We understand that billing and payment for healthcare services can be confusing. Knowing your insurance policy is important for you to receive the maximum benefits for your healthcare services. Your benefit coverage level for care provided by THMG is determined solely by your insurance.

Tower Health Medical Group is contracted with many health plans.

A list of those plans can be found below. You can also call our Patient Financial Services office at 484-628-5683 for a complete list. Please note: our list is not meant to be all-inclusive and is subject to change. Please check with your health plan to verify coverage.

Commercial

Insurance through your employer

  • Aetna
    • Aetna QPOS
    • Aetna Whole Health
    • Aetna Select
    • Aetna Value Performance Network
    • Aetna Voluntary Plans
    • Aetna Savings Plus
    • Aetna HMO
    • Aetna HMO (Open Access)
    • Aetna HMO / Health Network Only
    • Premier Care - Network & Premier Care Network Plus
    • Choice POS, Choice - POS (Aetna HealthFund), Choice POS II, Choice POS II (Aetna HealthFund)
    • Elect Choice EPO
    • Health Network Only & Health Network Option
    • Open Access - Elect Choice, Open Access EPO
    • Open Access POS, Open Access EPO Plus (Broad) & Open Access POS II (Broad)
    • Managed Choice, Managed Choice - Open Access, Managed Choice POS
    • Mercy Preferred Choice POSII, Mercy Preferred Choice Select, Mercy Preferred Elect Choice EPO
    • Mercy Preferred Managed Choice & Mercy Preferred Open Choice (PPO)
    • Open Choice PPO & Open Choice PPO - Aetna HealthFund
    • Preferred - Open Choice PPO, Preferred Choice POS II, Preferred Select
    • Preferred Elect Choice EPO, Preferred Managed Choice
    • Peak Preference Select HNOnly on the Altius Network and Peak Preference Select HNOption on the Altius Network

We do not participate in the following Aetna plans:

- Not PEBTF HMO

  • AmeriHealth Administrators

  • Capital Blue Cross 

    • CareConnect – PinnacleHealth ACA Network

    • Comprehensive

    • POS

    • PPO, PPO Choice

    • Traditional

    • HMO


We do not participate in the following Capital Blue Cross plans:
- Valley Advantage EPO

  • Cigna 
    • 
ChoiceFund OA Plus

    • Open Access Plus

    • OA Plus

    • ChoiceFund OA Plus with CareLink PPO

    • Choice Fund PPO Network

    • HMO

    • POS

  • Coventry
  • 
EHP Significa Network
  • 
First Health Network
  • 
Geisinger Health Plan
  • 
Great West
  • 
HealthAmerica/Health Assurance
  • 
Highmark Blue Shield (NOTE: standard tier)


We do not participate in the following Highmark plans:
- Community Blue Medicare HMO
◦My Direct Blue EPO

  • Independence Blue Cross
  • 
Keystone Health Plan Central
  • 
Keystone Health Plan East
  • 
Tower Health PPO (formerly Berkshire Health Partners)
  • 
TriCare
  • United Healthcare 
    • Unitedhealthcare Navigate 
    • All Savers 
    • Unitedhealthcare Catalyst 
    • Unitedhealthcare Choice and Choice Plus 
    • Unitedhealthcare Choice Advance and Choice Plus Advance 
    • Unitedhealthcare Options PPO plans
    • Unitedhealthcare Tiered Benefit Plans
    • Unitedhealthcare MD-IPA Plan

We do not participate in the following United Healthcare plans:
- Oxford (unless the member has access to choice plus)
- Heritage (unless the member has access to choice plus)
- Erikson Advantage

  • UPMC Health Plans
    • Premium Network Plans PPO and EPO Plans

    • UPMC Employees Out of Area PPO Plan 
      • UPMC Out of Area Gold

      • UPMC Out of Area Silver

    • MyCare Advantage PPO Level 2 Providers



We do not participate in the following UPMC plans:
- Partner Network Plans (HMO and EPO Plans)
- Standard Network Plans (HMO Plans)
- Partner Network Plans (HMO and EPO Plans) 
- UPMC Business Advantage HMO (Referral Required) 
- UPMC Business Advantage HMO (No Referral) 
- Enhanced Access (HMO and POS Plans) 
- UPMC Employees Advantage (EPO Plans) 
- Panther Gold Advantage HMO (For Pitt Employees) 
- Panther Gold HMO (For Pitt Employees) 
- FEHB Plans 
- UPMC Inside Advantage Level 1 Providers 
- MyCare Advantage HMO Level 1 Providers 
- MyCare Advantage HMO Level 2 Providers 
- MyCare Advantage PPO Level 1 Providers

  • Prime Care
  • 
Wernersville

Medicare Advantage

Insurance for people over 65 years of age or with disabilities.

Plans Offering Drug Coverage 

  • AARP Medicare 
    • Complete HMO 
    • Complete Choice PPO 
  • Aetna Medicare 
    • Choice HMO
    • Silver HMO
    • Gold PPO 
    • Premier HMO
    • Standard HMO 
  • AmeriHealth Caritas VIP Care 
  • Capital Blue Cross Medicare Advantage 
    • Blue Journey HMO 
  • Coventry Advantra 
    • Gold PPO 
    • Silver HMO
    • One PPO 
  • Highmark Medicare Advantage
    • Freedom Blue PPO 
    • Community Blue Medicare PPO 
    • Community Blue Medicare PPO Plus – Clinton, Lycoming, Sullivan, and Tioga Counties only 
  • Keystone 65
    • Basic Rx HMO
    • Preferred Rx HMO
    • Select Rx HMO 
  • Personal Choice 65 Rx PPO
  •  United Healthcare
    • Unitedhealthcare Dual Complete 
    • Unitedhealthcare Group Medicare Advantage Plan 
    • Unitedhealthcare Assisted Living Plan (PPO) 
    • Unitedhealthcare Nursing Home Plan
  •  UPMC for Life 
    • HMO 
    • PPO 

We do not participate in the following UPMC plans:
- UPMC for Life HMO Premier Rx

Plans without Drug Coverage
  •  Keystone 65
    •  Preferred Medical Only HMO
    •  Select Medical Only HMO 

•United Healthcare AARP Medicare Complete

Special Needs Plan
  • Gateway Health Medicare Assured 
    • Diamond HMO 
    • Ruby HMO 
  • Keystone First VIP Choice HMO
  • United Healthcare 
    • AARP Medicare Complete 
    • UHC Dual complete
    • UHC Group Medicare Advantage Plans ◦UHC Assisted Living Plan (PPO) ◦UHC Nursing Home Plan

CHIP

Children's Health Insurance Program through the state

  • Aetna Better Health Kids
  • Capital Cares for Kids
  • GHP Kids (Geisinger)
  • Highmark PPO Plus
  • UHC CHIP
  • UPMC for Kids

Medicaid HMO

Insurance program through the state for those requiring financial assistance

  • Aetna Better Health
  • AmeriHealth Caritas
    • Pennsylvania
    • Northeast
  • Highmark Blue Shield Special Care
  • Gateway Health Plan
  • UHC Medicaid
  • UPMC for You HMO

Marketplace/ACA Plans

Independent insurance plans through the Affordable Care Act

  • Capital Blue Cross
    • Bronze PPO 7350-0-60
    • Silver PPO 5000/10/30
    • Gold PPO 2000/10/20
  • ALL Geisinger Marketplace Plans, EXCEPT Geisinger Marketplace “Select” HMO (which says “Select Network” on the card)
  • Independence Blue Cross
    • Personal Choice Bronze Reserve IBC (Tier 3)
    • Personal Choice PPO Bronze IBC (Tier 3)
    • Keystone HMO Silver Proactive IBC (Tier 3)
    • Keystone HMO Gold Proactive IBC (Tier 3)
    • Personal Choie Silver Reserve IBC (Tier 3)
    • Keystone HMO Gold IBC (Tier 3)
    • Personal Choice PPO Silver IBC (Tier 3)
    • Personal Choice PPO Gold IBC (Tier 3)
    • Keystone HMO Platinum IBC (Tier 3)
    • Personal Choice Platinum IBC (Tier 3)
  • UPMC Health Plans
    • Tower UPMC Advantage Bronze
    • Tower UPMC Advantage Silver
    • Tower UPMC Advantage Gold

Insurance Information

Please select the name of the hospital with which your THMG practice is affiliated below to find out which coverage plans it accepts:


Billing 

We'll bill your insurance company in a timely manner and do everything we can to expedite your claim. But remember, payment is ultimately your responsibility. If we bill your insurer, and after 30 days the account is not taken care of, we'll look to you for final settlement of your bill.

We accept:

  • Cash
  • Check
  • Money order
  • VISA
  • MasterCard
  • American Express
  • Discover

We have answers to your billing questions. Please call 484-628-5820 or toll-free 866-333-5820 between the hours of 8 a.m. and 5 p.m. Monday through Friday.

Understanding Your Financial Responsibility

When you are scheduled for a doctor’s appointment or other test, study or procedure at any of our THMG locations, the representative who checks you in will enter information needed for your patient chart, and to help us bill your insurance.

At this time, we will:

  • Discuss your portion of the financial responsibility. We will let you know how much your co-pay and deductible will be for the service we will be providing.
  • Discuss any past-due balances you may have with THMG.
  • Discuss payment options for your co-pay, deductible and any past-due balances.

There are several payment options available to you at the time of registration. They include credit card using our secure card swipe at your point of service registration, or you can pay with a check, money order or cash.

If you cannot pay the patient responsibility portion of your bill, one of our patient financial service representatives will speak to you about options. This may include a partial payment at the time of service and arranging a payment plan.