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Choosing the Right Health Insurance Plan

As medicine becomes increasingly more advanced and complex, we are luckily able to save more people with more severe illnesses. But as a result, we have all seen an increase in the cost of providing this care and in purchasing health care insurance. Employers faced with the tasks of keeping a reasonable profit while responsibly maintaining health insurance coverage for their employees have sought new ideas to solve this problem. Most of what we hear now is the term 'Managed Care' or 'Accountable Care Organizations', or ACOs for short. We are participating members of several 'managed care' plans and the Integra ACO through RI Primary Care Physicians Corporation.

It is important for you to make an informed decision as to exactly what you are receiving for health insurance benefits. Decisions you make go far beyond whether your child can continue with us for pediatric care, but can impact on which hospitals, and which specialty care you and your family are eligible to receive. Some plans have a record of not providing appropriate pediatric specialists when needed. Other plans might be overly restrictive in whether you can see a specialist at all. We find that plans that reward a physician for not seeing your child (called capitation), or by overly limiting access to specialty care to be not in our or your interests.

Most larger employers offer a choice of two or three different health plans. We hope, of course, that you'll choose a plan in which we participate. But even if you choose a plan in which you must transfer your child's pediatric care elsewhere, we hope that you'll take the time to accurately assess the pros and cons of your new health insurance plan.  While high deductible health plans may cost less and give some protection against catastrophic expenses, you may have to pay the entire cost of the office visits, procedures, and immunizations that can mount up very quickly.  We will not bear these costs for you; so be forewarned that we do not consider these options appropriate for families with young children.

For your reference, here's a list of those insurance plans in which we DO participate:

  • Blue Cross & Blue Shield of Rhode Island (including VantageBlue, HealthMate, and HealthMate Coast to Coast)
  • BlueCHiP (Coordinated Health Partners)
  • Blue Cross & Blue Shield of Massachusetts (including BlueChoice, HMO-Blue, & Master HealthPlus)
  • United HealthCare
  • Tufts Health Plan
  • CIGNA Health Plan
  • Harvard Pilgrim Health Care
  • Aetna Health Care
  • TriCare
  • Private Health Care Systems
  • Health Care Value Management
  • MultiPlan
  • Mashantucket Pequot RxN (Foxwoods)
Note we DO NOT accept Neighborhood Health Plan of RI insurance.

While we do not directly participate in most other so-called indemnity plans, we do cooperate with your seeking reimbursement through your insurer by giving you the properly filled out receipt.

For those with RIteCare insurance as administered through the RI Medicaid program, we participate in the United HealthCare and Tufts Health Plan.  We DO NOT accept Neighborhood Health Plan of RI. We would  need you to  choose either United Health Plan, or Tufts Health Plan for RIteCare instead. 
You MUST have either Atlantic-Pediatrics, Dr. Concannon and/or Dr. Vitale listed as your Primary Care Provider (PCP) on your insurance card, and you MUST bring your insurance card with EACH VISIT to our office.

If after discussing the matter with our office manager and you feel that you have been treated unfairly by your health insurance plan, we suggest that you bring the matter up with your employee benefits manager at your work place. This person needs to know if the company's employees are dissatisfied with their health insurance plan.


Rev. 02/2021  Insurance.htm
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