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Insurance Information

Insurance Information

Insurance Information

Every insurance plan is different. Please be sure to check your insurance and ask about coverage for your specific procedure before coming to the hospital. See a list of Insurances We Accept

Your Insurance Plan

Many changes have taken place in the health insurance industry in recent years. Procedures and services once covered in full are now only partially covered, covered only under certain circumstances, or in some cases not covered at all. Many insurance plans and health maintenance organizations (HMOs) now require pre-admission approval and/or a second opinion for certain procedures. For your own peace of mind, we advise that you know the benefits of your insurance plan.

Insurance Cards and Forms

Having your insurance information readily available will facilitate processing your admission and billing questions. If Patient Registration did not get copies of your insurance cards at pre-admission testing or admission, please

make sure to provide them with the information at your earliest convenience in order to avoid billing problems.

Note: We will require you to sign numerous documents. Insurance regulations dictate that certain forms be signed for each admission in order for payment to be made.

Insurance Plans Accepted by PinnacleHealth

PinnacleHealth facilities and employed physicians participate in the following list of health insurance plans. This list of accepted insurance plans is updated periodically so please check with your health plan to verify coverage.

There may be certain services provided at our facilities that are not covered by our contract with your health plan. For example, some health plans require members to use specific laboratories and may not pay for laboratory services at our facilities. Please contact your health plan's Member Services department to confirm specific details of your plan. Also, your health insurance plan may require you to obtain a referral or authorization before the delivery of certain types of care. Please inquire with your health plan prior to scheduling an appointment.

Please be aware that you may receive bills from other sources not employed by PinnacleHealth such as Tristan Radiology Specialists, Quantum Imaging Radiology, Riverside Anesthesia, Pediatrix Medical Group (neonatologists), Pathology Associates of Central PA, community ambulance services, etc.

Please confirm your health plan's participation with all appropriate entities prior to having services.


Product Names Associated with Current Agreement       

Commercial Health Plans
Aetna HMO
Quality Point of Service (QPOS)
Elect Choice
Managed Choice POS
Aetna Choice POS II
Aetna Select
Open Choice PPO
Aetna PinnacleHealth Whole Health

Capital Blue Cross
Capital Advantage Insurance Company (CAIC)
Keystone Health Plan Central
Direct Access HMO
PPO Plus
PPO 1-2-3
PPO Choice
Care Connect
Consumer Directed Health Plans (CDHP)

Cigna PPO
OAP Open Access Plus
GWH(Great West)
Strategic Alliances
Indemnity plans for Cigna
TriCare/HealthNet Services TriCare Standard, TriCare Extra, TriCare Plus, TriCare Prime and TriCare for Life
Devon Health Services PPO Network  

Geisinger Health Plan **participating for Geisinger Employees only
Geisinger Health Options - A Health Plan for Employees of Geisinger Health System and Geisinger Affiliates, including Holy Spirit Employees..
HealthAmerica HMO
HealthAssurance PPO
HealthAssurance POS
First Health PPO
HealthNet Federal Services (TriCare) TriCare Standard
TriCare Extra
TriCare Plus
TriCare Prime
TriCare for Life
Highmark Blue Shield All Products
InterGroup PPO  
PrimeSource Health Network (PPO) PPO
Pennsylvania’s Preferred Health Networks (PPHN)

Private HealthCare System (PHCS) PPO & MultiPlan
PHCS and MultiPlan products

SouthCentral Preferred PPO (Hospital Only)

United Healthcare
United Healthcare,
Definity Healthcare,
Oxford Healthcare,
OneNet PPO,
Golden Rule
**PHS is not participating with any affiliated Medicare products
UPMC Health Plan (Not directly contracted but members can access PinnacleHealth through our Private HealthCare System contract above)

UPMC Health Plan
UPMC Small Business Advantage
UPMC Business Advantage
Medicare and Medicare Advantage Programs
Blue Journey HMO formerly known as Senior Blue 
(Medicare Advantage HMO) (Capital Blue Cross)
Senior Blue HMO
BlueJourney Premier HMO
BlueJourney Value HMO
BlueJourney Essential HMO
Blue Journey PPO formerly known as Senior Blue 
(Medicare Advantage PPO) (Capital Blue Cross)
Senior Blue PPO
BlueJourney Prime PPO
BlueJourney Classic PPO
Vibra Health Pan Medicare Advantage Essential Coverage PPO, Medicare Advantage Enhanced Coverage PPO, and Medicare Advantage HMO Plans
Advantra Medicare (A HealthAmerica product) Advantra HMO
Advantra PPO
Aetna Gold Aetna Gold
Aetna Medicare Advantage Open Access HMO
Aetna Medicare PinnacleHealth Prime HMO
Gateway Assured Medicare PPO
Gateway Assured Medicare PPO
Highmark Freedom Blue Medicare PPO Freedom Blue PPO
Geisinger Gold Medicare Geisinger Gold HMO Classic 1,
Classic 2, or Classic 3
Geisinger Gold PFFS (Open 1, Open 2, Open 3 or Open 4)
Geisinger Gold Reserve PFFS
Geisinger Gold Preferred PPO
Geisinger Gold Secure 1 (Dual eligible only)
Geisinger Gold Secure 2 (>90 days in Long Term Care facility).
Humana (only Medicare products) Humana Gold PPO
Humana Gold Choice PFFS
Senior Blue Medicare HMO (Capital Blue Cross, Keystone Health Plan Central) Senior Blue HMO
Senior Blue Medicare PPO (Capital Blue Cross)
Senior Blue PPO
Sterling Life Insurance Co. Sterling Option One Medicare Private Fee For Service (PFFS) - Non-par after 12/31/16
Universal American / American Progressive (Today's Options) Today's Options Private Fee For Service (PFFS)- Non-par after 12/31/16

PA Medical Assistance, PA Medicaid Managed Care Plans, PA Chip Plans
PA State Medical Assistance  
Aetna Better Health

Aetna Better Health Medicaid HMO
Aetna Better Health Kids (CHIP)

AmeriHealth Caritas AmeriHealth Caritas Medicaid HMO
AmeriHealth Northeast Medicaid HMO
Gateway Health Plan (Medicaid HMO) Gateway Health Plan Medicaid HMO
United Healthcare Community Plan United Healthcare Community Plan for Adults
United Healthcare Community Plan for Families
United Healthcare Community Plan for Kids (CHIP)
Workers Compensation

CorVel Corporation

First Health PPO
Focus Healthcare Mgmt.  
Behavioral Health PinnacleHealth Psychological Associates (PHPA) Providers Only
Mental Health Network (MHNet)
Participating in commercial and Medicare behavioral health plans. Par with Coordinated Care Network & Preferred Provider Network.
Magellan Behavioral Health  
Quest Behavioral Health  
United Behavioral Health  


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