Insurance

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 (enrollment closes 4/21/10)
     
• AmeriHealth^®
  • PPO
  • HMO POS
  • Open Access
  • Open Access Plus
     
• Anthem^® Blue Cross^® and Blue Shield®
  For select employer groups only. This plan also excludes care received at a Summit Medical Group office located in Morris or Somerset counties, unless you are employed with Verizon. Patients who are employed with Verizon are covered for care at any Summit Medical Group location.
  
  Please check with your plan to be certain the services you need are covered.
  • HMO
  • PPO
  • POS
  • EPO
  • Blue Cross/Blue Shield (when Anthem is indicated on the card )  

• Atlantic Health
  
  
  • PPO
     
• Cigna^®
  
  
  • PPO
  • HMO
  • Network Open Access
  • Cigna Healthplan (CHP)
     
• Cigna Great-West Healthcare^®
  
  
  • HMO
  • PPO
     
• Coventry Health Care, Inc. (First Health)
  • PPO
     
• Empire Blue Cross^® and Blue Shield^® 
  Excludes care received at a Summit Medical Group office located in Morris or Somerset counties.
  Please check with your plan to be certain the services you need are covered.
  • HMO
  • PPO
  • POS
  • EPO
     
• Health Net^®
  
  
  • HMO
  • PPO
     
• MagnaCare^TM
  • PPO
     
• Horizon Blue Cross/Blue Shield (BCBS)
  Summit Medical Group does not participate in Horizon Blue Cross/ Blue Shield unless you are an employee of Novartis, Wyeth, or Pfizer, or if your visit is with a former Paramount Medical Group physician or a former Heart Group physician.
  
  Former Paramount Medical Physicians are:
  
  
  • Stacy Bernstein, MD
  • Stephen K. Bobella, MD
  • Lisa F. Brodkin, MD
  • Epifanio Calcara, MD
  • Susan J. Cantor, MD
  • Kathleen Cuddihy, MD
  • Elizabeth A. Delaney, MD
  • Christopher L. De Masi, DO
  • Maurice A. Ferrante, MD
  • Alan I. Fine, MD
  • Nicole Henry-Dindial, MD
  • Kathleen H. Leistikow, MD
  • John O. Percy, Jr, MD
  • Susan B. Profeta, MD
  • Jamie L. Reedy, MD, MPH
  • Kristen M. Shapren, MD
  • Sharon Stoch, MD
  • John F. Tabachnick, MD
  • Joyce R. Talavera, MD
  • Claudia A. Wagner, MD
     
  In-network care for Horizon patients who are seeing their former Paramount Medical Group physicians will not be interrupted. Please click here if you are a former Paramount Medical Group patient.
  
  Please click here if you are an employee of Novartis, Wyeth, or Pfizer.
  
  
  Beginning January 1, 2012, employees of Merck & Company can begin receiving Horizon coverage for in-network care at Summit Medical Group.   
   
• 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:

• Horizon Blue Cross/Blue Shield (please see exceptions listed under the header, Horizon Blue Cross/Blue Shield above)
• Empire Blue Cross/Blue Shield for services at offices located in Morris and Somerset counties only. Care in all other Summit Medical Group locations is covered
• Oxford Liberty Plan
• Medicare Advantage Plans, except Aetna Golden Medicare

FOR FORMER PARAMOUNT PATIENTS
There will be no interruption of in-network care for Horizon patients who are seeing their former Paramount Medical Group physicians. Please click here if you are a former Paramount Medical Group patient.