Insurance

Summit Medical Group is pleased to announce
that all Summit Medical Group providers, services, and locations
are now included in the Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) network!

In addition, Summit Medical Group will participate in Horizon Medicare Advantage plans
and again provide services in network
for Blue Plans that participate in the BlueCard program,
(this includes patients covered by Empire BCBS and Anthem BCBS,
but excludes managed Medicaid under Horizon NJ Health)
at our Essex, Morris, and Somerset county sites.
  

Now more than ever, ongoing changes with health insurance plans make it especially important to understand your coverage and know the costs you must pay when visiting your physician, having tests, and undergoing procedures. For this reason, Summit Medical Group recommends that you learn the specifics of your plan before upcoming health care visits.

Your insurance plan may require multiple copays, higher deductibles, and coinsurance. Coverage will depend on the type of plan you have chosen.

Summit Medical Group participates in a variety of health plans. For this reason, we have developed a billing process that accepts benefits from participating plans.

You can learn the details of your policy by visiting your insurance company’s Web site or contacting its customer/member services department. The back of your insurance card should include the phone numbers and Web site addresses you’ll need.

Questions to ask your insurer:

• Is my doctor's visit covered completely? If not, how much will I be expected to pay?
• If I need tests, will they be covered completely? If not, how much will I be expected to pay?
• If I need a procedure, including surgery, how much will my insurance cover? How much will I be expected to pay?
• Will I need authorization before my health care visit?
   

Summit Medical Group accounts representatives and financial counselors
can answer billing questions Monday through Friday
9:30 AM to 4:30 PM.

Call us at 908-790-6500
or email us at billing@smgnj.com.

Please click here for information on Workman's Compensation and Personal Injury Protection.

Click on a provider below for the details of their plans:

• Aetna^®
  • PPO
  • HMO
  • Choice Plans
  • Open Access
  • POS
  • EPO
  • Aetna Medicare Advantage
     
• AmeriHealth^®
  • PPO
  • HMO POS
  • Open Access
  • Open Access Plus
     
• Anthem^® Blue Cross^® and Blue Shield®
  Please call the health plan to verify participation before scheduling an appointment!
  • PPO
  • POS
  • EPO
  • HMO

• Atlantic Health
  
  
  • PPO
     
• Cigna^®
  
  
  • PPO
  • HMO
  • Network Open Access
  • Cigna Health Plan (CHP)
     
• Cigna Great-West Healthcare^®
  
  
  • HMO
  • PPO
     
• Coventry Health Care, Inc. (First Health)
  • PPO
     
• Empire Blue Cross^® and Blue Shield^®
  • HMO
  • PPO
  • POS
  • EPO
     
• MagnaCare^TM
  • PPO
     
• Horizon Blue Cross/Blue Shield (BCBS)
  • HMO
  • EPO
  • POS
  • PPO
  • Horizon Blue Medicare Advantage
  • BCBS out-of-state PPO plans (Please call the health plan to verify participation before scheduling an appointment!)
     
• Medicare
  
  
  • Traditional Medicare
  • Railroad Medicare 
     
• Oxford^® (Freedom plans only; SMG does not participate with Oxford Liberty plans)
  • HMO
  • PPO

• Private Healthcare Systems^® (PHCS) Multiplan
  
  
  • PPO
  • TPA
     
• Qualcare, Inc. 
  • PPO
  • HMO
  • TPA
     
• United Healthcare Services, Inc.^®
  
  
  • PPO
  • HMO
  • POS
  • EPO
  • TPA
  • New York State Health Insurance Plan (NYSHIP)

Nonparticipating Insurance
If your health insurance plan does not appear on the list above and Summit Medical Group is not participating with it, you may still be seen by a Summit Medical Group provider; however, you must:

• Use your out-of-network benefits
• Pay for your services in full when you receive them
• Obtain a universally accepted claim form from Summit Medical Group
• Complete the claim form
• Ask your insurance company to reimburse you

Summit Medical Group does not participate with:

• Oxford Liberty Plan
• Medicare Advantage Plans, except Aetna Golden Medicare and Horizon Blue Medicare Advantage