Networks we are contracted with:

• PHCS
• USA MCO
• Three Rivers
• Evolutions
• Healthscope Benefits
• VHAN

Networks we are NOT contracted with:

• First Health
• MultiPlan

West Tennessee Marketplace health plans we accept from www.healthcare.gov*:

• The Marketplace
• BlueCross BlueShield – All Plans
• Cigna Healthcare – All Plans
• United Healthcare – All Plans

*We DO NOT accept, nor participate with, any Ambetter of Tennessee plan. If your plan is from another state, your visit may be processed as out-of-network. We do not participate with any Memphis PPO/EPO/HMO or Nashville PPO/EPO/HMO.

The Marketplace - Open Enrollment Period

The Open Enrollment Period runs November 1st – January 15th for each benefit year.  You can also enroll at other times throughout the year if you qualify for a Special Enrollment Period based on household income, or if you experience a life event. Find more information and discover if you qualify by clicking the button below to go to Healthcare.gov:

Healthcare.gov: Special Enrollment Period

Medicare and Medicare Advantage Plans for Tennessee we are in-network with*:

• Palmetto GBA – traditional Medicare and Railroad Medicare Part B
• AARP Medicare Advantage from United Healthcare
• Amerivantage Dual Premier (DSNP) (Medicare Advantage Plan) – Medicare with Medicaid
• Amerivantage ESRD (HMO-POS SNP) (Medicare Advantage Plan) – Medicare with Medicaid
• BlueAdvantage (PPO)
• BlueAdvantage Freedom (PPO)
• BlueCare Plus (HMO SNP) – Medicare with Medicaid
• Cigna Fundamental Medicare (HMO)
• Cigna TotalCare Plus (HMO D-SNP)
• Cigna Premier Medicare (HMO-POS)
• Cigna Preferred Medicare (HMO)
• Cigna Primary Medicare (HMO)
• Cigna True Choice Medicare (PPO)
• Humana Gold Plus (HMO)
• Humana Honor (HMO)
• Humana Gold Plus SNP-DE (HMO D-SNP)
• Humana Honor (PPO)
• HumanaChoice (Regional PPO)
• HumanaChoice (PPO)
• UnitedHealthcare Dual Complete (HMO D-SNP) – Medicare with Medicaid
• UnitedHealthcare Dual Complete ONE (HMO D-SNP)
• UnitedHealthcare Dual Complete ONE Plus (HMO D-SNP)

*If your plan is on our in-network list, but is from another state, your visit may be processed as out-of-network.  

Medicare and Medicare Advantage - Enrollment Periods

Initial Enrollment Period: When you first become eligible for Medicare, you can join a plan.

Open Enrollment Period: From October 15 – December 7 each year, you can join, switch, or drop a plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).

Medicare Advantage Open Enrollment Period: From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Note: You can only switch plans once during this period.

For more information:

Medicare.gov: Joining a Health or Drug Plan

Medicare and Medicare Advantage Plans for Tennessee we are out-of-network with*:

• Advantra Freedom Medicare
• Aetna Medicare Advantage
• American Health Advantage of Tennessee
• Amerivantage Classic
• Amerivantage PLUS
• Amerivantage Balance HMO
• Ascension Complete
• Clover Health
• Devoted Health
• Iron Road Healthcare (formerly Union Pacific Retirees)
• NHC Advantage
• Signature Advantage (HMO SNP)
• UnitedHealthcare plans that are not Dual Complete (Medicare with Medicaid)
• Wellcare Medicare (Harmony Health Plan)

*Out-of-Network Medicare plans are accepted, if they include out-of-network benefits. You may owe a higher cost-share if you go outside your network. If your plan does not have out-of-network benefits, you will be considered a self-pay patient and will be asked to pay a portion of your visit on the day of your visit.

*Some plans require a referral or authorization before you can be seen outside your network. Call the number on your card to find out.

Commercial Insurances we are in-network with:

• Aetna PPO and EPO plans only
• Aetna Open Access Select
• Aetna Baptist Employees network
• Aetna Choice POS II (West TN Healthcare employee plans)
• Allegiance Cigna
• Anthem BlueCross BlueShield
• APWU (American Postal Workers Union) Cigna
• BlueCross BlueShield of TN – Network P, S and FEP (Federal Employees Plan)
• Cigna (all plans including Connect, Great West, SureFit and HMOs)
• Health Partners of TN or MN
• Healthscope Benefits Cigna
• Humana commercial plans
  • ChoiceCare Network PPO
  •  ChoicePOS
  • Humana/ChoiceCare Network PPO
  • Humana/ChoiceCare+ Network PPO
  • National POS – OpenAccess
  • National POS – OpenAccess Plus
  • Oscar+Humana National Network
• Mail Handlers
• Meritain Health / TICUA
• NALC (National Association of Letter Carriers)
• Rural Carrier Benefit Plan (Aetna)
• UFCW (United Food and Commercial Workers) Cigna
• UMR – United Medical Resources
• United Health Care (all plans including Compass, Navigate, Nexus ACO, Oxford, Student Resources and River Valley)

Commercial Insurances we are out-of-network with:

• BlueCross BlueShield of TN – Network V, H or E

Military Insurances we are in-network with:

• ChampVA (Champus)
• Humana Military – Tricare Select or Reserve Select*
  • *Preferred provider for Tricare Prime, but are out-of-network. By PCP referral only.
• Tricare For Life – secondary to Medicare
• VA Community Care Network – by referral only

Tennessee State Plans we are in-network with*:

• Amerigroup
• BlueCare
• Cover Kids
• Tenncare Select
• United Healthcare
• Tennessee Medicaid secondary to Medicare

*You must have a Jackson Clinic Primary Care Provider assigned for primary care services.  For most of our Primary Care Providers, our panels are closed.

Specialist visits require a referral from your PCP.  If your plan is from another state, your claim may be denied as out-of-network.

Vision Plans we are in-network with:

• Superior Vision Plan

Behavioral Health Plans we are in-network with:

• Cigna Behavioral Health
• United Behavioral Health

The Jackson Clinic does not bill Third Party Insurance or entities such as auto, home owners, accident, school, renters, attorneys, cancer policies, disability or insurance discount cards. We can provide an itemized statement along with any medical records required to file your own claim.

If you have further questions, please call the member services number on your insurance card or 731-422-0330 and ask to speak to a Patient Representative.

Before insurance companies can be billed for the services provided to you, you must register your insurance company and policy number with our business office. You must also authorize the clinic to file your insurance claim. The Business Office is available to assist you in requesting that the insurance company pay for the services that the clinic has provided to you. We will help you file and try to get the insurance company to pay as much of your balance as we can. Ultimately, you have paid the insurance premium directly or had it deducted from your payroll account so that you are the insurance company's customer, not The Jackson Clinic. Any amount that the insurance company does not pay will be your responsibility.

The Jackson Clinic is able to file your claim electronically for quick evaluation if your insurance company is programmed to receive an electronic filing. If your insurance cannot receive the claim electronically, we will mail them a paper copy. There are times that the insurance company does not acknowledge receiving claims that were mailed via paper or electronically; therefore, six percent of claims must be filed more than once to get the insurance company to even respond to the filing. We may have to request that you participate in the communication with your insurance company or even the state insurance commissioner. These efforts are to reduce the amount that you will have to pay for your medical treatment.

Your first billing from The Jackson Clinic will arrive after the clinic has had time to file your claim and to receive a response from your insurance company. The statement will show the clinic's charges and the response from your insurance company. If we do not receive a response from your insurance company, the statement will be mailed so that you and the clinic may begin working to get your insurance company to acknowledge and respond to our filing. Your insurance company will also send you an Explanation of Benefits (EOB) that explains the coverage your insurance company has allowed for your clinic visit. Your insurance company may have paid your claim, paid a portion of your claim, disallowed the claim, or not responded. You will be billed for deductibles, non-covered charges, co-insurance, and amounts that your insurance company has failed to address after a reasonable time.

Please keep in mind that services provided by a Jackson Clinic physician at a hospital or outpatient center are billed separately from the facility. You will also receive a bill from the hospital or outpatient center that will include the use of their facility or services.  The Jackson Clinic does not receive an Explanation of Benefits (EOB) that explains the coverage your policy provides for the clinic visit. Any questions about what was paid or not paid should be directed to your insurance company. If you need help understanding the EOB, or if the payment applied to your account does not match the EOB, please bring the EOB to a patient representative for assistance. If you wish to discuss the EOB by telephone, it would be helpful if you would mail, fax, or e-mail the EOB and ask to be called to discuss your question.