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Provider Networks

We have included links to most of the networks utilized by our clients on this web site. The name of your preferred provider network is included on your ID card and by selecting the link matching the name on your ID card, you can view information about the providers in your network. We encourage you to use the web site of your network because it is more up-to-date than any published directory.

If you are an employer, or an employee offered a choice of networks during enrollment, you can also review information about several alternative networks to select the best choice to meet your network needs.

Employers select certain preferred provider networks to serve their population of employees. So your network option as an employee does not consist of all the networks listed on this web site, but it may be more than one of the networks listed. Your employer will inform you of the options available.

Once the network is named, the employee should obtain services from network hospitals, physicians and other medical providers to obtain the maximum benefits available under the plan. There is coverage outside the network but it is lower than in-network coverage.

Several hints that apply to most plans when using network providers follow. However, please see your Summary Plan Description to confirm your exact benefits.

  • Make sure the claims filing address on your current identification card is communicated to the provider by showing the card at every visit;
  • Check to assure that the provider is in the network before your visit, even if the provider was in the network in the past. Call the phone number of the network, as listed on your identification card, or check the web site at the address of your network provider and look up the current status of participating physicians. There is a link, in the column to the left, for most of the networks utilized by our customers on this web site.
  • The network has a discounted fee that the medical provider will accept as payment in full. Of course you are responsible for any copayments, deductibles or coinsurance as defined by plan benefits, but you should not pay for the amount of the network discount. If the provider charges the network discount, explain that you do not owe the discount. If they insist, call us at the numbers indicated (Contact Us) and we will intervene to solve the problem.
  • Some plans have a designated amount, or copayment, for office visits to an in-network physician. If your plan has a copayment for office visits, only pay the office visit copayment at the time of the in-network office visit. The physician should not attempt to collect more than the office visit copayment.
  • You may see an physician who you have confirmed as being in-network but who is referring you to another physician for services. In this situation, it is your responsibility to assure that you are referred to an in-network physician. Do not assume that an in-network physician will always refer you to an in-network physician or hospital.
  • If it is determined that certain highly specialized services are required but not available from providers within the network, the services may be covered as if provided by a network provider. The services must be pre-approved in writing before they are provided by calling the Preferred Provider Network to verify that the services are not available from network providers. Please keep the written approval to document that the services can be paid in-network.
  • For Emergency Care or Urgent Care situations when the closest medical care provider is not a PPO participant, payment for services from the closest medical care provider will be made as if these services were provided in the network. A network provider must be used for follow-up services to assure the maximum benefit level is paid.

Click here for the List of Preferred Provider Networks

 

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