Upstate Carolina Radiology

Serving the Upstate of South Carolina

Insurance Information

Insurance Information

Types of Managed Care Insurance

Health Maintenance Organization (HMO)

  • HMOs offer members a range of health benefits, including preventive care, for a set monthly fee.
  • With some HMOs, you will pay nothing when you visit doctors; with others there may be a copayment for various services.
  • An HMO plan usually covers only the cost of charges for doctors in that HMO. If you go outside the HMO, you will pay the bill.
  • Generally, with an HMO, a patient will select a primary care doctor who will coordinate their care, including referring them to a specialist.

Preferred Provider Organization (PPO)

  • A PPO has arrangements with doctors, hospitals and other providers of care who have agreed to accept predetermined fees from the insurer for their services.
  • If you go to a doctor within the PPO network, you will pay a copayment (a set amount you pay for certain services-for example, $15 for a doctor or $10 for a prescription).
  • If you go outside the PP0 network, you will have to meet the deductible and pay coinsurance based on in higher charges. You may also have to pay the difference between what the provider charges and what the plan will pay.

Point-of-Service (P0S) Plan

  • Many HMOs offer an indemnity-type option known as a POS plan.
  • In a POS plan, there are primary care doctors who make referrals to other providers in the plan. If the doctor makes a referral out of the network, the plan pays all or most of the bill.
  • But, generally in a POS plan, members can refer themselves outside the plan and still get some coverage.
Check with your insurer regarding coverages and copayments.

Accepted Insurance Carriers

Carrier Type Of Plan
Aetna EPO / POS / PPO
Beech Street PPO
Blue Cross Blue Shield of North Carolina

  • Costwise
  • MedPoint
  • Preferred Care Select
 Other
Blue Cross Blue Shield of South Carolina

  • Preferred Blue
  • PHS
  • State Health Plan (SC State Employees, BCBS)
 Other
Capp Care (under Beech Street) PPO
Carolina Care Plan (formerly Physicians Health Plan) EPO / POS / PPO
CIGNA PPO / POS / HMO / Flex Care
Crescent PPO
Southcare (formerly Ethix PPO) PPO
Evolutions Healthcare PPO
Hamrick's PPO
Health Care Savings Other
Healthfirst "Options"

  • Preferred PPO
  • Signature HMO
  • Options POS
 PPO / HMO / POS
HealthSource HMO / POS
PPO Next / Healthstar / HealthMark / PHN PPO PPO / EPO
Inman Mills/ACMG Other
Kanawha Preferred Solutions

  • Preferred Benefit Solutions PPO
  • Kanawha HMO
  • Kanawha EPO/POS
 PPO / EPO / POS / HMO
KEBA

  • ABCO Industries
  • Christman and Parson, Inc.
  • SJWD Water District
  • Spartanburg Water District
 Other
MedCost

  • American Healthcare Alliance
 PPO
Medicaid Other
Medicare
MPI/Southern Fine Banking PPO
One Health Plan PPO / POS
CCN/One Source (formerly THAN) PPO
Opitmum Health Plan PPO for St Francis Employees PPO
Patient First PPO
Partners HMO of NC HMO
PHCS

  • John Alden PPO
 PPO / POS
Physicians Care Network Other
Premier Health Systems PPO
Provident/Healthsource

  • Preferred Network (PPO)
  • Point of Service (POS)
 PPO / POS
Prudential Healthcare PPO PPO
Rutherford Health Plan PPO
Spartanburg Advantage PPO
Sunbelt Container/Tim-Bar PPO
Synthetic Industries, Inc. PPO
Unicare Life & Health/Metromont PPO
WellPath HMO
Regional Select

  • SRHS Employess
 HMO