Out of Network Care

Stormont Vail is continuously engaging with payors to negotiate and maintain strategic agreements that allow us to be in-network, support patients’ access to care, and foster partnerships with insurance providers. 

As of April 1, 2025, Stormont Vail Health is an OON provider for the following insurance plans:  

Marketplace Plans

Ambetter Marketplace Plan

Oscar Marketplace Plan

United Healthcare Marketplace Plan

Medicare Advantage Plans

United Medicare Dual Complete

UHC AARP Medicare Advantage

Healthy Blue Medicare Adv DSNP

Allwell Medicare Advantage

Choosing an insurance

Choosing an insurance can be complicated. Here are some things to consider when deciding which insurance will best suit your needs:

What does the plan cover?

Not all insurance plans cover all health needs the same. Before you choose a plan, consider what you want and need the insurance to cover.

Do you have health conditions that require specific treatments or specific health care providers?

Make sure they are covered by or are in network with the plan.

Is my doctor or hospital in network?

Very few health systems participate with all insurance providers. You need to check to see if your preferred doctor or hospital is in network for the insurance you are thinking about choosing. Once you have chosen an insurance, you may not be able to change to a different plan for a year, so please choose carefully.

What does the coverage REALLY cost?

  • Don’t just look at the monthly premium. A plan with a low monthly premium might have high out of pocket costs, while a plan with a higher monthly premium might cost you less out of pocket when you seek healthcare. Each plan will also have additional costs that you may need to pay when  you receive healthcare.
  • The premium pays for your coverage each month whether or not you seek health care.
  • Copays are amounts due at doctor’s or emergency room visits.
  • A deductible is the is the total amount that you will owe before your insurance will start paying for health care expenses. You may still owe more after meeting your deductible, but this is where your insurance will start paying for more.
  • The maximum out of pocket is the total amount you would have to pay for in covered health care expenses before your insurance pays for everything else.

How do all of those work together when you seek health care?

  • If you are likely to need a large amount of health care throughout the year, you could consider a plan with a lower maximum out of pocket. That might be a better option for you.
  • If you are healthy and not likely to need a large amount of health care throughout the year, you could consider a plan with lower premiums, but a higher maximum out of pocket. It is a risk, but if you don’t end up needing a large amount of health care during the year it could save you some money.
  • Consider setting up a savings account for unexpected expenses. Setting aside a few dollars each month can add up over time to help with unexpected expenses including health care.