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PHCS Health Insurance

PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. Although not a provider of health insurance, PHCS is a provider of PPO (Preferred Provider Organization) networks.

Their services are offered to health care plans, not individuals, as they do not sell insurance or offer any medical services. As part of MultiPlan, PHCS Health Insurance has over 40 million customers with approximately 65 million claims processed every year.

Read through this PHCS review, take a look at the reviews of PHCS left by customers that have plans that use the PHCS network, and then use the free tool on the side of this page to compare quotes from the top health insurance providers in your state for free!

History of MultiPlan

Since MultiPlan’s inception in 1980, as a hospital network in New York, it has acquired several networks including WPPN, forming HealthEOS, BEC Emergis Corp (which doubled its size), Northeast Healthcare Alliance, and Private Healthcare Systems, Inc. Currently it is in the process of acquiring Viant, Inc.

Viant, Inc. has a network of 600,000 providers, 5,400 hospitals, and 95,000 auxiliary facilities. Adding this to MultiPlan’s network of 625,000 providers, 5,000 hospitals, and 115,000 auxiliary facilities will once again almost double its size. Having gone national in 1989, MultiPlan is the nation’s largest PPO network. MultiPlan has also obtained Life Care Hospitals, which is a network of 20twenty hospitals that deal in concepts such as early intervention in order to provide the fastest and most effective recovery for difficult illnesses.

Accredited by the URAC, which is the American Accreditation HealthCare Commission, and the NCQA (National Committee for Quality Assurance), MultiPlan is now owned by a group of investors called The Carlyle Group.

The MultiPlan Networks

There are three main networks within MultiPlan. The primary network is the PHCS Network, which provides the lowest out of pocket expenses for its members. The PHCS Health Directions is an extended network which also provides the lowest cost and is intended to provide health care coverage for members traveling outside their service area. These networks host 550,000 providers, 4,100 hospitals, and 67,000 auxiliary facilities.

The MultiPlan Network is a complementary network for members who choose to go outside of the primary network. Although out-of-network costs will apply per the policy, providers working with the MultiPlan Network are contracted to provide services at the MultiPlan Network Discount. Over 27 million members access the MultiPlan Network of 569,000 providers, 4,500 hospitals, and 87,000 auxiliary facilities.

Wisconsin residents have access to HealthEOS by MultiPlan. This includes 20,000 providers and 160 hospitals. The HealthEOS network is accessed by 1.2 million people.

Another service provided by MultiPlan is Fee Negotiation Services. With 200 expert negotiators, participants are almost guaranteed never to pay retail price for health care services. MultiPlan has also negotiated with 65 facilities that specialize in organ transplants and stem cell transplants. The Centers of Excellence offers savings of up to 30% and includes up to 400 transplant programs. This allows participants to obtain quality specialized care when they need it instead of letting costs dictate their medical care.

MultiPlan’s Grants & Gifts

MultiPlan hosts an annual grant program called Rural Health Outreach Program. In 2009, it awarded $30,000 to ten different hospitals out of 163 applicants. States of the winning recipients are Illinois, Indiana (times two), Iowa, Kentucky, New Mexico, New York, Ohio, Tennessee, and Texas. Each winner will receive $3,000 to fund various programs such as cancer screenings and education, car seat safety inspections, dental screenings, fitness assessment, health clinics, health and wellness days, and nutrition and exercise.

The Annual Holiday Card Program is also underway for 2009. Every year MultiPlan hosts a contest for hospitals that are in the network, including PHCS, HealthEOS, and the MultiPlan Network. Holiday drawings from pediatric patients are submitted to MultiPlan and then voted on. The five entries who receive the most votes will have their drawings turned into holiday greeting cards, which are then supplied for no charge to the winning hospitals to use at their discretion, such as for sale in their gift shops or for a fund raising event.

The Purpose of a Preferred Provider Organization (PPO)

A PPO is a network that offers a large selection of health care providers while still allowing the flexibility of going outside of the network if you so choose. Although out of pocket costs are higher when you go out of the network, the option is there if you want it. HMO’s (Health Maintenance Organizations) do not have this alternative. Also, unlike in a HMO, with a PPO you do not have to choose a primary care provider and you are free to see specialists without a referral. Of course, these added benefits come at an additional cost as PPO’s are typically higher priced plans than HMO’s.

Deciding on a HMO or a PPO should not be strictly based on costs. You should consider how much involvement you want in your own health care management as a PPO is more consumer driven. Also, not only do you have more provider choices in a larger PPO network, but you also have more flexibility in changing your providers at will. However, HMO’s are regulated more closely by the government than PPO’s, and with a HMO you shouldn’t anticipate getting a bill from your provider.

With either type of network you should expect to receive quality medical care and complete access to all of your benefits as defined in your plan.

Compare PHCS Health Insurance Quotes

While it is not really possible to get PHCS health insurance quotes from PHCS or MultiPlan it is certainly possible to get quotes from insurance companies that use their networks. Make sure to get several quotes from those providers and many others that service your area before making a final decision on your health insurance provider, plan, or policy. To start shopping for your health insurance plan now, just enter your zip code into the box on the right side of the page. Get started comparing the best health insurance providers now!

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35 reviews

  • Doris Carlton /
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    I find that it is hard to find a doctor that will take this insurance. I did request a directory from multi plan for a primary care phy. They gave me everything but what I ask for.

    PHCS is not a good health insurance. What good is this insurance if no doctor wants to be a part of it?

    Doris Carlton

  • Naeem Ahmad /
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    As they say in presentations but totally opposite to when come to ask any question or information a person inquired of them. Good for nothing!

    For health care, a person does not need a network or list of doctors who can treat you. Anyone can find a doctor who is willing to take a patient in her or his area. Free loaders are these network. They are just another burden on the health industry.

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    Can’t find a doctor who takes this insurance in my area. You have them listed as accepting your insurance; but when called they claim they don’t.

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    They don’t want to pay the coverage.

    Dental filling required 2 years once for the same tooth.

    And insulin pens and needles refill should at the same time. Otherwise, they don’t pay you after you refill needles. I can’t find a policy in their explain book.

  • Jennifer Smart /
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    CRAPPY CRAPPY CRAPPY! Those are the only words to describe this so called insurance.

    They “claim” to cover things but they refuse to pay anything. My daughter went for her recent wellness check up which according to the insurance they will pay $150 for, well I get a bill and insurance denies it saying wellness check-ups are not a covered benefit.

    We have only had this 2 months and both my kids and I have only used it once each and all 3 claims were denied saying what we went for are not covered benefits. Our doctor is a PCP in the network yet the insurance refuses to pay anything.

    This is employer coverage and my husband is ready to cancel it and we will pay out pocket for something else. AVOID THIS INSURANCE AT ALL COST!!!!!!!!!!!!

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    Worst insurance ever!!

    My employer just changed us to this and so far 3 out 5 claims are being denied even though they say they’re covered. And today I took my son to the doctor where a prescription was prescribed. The pharmacist informs me that they won’t cover it cause in their opinion it’s too much for an 11-year-old child, what??? Since when did an insurance billing company become doctors?? Who gave them the power to over rule a physician and the care that is being provided??

    STAY AWAY, this is the worst insurance and billing company!!!!

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    PHCS has to be one of the worst that I have ever seen. I have a reference number in regards to if my doctor is participating and accepting PHCS or not. PHCS say that he is and my doctor says that he sent PHCS back on 31 March 2012 telling PHCS that he no longer accepts PHCS Insurance. The gentleman that I just spoke with this morning told me that they have to record of that case number with was given to me yesterday by Amanda.

    I have found numerous instances where PHCS indicates that a doctor is participating in PHCS but when you call the doctor’s office up, they do not participate. If just one doctor said that he did not participate whilst PHCS said that they did, I might tend to believe PHCS. But when y’all have multiple doctors all saying the exact same thing, I then tend to believe the doctors.

    PHCS tell you one thing one day and something completely different the next day. Horrible company to deal with!!!! Stay away if at all possible…..

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    This is the worst plan I have ever encountered. After over 90 minutes of trying to find a doctor that took my insurance, I finally found a single one. I used Multiplan’s website and their phone service. The search on the website is horrible.

    It returns providers all over the state instead of those within the search radius. When searching for a General Practitioner I was given phone numbers of OBs, pediatricians, spinal specialists, urgent care, but not a single GP.

    When I called, I was given a list of physicians only one of which was even close to where I live. When I tried to get better information, the customer service representative hung up on me.

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    No One Takes This INSURANCE! I’m so sick of not being able to go to my regular doctors.

    Point of Service = POS, which = Piece of S***!

    No Pharmacy will deal with this so called insurance either.

    It’s b.s.

  • cristina macias /
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    ellos solo quieren dinero, cuando pedi informacion de la cobertura por email ellos fueron muy groseros, y exijentes que perderia los beneficios que me ofresian si no les pagaba en ese mismo momento el pago inicial de $259.00 les dije lo consultaria con mi marido y no colgaron asta que hable con el lo cual me paresio sospechoso , les dije lo voy a pensar y les colge . son malisimos

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    I have a plan that uses the PHCS network. My 10 blood tests cost $1400. I used an in-network lab and PHCS discounted $1200. My plan also paid $100 toward the remaining bill so my 10 blood tests cost me $100 out of pocket.

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    My kids were just put on this plan. There is no Dr in my area to take this insurance. All but one Dr on their list actually takes it and it is 36 miles away in another state. I have never had so much difficulty, with an insurance company trying to get information.

  • Deborah Spitzinger /
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    THIS IS THE WORST HEALTH INSURANCE I HAVE EVER HAD. I CANNOT FIND A GOOD REPUTABLE DOCTOR IN THE SW FLORIDA AREA.

    WHEN I ADVISE THE NAME OF THIS INSURANCE, 99.9% OF DOCTOR OFFICES HAVE NEVER HEARD OF PHCS. WHAT GOOD IS THE INSURANCE IF DOCTORS DO NOT USE THIS.

    THIS INSURANCE SUCKS! I DO NOT WANT TO LEAVE A STAR IN ANY CATEGORY AS THEY DO NOT DESERVE IT BUT I CANNOT SUBMIT THIS REVIEW WITHOUT ONE.

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    Worst insurance I have ever even heard of! We bought it through a company that searches various health plans to fit your family, and I’m assuming every bit of information they had about PHCS was a lie.

    I have yet to find a doctor from their website that even knows this insurance exists. My pelvis was twisted in an accident, and they won’t cover chiropractor even though the only thing any other doctor could do is give me pain medications, which I can’t take. I have had doctors call them three times or more to ask about my coverage, and they get a different answer every time.

    My daughter’s checkup with her PCP (which we were told would be covered at least 80%) was only covered 25%, but their contract is so convoluted, the manage to get away with continually taking $400 a month and giving practically nothing in return. And these are only the things worth mentioning.

    I have yet to have a positive experience with PHCS. I say stay away from this company unless it’s your last resort!

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    When I was signing up the agent didn’t tell me that to get ANY procedure the 7500 dollar co-pay must be paid first! He out right lied about the prescription cost – saying 20 dollars for generics, 50 dollars for brand name drugs. The truth is – I only received a generic discount card. That’s the prescription insurance. UP to 50 percent-off.

    I needed a prep med for a colonoscopy (under a different insurance, thank God) The prescription cost 104.00 ,this insurance paid 28.00 ! I am outraged ! I could go on with my dissatisfaction for days.

    This should be against the law. When I called to complain, I was told a supervisor would call me to discuss. It has been over a week, no call.

    My rating of one star means very poor.

  • Kimberly /
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    This Insurance is a total Joke! talk about major policy fraud!

    We had this insurance back in 2008. My son had an accident on a four-wheeler, and they did actually pay the $10,000.00 rider for him, but I had the same issue with a four-wheeler this last September 2013 and they no longer cover any motorized vehicles. Really!?! What do they cover?

    I have been paying my premium since 2008, and now they tell me and my agent that the policy changed four years ago? Neither one of us ever got that memo! What a joke! I am definitely sending this info to my state investigator about insurance fraud!

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    I can not find a doctor that would take this insurance and the one doctor that did accept the insurance told me today that he no longer take the insurance because they are refusing to pay the claims and I can not drop the plan until October.

    This is out right insurance fraud.

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    Terrible! Avoid PHCS like the plague (which I’m sure they won’t cover).

    Want an example? I went to see a doctor for a follow-up visit. Was told it’s not covered because my insurance was maxed out. What?

    Apparently, I was entitled to only one doctor’s visit over a three month period. And the max reimbursement? $50! So I pay approximately $1,100 over three months with the prospect of a $50 reimbursement total. Ridiculous.

    As my son said, PHCS is a criminal organization. Amen.

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    I’d be better off not having insurance at all.

    My chemo treatments are not covered at all through this insurance. I am responsible for paying the cost for my treatments in their entirety. I’m not even able to get a cash pay discount at the hospital since I do have this extremely limited insurance.

  • Michelle Freed /
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    Scam. Never leave any personal information online.

    I was yelled at by agent when I didn’t want to sign up on the spot. The agent called me insulting him, wasting his time, he could have picked up other call instead of mine. What a joke. I rate everything negative. Be aware of online scam.

  • Dr. Bob Rozner /
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    We have taken PHCS for years in our office, we are in Naperville, IL. We have NEVER had a problem with payment, or fights for prior authorization for tests. I was recently looking at Multiplan/PHCS for our office coverage and may go with it for next year.

    Read your policy yourself and ask questions before you buy. All Healthcare insurance is expensive. Nobody should expect to get out what they put into it. That is reserved for the small minority that gets REALLY sick and you don’t want that to be you!

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    Can’t blame it on the affordable care act, like I thought was my issue until I started reading the reviews here. It’s the same as multiple complaints going back years on here apparently. NO DOCTORS on the list take this.

    Of course during open enrollment, you trust the website is accurate and go ahead and sign up (through my employer). It isn’t until after you’re enrolled and you start calling to actually set up an appointment that you realize it’s ALL LIES. I can’t find a doctor in my area that takes this based on the fist 5 I called.

    I don’t have time to call every doctor on their list until I find the one or two that may take it- nor do I want to settle just because I finally find one that does. SMDH … AVOID THIS!!! Hopefully, you do your due diligence and read this BEFORE you enroll.

  • Steve Richman /
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    Best network I’ve ever dealt with. Great price point and excellent customer service. I have over 200 doctors located within 15miles of my zip code that accept this insurance. Much cheaper than Obama Care.

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    Worst insurance I ever had. But the most I ever paid monthly. They refuse to pay most bills including emergency. SAD! Avoid!

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    Very very frustrating to use this plan. The website search feature is very narrow – a doctor may have 2 offices, but will only be listed in one location. So if you use the wrong zip code, the doctor does not come up. The help line is useless.

    I’ve had issues with some doctors in offices being on the plan but the other doctors are not on the plan so I have to double check everything.

  • shineola /
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    PHCS not paying my medical claims. I have met my deductible for the yr. & require further tests. But specialist cannot confirm that deductible has been met due to the fact it is taking PSCS 30-45 days to upload EOB…frustrating to say the least.

    Company provided insurance to employees. PHCS brings plenty of smoke & mirrors when selling their policies.

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    I am an international student and this is the insurance my school requires me to enroll. I don’t have a SSN so this is the only insurance I can have in this country.

    I’ve called so many doctors on the list of providers PHCS website gave me, and none of them could take me because either 1) Wrong number or information listed on the list, 2) They don’t accept new patients, or 3) They need referrals from other doctors.

    I called one of the customer service numbers and all they do is giving me the list of providers. When I called the number of my insurance card the ladies were so rude and never called me back even though I left them a voice message.

    They are not willing to help sick people. If you keep doing this you will lose your customers because there are so many bigger and better insurance companies out there.Please please improve your coverage and customer service. I’m desperate.

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    The worst insurance ever, they cover the doctor but not the hospital?

    I was scheduled for a surgery, the week before, they tell me that they cover the surgeon only, not any hospitals in my area. Where is my surgeon supposed to do the operation, on my kitchen table? This is ridiculous, even the hospital and the doctor have said they never heard of this ever happening.

    This is a joke, do not waste your time and money. They do not pay for anything! their website and representatives lie. I have a letter of authorization for my surgery and yet I cannot use it anywhere!

  • Tobey Holcomb /
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    Worst Insurance I have ever had to pay for.I have gotten epidural injections in my back for sciatic nerve pain for several years,all my previous insurance has covered this . PHCS claims this is not a wellness visit ,therefore I have a $ 5000.00 deductible .

    I can only receive 4 injections a year @ $841.00 a piece, therefore, I will never meet my deductible .I also checked into possible laser surgery,$ 15,000.00 deductible , I can have the surgery done for $ 13,500.00 if I pay it myself .

    I see no need in having insurance that pays nothing, so never enroll in this company insurance.

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    Can I give negative stars??

    I thought United Healthcare was bad but PHCS is the absolute worst insurance we have ever had. What I wouldn’t give to have UH back. My company made a big mistake moving to them.

    My wife has had a life-threatening emergency that has required an extended hospital stay at a significant cost, $45K and still counting. PHCS is supposed to cover 60% (it should be 80% but of course, most of the doctors etc, that have worked with here are not covered under this plan).

    My hospital is battling for us but I’ve got a glimpse at some of the charges and the corresponding payments by PHCS and it’s obscene, they’re covering less than 5% currently. I don’t know what’s going to happen if it can’t be worked out, it’ll cost more in legal fees to battle it.

    I can’t even change insurance now because of the idiotic enrollment rules. If your company says they use PHCS or are looking at it, I advise to run the other way as fast as you can

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    Already have insurance. How would this insurance benefit me?

  • Rachel Schroeder /
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    PHCS has been a great network to work with. Every doctor/hospital I have come across accepts this network.

    Unfortunately, there are people out there that want to have a low monthly cost + 100% covered services and that’s just not how it works anymore.

    Also, for all the negative comments above, PHCS is not the insurance company, it is the network. There is a huge difference. It wouldn’t be the network paying for your bills.

    No complaints here!

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    The 1-star ratings I gave PHCS is bogus. They deserve NO stars.

    This company is a bunch of CROOKS.

    I checked with the website and was assured that a particular physician I wanted a consult from was part of the plan. They never paid him, even after two years of go-rounds with them.

    Yesterday I received a bill from the doctor’s office. I will pay it because I am an honest person, and I believe he should be compensated. But that means that greedy, evil PHCS has won again.

    Never enroll with these jerks. (We had to deal with them because we had insurance through my husband’s employer.)

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    We have great insurance but will be paying out of network since no doctors are with PHCS in our rural area. If you live in the western rural towns DO NOT get this!

    If you live in a rural area, they will tell you a town is within the 50-mile radius but it is “as the crow flies”. We use many doctors in Rapid City, but every clinic we are contacting is not in network and of all doctors in RC only a handful are participating! So much for affordable health care!

    Once again the insurance companies and their affiliates stick it to their paying customers!

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    I have this insurance through work. And I had to use it for the first time recently.

    I looked up a doctor on the multiplan website and called. Within a couple hours I was being seen by the doctor and there was no cost to me for the visit. Generic prescriptions were free as well.

    I have nothing to complain about here, very happy that everything went so smooth. I guess I’m lucky there are doctors in my area who take this insurance, unlike many other reviewers.

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