Coordinated Care Corporation (Centene)

Can I select a Virginia Mason primary care provider with this insurance plan?

No

Does this plan require pre-approval to see a specialist?

Yes

General Comments

• May not select a Virginia Mason primary care provider (PCP).
• Virginia Mason is contracted, and will accept Coordinated APPROVED referrals for specialty care. Unless emergency, patient will need to have an authorized referral(s) in place PRIOR to scheduling.
• Note: COORDINATED may advise they do not require their approval for consultations, however since VM is non-contracted with this program it is our policy to require Coordinated approved referrals for all services, including consultations.
• Not accepting for psychiatry.
    

Accepted Insurance Plans

• Bronze
• Silver
• Gold

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes

Does this plan require pre-approval to see a specialist?

When medically necessary care is needed beyond the scope of what the PCP can provide, PCPs and Ambetter members are encouraged by Ambetter to initiate and coordinate the care members receive from specialist providers. Authorization from Ambetter is not required unless the specialist is out of the Ambetter network.

General Comments

• Effective January 1, 2022, Virginia Mason Franciscan Health (VMFH) contracted with Ambetter for their individual and family members.
• PCP Selection: Ambetter members are required to select a PCP. If they do not select a PCP one will be selected for them by Ambetter based upon either geography or a relationship with a previous PCP (if in-network).
• Hospital admissions: Unless emergency, hospital admissions MUST be authorized by Ambetter. Prior Authorization is required five business days prior to the scheduled admission date. If emergency admission, notification of the admission is required within 24 hours, or the next business day if weekend or holiday.