health Net Healthy Options |
NO |
800-438-7886 |
800-438-7886 |
| Medicare Managed Care |
| Aetna Golden Medicare Plan (HMO) |
YES |
800-624-0756 |
800-624-0756 #3 |
| Aetna Golden Choice Plan (PPO) |
NO |
800-624-0756 |
800-624-0756 #3 |
| Aetna Medicare Advantage (MediBlue) |
NO |
800-364-2374 |
800-364-2374 |
| Oxford |
YES* |
800-666-1353 |
800-666-1353 |
| Health Net Medicare Advantage (formerly Smart) |
NO |
800-438-7886 |
800-438-7886 |
| Tricare For Life |
NO |
1-866-773-0404 |
1-866-773-0404 |
| Worker's
Compensation |
| All carriers registered with St of CT |
YES |
Call #on pg 2 of
Case Screen |
Call #on pg 2 of
Case Screen |
| Yale - New Haven Hospital |
YES |
203-688-1974 |
203-688-1974 |
| Yale University |
YES |
203-432-7397 |
203-432-7397 |
| Non-Participating
Plans (Require Out-of-Network Referral from Health Plans): |
| Community Care Network |
YES |
Call # on ID Card |
Call # on ID Card |
| Connecticare Medicare |
YES |
800-224-2273 |
800-224-2273 |
| Wellcare Medicaid (FirstChoice) (Termed 6/1/02) |
YES |
800-925-3606 |
800-925-3606 |
| Wellcare Medicare |
YES |
800-925-3606 |
800-925-3606 |
| Participating
For Yale Pathology (Bridgeport and Therapeutic Radiology Providers
at L&M and Backus ONLY: |
| Northeast Health Direct |
Varies
by Employer |
Call
# on ID Card |
Call
# on ID Card |
*Specialist can refer to Specialist
Exceptions:
- New YMG providers currently in the YMG credentialling process.
- Pathology (Bridgeport location) and Therapeutic Radiology (Lawrence & Memorial location) also participate with Northeast Health Direct.
- Selected providers in Dermatology do not participate with Oxford, Cigna, or Health Net. Please contact Yale Dermatology Associates (YDA) at 2 Church Street
South, New Haven (203-789-1249) to verify insurance.
- Mental health services and some vision services are carved out for many carriers. Click here to view the list.
- Not all managed care plans credential mid-level providers (i.e., APRN, PA, CNM, LCSW), so please check with your insurance prior to scheduling an appointment with someone other than an MD.
|
Health Insurance Guide 
