Out-of-Network Policy
UVM Health Network will no longer schedule appointments or procedures for patients with health care insurance that considers UVM Health Network out-of-network, except in rare circumstances.
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Out-of-Network Policy
At University of Vermont Health Network, we strive to work with insurance companies in our region so that our patients have greater choice in health insurance plans. However, some plans do not include UVM Health Network hospitals or providers in their network and UVM Health Network is considered “out-of-network.” In these instances, even if members have “out-of-network" benefits, we do not always receive adequate compensation for the services we provide.
For this reason, effective January 1, 2025, patients with health insurance that considers UVM Health Network hospitals and providers out-of-network will undergo a review process before being able to schedule an appointment. This review process might result in requiring patients to (1) pay out-of-pocket at the time of service, (2) coordinate approval with the patient’s insurance company and/or (3) work with their insurance company to identify an in-network provider.
Frequently Asked Questions
- If you are a patient with an existing relationship with a UVM Health Network provider, please talk with your provider and your insurance company about your ongoing care needs.
- We will continue to see you for emergency services, regardless of your insurance coverage.
- If you are a new patient, please work with your insurance company to find an in-network provider to meet your care needs.
- If UVM Health Network is out-of-network with your insurance plan, additional requirements may apply before you will be able to schedule an appointment. You may need to pay out-of-pocket at the time of service, and you may be responsible for coordinating with your insurance company to submit claims for reimbursement and obtain any required approvals.
- If you have a unique need that you believe can only be delivered at UVM Health Network, talk with your provider and insurance company.
We accept original Medicare (parts A and B). If you select a Medicare Advantage plan or private insurance, please contact your insurance provider to confirm in-network coverage for UVM Health Network.
At this time, UVM Health Network accepts the following Medicare Advantage plans. Please note that these insurers may have certain plans that do not include UVM Health Network hospitals and providers (e.g., WellCare) or do not cover all services offered by UVM Health Network (e.g., mental health). It’s best to confirm coverage with your insurance company before choosing a Medicare Advantage plan or scheduling an appointment.
Insurance | Accepted by these UVM Health Network Hospitals and Providers: |
---|---|
Aetna | Accepted by all UVM Health Network hospitals and providers |
CDPHP/CDPHN | Accepted by all UVM Health Network hospitals and providers |
Empire BlueCross BlueShield (Anthem) | Accepted by Champlain Valley Physicians Hospital and providers, Elizabethtown Community Hospital and providers (Anthem patients may have in-network access with other UVM Health Network hospitals and providers through National BlueCross BlueShield networks) |
Excellus BlueCross BlueShield | Accepted by Alice Hyde Medical Center and providers, Champlain Valley Physicians Hospital and providers, Elizabethtown Community Hospital and providers, UVM Medical Center and providers (Excellus patients may have in-network access with other UVM Health Network hospitals and providers through National BlueCross BlueShield networks) |
Fidelis* | Accepted by Alice Hyde Medical Center and providers, Champlain Valley Physicians Hospital and providers, Elizabethtown Community Hospital and providers, UVM Medical Center and providers |
Humana/Choice Care | Accepted by Alice Hyde Medical Center and providers, Champlain Valley Physicians Hospital and providers, Elizabethtown Community Hospital and providers |
MVP/UVM Health Advantage** | Accepted by all UVM Health Network hospitals and providers |
United Healthcare | Accepted by all UVM Health Network hospitals and providers |
Vermont Blue Advantage (VBA) (BlueCross BlueShield VT)*** | Accepted by Central Vermont Medical Center and providers, Porter Medical Center and providers, UVM Medical Center and providers (VBA patients may have in network access with other UVM Health Network hospitals and providers through National BlueCross BlueShield networks) |
*Fidelis Medicare Advantage plans are standardly labelled “WellCare by Fidelis”, which is in-network with the partners listed above; whereas if the plan doesn’t include the “Fidelis” label, then it is likely out-of-network and not accepted by UVM Health Network hospitals and providers.
**UVM Health Advantage is open for membership to residents of certain counties in New York. The plans are accepted by all UVM Health Network hospitals and providers.
*** In a recent letter mailed to Medicare-eligible patients, this list did not include Vermont Blue Advantage. We apologize for any inconvenience this may have caused.
January 1, 2025. We will work with existing patients over the following months to transition their care to in-network options. Beginning January 1, 2025, there may be additional requirements before a patient with a benefit plan for which UVM Health Network is out-of-network can schedule an appointment.
The following hospitals, agencies and all related entities are affected:
- Alice Hyde Medical Center (including The Alice Center)
- Central Vermont Medical Center (including Woodridge Rehabilitation and Nursing)
- Champlain Valley Physicians Hospital (including CVPH Skilled Nursing Facility)
- Elizabethtown Community Hospital
- Porter Medical Center (including Helen Porter Rehabilitation and Nursing)
- University of Vermont Medical Center
- Talk to your employer (or former employer if you’re a retiree) if you receive health insurance benefits through them.
- Medicare.gov has resources for individuals seeking to sign up for Medicare, as well as resources for exploring Medicare Advantage.
- Vermont Health Connect can help with VT Medicaid and commercial plans through the Qualified Health Plan. Call customer support at 855-899-9600 or visit Vermont Health Connect.
- New York State of Health, New York’s website for the marketplace: New York State of Health | Health Plan Marketplace for Individual and Small Business Health Insurance (ny.gov)
- If you’re in the middle of active treatment, we will continue your treatment plan until it is complete, or until a time when it is clinically or financially appropriate for you to transition to an in-network provider.
- We will maintain appointments that are currently scheduled through March 31, 2025. If you’d like to reschedule with a provider in your network, please contact your insurance company to identify an in-network provider.
- Absent special circumstances, we will not schedule any routine or preventive procedures or appointments for new patients with benefit plans for which UVM Health Network is out-of-network after January 1, 2025.
- If you have a unique need that you believe can only be delivered at UVM Health Network, talk with your provider and insurance company.
- Health care providers enter insurance networks for various reasons, including the benefit of direct payment and the ability to more easily request things like prior approval, etc.
- Payments from insurance companies with which we do not contract are generally lower, do not cover the cost of providing care, and usually involve greater out-of-pocket costs for the patient.
- Insurance companies with which we are out-of-network do not always authorize care their members need, and managing these administrative processes can be difficult and costly.
- UVM Health Network is operating with increasingly limited budgets and we accumulate a significant amount of debt each year due to providing care to patients without in-network benefits.
- In order to provide access to care for our community, we need to ensure services remain available. To do that, we require adequate reimbursement for the services.