Patient Resources

Contact your health insurance carrier to verify coverage for your specific benefit plan.

Most common commercial plans

• Aetna
• Anthem Blue Cross & Blue Shield
• Cigna
• Medical Mutual of Ohio
• Humana Insurance Company
• United HealthCare of Ohio, Inc.

Other commercial plans:

• Baptist Health Network
• Beech Street Corporation
• Evolutions Healthcare Systems, Inc.
• First Health Group / Coventry Health Care
• Galaxy Health Network
• HealthLink, Inc.
• Health Ohio Network - Elite Product
• Health Ohio Network
• HealthSmart Preferred Care
• National Provider Network
• Ohio Health Choice
• Paramount Health Care (Letter of Agreement only, not advertised as a participating provider)
• ppoNext, Inc.
• Private Healthcare Systems, Inc.
• TriHealth Benefit Solutions transitioned to Anthem as of 1/1/2020

Direct Employer Agreements contracts administered by Custom Design Benefits:

• ATM Solutions
• BGR, Inc.
• City of Wyoming
• Clippard Instrument Lab
• Cohen Brothers, Inc.
• Combined Technologies
• Flottweg Separation Technology, Inc.
• Great Parks of Hamilton County
• Hamilton Caster & Manufacturing
• Hyashi Telempu North America
• Holland Roofing Group
• Johnson Investment Counsel
• Kenwood Dealer Group
• Magellan Aerospace
• Munninghoff, Lange & Co.
• Pure Romance
• Ruthman Pump and Engineering
• Scroggins Grear
• Seilkop Industries
• The Gilkey Window Company, Inc.

Direct Employer Agreements contracts administered by Tristar:

• Lyons Magnus, Inc.

What if I don’t see my plan listed?

If you don’t see your plan listed you may need to obtain permission for your child to be treated at Cincinnati Children’s in order to insure you and your family do not incur any unexpected out-of-pocket expenses. We recommend you do the following:

1. Check with your child’s Primary Care Physician (PCP) to obtain a referral to Cincinnati Children’s;
2. Check with Member Services or your Care Manager with your insurance plan to seek an exception and authorization for your child to be treated at Cincinnati Children’s; and
3. You may also need to contact your employer’s HR department.

Each state approved specific companies to sell plans on the exchanges. Many hospitals, including Cincinnati Children's, do not contract with all of the plans in their state's exchange.

Learn more about the Health Care Exchange plans contracted by Cincinnati Children’s.

Contact your health insurance carrier to verify coverage for your specific benefit plan:

Ohio

• Ohio Medicaid
• Buckeye Community Health Plan
• CareSource
• Molina Healthcare of Ohio, Inc.
• Paramount Advantage Plan
• United HealthCare Community Plan

Kentucky

• Kentucky Medicaid
• Anthem
• Aetna Better Health of Kentucky
• Humana
• WellCare of Kentucky
• Passport

Indiana

• Indiana Medicaid
• Anthem
• CareSource
• MDWise Excel Network 

West Virginia

• WV Medicaid
• The Health Plan (Letter of Agreement only, not advertised as a participating provider)

What if I don’t see my plan listed?

If you don’t see your plan listed you may need to obtain permission for your child to be treated at Cincinnati Children’s in order to insure you and your family do not incur any unexpected out-of-pocket expenses. We recommend you do the following:

1. Check with your child’s Primary Care Physician (PCP) to obtain a referral to Cincinnati Children’s; and
2. Check with Member Services or your Care Manager with your Medicaid plan to seek an exception and authorization for your child to be treated at Cincinnati Children’s.

Please Note: Behavior Health Plans may be managed by a different insurance provider than your health insurance. Please check your health insurance card for a separate plan that manages your behavioral health benefit.

• Beacon Health Services, LLC (Humana CareSource behavioral health carrier)
• Cenpatico (Buckeye Health Plan members only)
• Cigna Behavioral Health (Cigna behavioral health carrier)
• HealthNet Advantage, LLC
• Humana Behavioral Health
• Optum Behavioral Health (formerly United Behavioral Health, Inc.)(United Healthcare behavioral Health carrier)

What if I don’t see my plan listed?

If you don’t see your plan listed you may need to obtain permission for your child to be treated at Cincinnati Children’s in order to insure you and your family do not incur any unexpected out-of-pocket expenses. We recommend you do the following:

1. Check with your child’s referring provider and/or Primary Care Physician (PCP) to obtain a referral to Cincinnati Children’s;
2. Check with Member Services or your Care Manager with your insurance plan to seek an exception and authorization for your child to be treated at Cincinnati Children’s; and
3. You may also need to contact your employer’s HR department.

Cincinnati Children’s has contracted with the majority of networks that provide Specialty/Transplant care. Contact your plan manager to verify coverage for your specific benefit plan:

• Aetna
• Anthem
• Blue Cross/Blue Shield Association (BDCT)
• Cigna LifeSource
• Coventry Health Care, Inc.
• Health Management Network
• Humana
• INTERLINK Health Services, Inc.
• LifeTrac
• MultiPlan, Inc.
• Optum (formerly United Resource Networks)
• Protocol Tertiary Networks, LLC
• Strategic Health Development Corporation
• 6 Degrees

What if I don’t see my plan listed?

If you don’t see your plan listed you may need to obtain permission for your child to be treated at Cincinnati Children’s in order to insure you and your family do not incur any unexpected out-of-pocket expenses. We recommend you do the following:

1. Check with Member Services or your Care Manager with your insurance plan to seek an exception and authorization for your child to be treated at Cincinnati Children’s; and
2. You may also need to contact your employer’s HR department.

Cincinnati Children’s does not have a contract with the following plans/payors:

All Medicare Advantage Plans (Anthem, Humana, UHC, etc):

• Please Note: Oncology, Hematology Care (OHC) referred labs is contracted with Cincinnati Children’s under most Medicare Advantage plans

Marketplace Plans including:

• Ambetter Buckeye Marketplace Plan
• Anthem Pathway HMO/Anthem Pathway HMO X
• CareSource Marketplace Plan (Indiana only)
  Please Note: We do accept CareSource Marketplace plans in Ohio and Kentucky.

• MMO Marketplace Plan
• Molina of Ohio Marketplace Plan
• United Compass

Other plans including:

• Indiana HIP plans (managed by Anthem, MHS, MDWise) 
• Managed Health Services (Indiana Medicaid HMO)
• MedBen plans not utilizing a provider network

MyCare Ohio Plans:

• Molina
• Aetna Better Health
• Buckeye
• CareSource
• United Healthcare Connected