For Patients & Families | Participating plans

Boston Children’s and its affiliated providers are participating providers with the health plans listed below. Participation in these plans is not a guarantee of payment or coverage. Many health plans require a referral or prior-authorization for coverage of services and not all services are covered depending on your health plan. You should verify coverage and out of pocket expense responsibilities, by contacting the member services number on your health plan card. You may also contact Boston Children’s at 617-355-3397, if you have a question regarding Boston Children’s or its providers’ participation status with your health plan.

YOUR FINANCIAL RESPONSIBILITY: If you are enrolled in a tiered, high deductible or limited network, your coverage and/or out of pocket expenses may vary based on the provider and/or place of service. We recommend that you contact your health plan to determine your liability/out of pocket financial responsibility.

BEHAVIORAL HEALTH COVERAGE: Behavioral Health benefits should always be verified with your health plan.

NON-PARTICIPATION: If you do not see your health plan listed below, please contact member services at your health plan to inquire about coverage for care provided at Boston Children’s or you may contact Boston Children’s with questions at 617-355-3397

AETNA

• AETNA CHOICE POS/PPO
• AETNA MANAGED CHOICE
• AETNA OPEN ACCESS MANAGED CARE
• AETNA HEALTH NETWORK
• AETNA NETWORK OPTION PLANS
• AETNA INDEMNITY PLANS
• AETNA US HEALTHCARE HMO
• AETNA US HEALTHCARE PPO & INDEMNITY
• INTERNATIONAL AETNA GLOBAL BENEFITS
• INTERNATIONAL AETNA

BLUE CROSS BLUE SHIELD

• BLUE CROSS BLUE SHIELD OF MA PPO & INDEMNITY
• BLUE CROSS BLUE SHIELD OF MA SELECT BLUE
• BLUE CROSS BLUE SHIELD HIGH PERFORMANCE NETWORK
• BLUE CROSS BLUE SHIELD OF MA HMO & BLUE CHOICE (POS)
• BLUE CROSS BLUE SHIELD 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 BLUE SHIELD/ANTHEM OUT-OF-STATE HMO, PPO & INDEMNITY*
• BLUE CROSS BLUE SHIELD CONNECTORCARE

* — The BlueCard program is a national program that enables members of Blue Cross Blue Shield and Anthem plans to receive health care service benefits while traveling or living in another plan’s service area. Benefits vary from plan to plan and state to state. We recommend that you contact your health plan to confirm your coverage and determine your liability/out of pocket financial responsibility. BlueCard members have a suitcase logo on their ID card.

CARELON BEHAVIORAL HEALTH STRATEGIES (formerly known as Beacon Health Strategies)

• CARELON BEHAVIORAL HEALTH STRATEGIES - FALLON HEALTH
• CARELON BEHAVIORAL HEALTH STRATEGIES - GIC
• CARELON BEHAVIORAL HEALTH STRATEGIES - WELLSENSE MEDICAID(NH)

CIGNA

• CIGNA CARELINK
• CIGNA OPEN ACCESS PLUS
• CIGNA NETWORK OPEN ACCESS & OPEN ACCESS PLUS
• CIGNA HMO OPEN ACCESS & POS OPEN ACCESS
• CIGNA NETWORK & NETWORK POS, PPO or EPO
• CIGNA OPEN ACCESS PLUS NETWORK
• CIGNA NETWORKS IN THE US: PPO & AOP
• CIGNA HEALTH PLAN-PPO & INDEMNITY
• CIGNA MVP
• INTERNATIONAL CIGNA

CIGNA BEHAVIORAL HEALTH/EVERNORTH

CIGNA LIFESOURCE

COVENTRY/FIRST HEALTH

FALLON HEALTH

• FALLON SELECT CARE (HMO)
• FALLON PREFERRED CARE (PPO)
• FALLON MEDICARE PLUS (HMO)
• FALLON HEALTH AND LIFE ASSURANCE COMPANY PROGRAMS (COMMERCIAL)
• FALLON COMMUNITY CARE (HMO)

HARVARD PILGRIM HEALTH CARE

• HARVARD PILGRIM HEALTH CARE-HMO, POS & PPO
• HARVARD PILGRIM HEALTH CARE CHOICE PLUS PASSPORT
• HARVARD PILGRIM HEALTH CARE OPTIONS-PPO
• HARVARD PILGRIM HEALTH CARE STUDENT INSURANCE PL-PPO
• HEALTH PLANS INC-PPO
• HARVARD PILGRIM HEALTH CARE CHOICE NET–HMO & PPO
• HARVARD PILGRIM HEALTH CARE QUALITY HMO (GIC)
• HARVARD PILGRIM HEALTH CARE EXPLORER POS (GIC)
• HARVARD PILGRIM HEALTH CARE FOCUS NETWORK
• HARVARD PILGRIM HEALTH CARE HOSPITAL PREFER-HMO & PPO
• HARVARD PILGRIM HEALTH CARE BIDMC SELECT
• HEALTH PLANS INC- UMR
• MAINE’S CHOICE PLUS
• OPEN ACCESS
• ACCESS AMERICA

HEALTH NEW ENGLAND (HNE)

• HEALTH NEW ENGLAND HMO/POS
• HEALTH NEW ENGLAND PPO HEALTH NEW ENGLAND QHP
• HEALTH NEW ENGLAND GIC

HUMANA

• CHOICE CARE NETWORK-PPO

LIFETRAC

MAINE COMMUNITY HEALTH OPTIONS

• COMMUNITY HEALTH OPTIONS–HMO & PPO

MASS GENERAL BRIGHAM HEALTH PLAN (formerly known as AllWays Health Partners)

• COMPLETE HMO
• COMPLETE HMO (GIC)
• COMPLETE PPO PLUS
• COMPLETE ACCESS EPO
• MGB SELECT AND PLUS PPO 2022
• CHOICE EASY TIER HMO PLUS
• CHOICE EASY TIER PPO PLUS

MASSHEALTH – ACCOUNTABLE CARE ORGANIZATION (ACOS)

• COMMUNITY CARE COOPERATIVE (C3)
• FALLON ATRIUS HEALTH
• MASS GENERAL BRIGHAM ACO
• STEWARD MEDICAID CARE NETWORK
• TUFTS HEALTH TOGETHER CAMBRIDGE HEALTH ALLIANCE
• TUFTS HEALTH TOGETHER UMASS MEMORIAL HEALTH
• WELLSENSE BILH PERFORMANCE NETWORK ACO
• WELLSENSE BOSTON CHILDREN’S ACO
• WELLSENSE CARE ALLIANCE
• WELLSENSE COMMUNITY ALLIANCE
• WELLSENSE EAST BOSTON NEIGHBORHOOD HEALTH CENTER ALLIANCE
• WELLSENSE MERCY HEALTH
• WELLSENSE SIGNATURE HEALTHCARE
• WELLSENSE SOUTHCOAST ALLIANCE

MASSHEALTH – Mass Medical

• 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

MEDICAID – OUTSIDE OF MASSACHUSETTS*

• CONNECTICUT MEDICAID
• MAINE MEDICAID
• NEW HAMPSHIRE MEDICAID
• VERMONT MEDICAID

MEDICAID MCOs – OUTSIDE OF MASSACHUSETTS

• NEW HAMPSHIRE – AMERIHEALTH CARITAS NH
• NEW HAMPSHIRE – WELLSENSE
• RHODE ISLAND – TUFTS HEALTH RI TOGETHER

MEDICARE

MULTIPLAN/PHCS

OPTUM CENTERS OF EXCELLENCE

OPTUM UNITED BEHAVIORAL HEALTH

TUFTS HEALTH PLAN

• TUFTS HEALTH PLAN-HMO, PPO & POS
• TUFTS HEALTH PLAN CARELINK
• TUFTS HEALTH PLAN YOUR CHOICE – HMO & PPO
• TUFTS HEALTH PLAN STEWARD – DPO & EPO
• TUFTS HEALTH PLAN SELECT NETWORK PLANS
• TUFTS HEALTH DIRECT (QHP)
• TUFTS HEALTH TOGETHER (MCO)

UNICARE

• UNICARE – BASIC GIC
• UNICARE – COMMUNITY CHOICE (GIC)
• UNICARE – PLUS (GIC)

UNITED HEALTH CARE

• UNITED HEALTHCARE - HMO, PPO, POS & MEDICARE
• UNITEDHEALTHCARE – PASSPORT
• UNITEDHEALTHCARE – CHOICE/CHOICE PUS
• UNITED EMPIRE PLAN
• OXFORD HEALTH PLANS
• INTERNATIONAL UNITED HEALTHCARE

WELLSENSE (formerly known as BMC HEALTHNET)

• WELLSENSE MCO

For further information, please call Boston Children’s Patient Financial Services at 617-355-3397.