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 How To Effectively Use The Plan

Suggestions To Make The Plan Work Effectively
Prepared By
The Employee Benefit Service Center

6     Be Careful On Physician Referrals Made By In-Network Physicians 
Some in-network physicians make refer you to non-network physicians for specialized care or for other medical services. To assure that you maximize Plan benefits, ask for referrals to in-network physicians or other care providers. If you are referred to an out-of-network medical care provider, the benefit will be considered an out-of-network benefit and will be paid accordingly. While most physicians will assist you on staying innetwork, it is your responsibility to determine where you obtain services

7     Watch For Balance Bills 
Your network has negotiated a discount for most services. You are responsible for deductibles, coinsurance and co-payments, but not for "balance billing" from a physician or hospital. If the medical care provider bills you for the amount of charges over the network fees, you should not pay the bill. Your Explanation of Benefits (EOB) gives more detail about your responsibility. Keep the EOB and when you receive a physician bill, match the EOB for the date of service being billed. If the bill is for a "balance bill", call the medical provider and explain that your network has negotiated a discount and that they should not bill for the discount amount. If the problem remains after calling the provider, call the network (number on your ID card) or call the claims administrator (number on the ID card) or submit an inquiry from the Inquiry Section of this Web Site.
 
8     Never Pay More Than The Office Visit Co-Payment
When you visit an in-network physician, most plans have a co-payment amount due at the time of the visit. If your Plan has a co-payment for in network office visits, only pay the co-payment amount at the time of the visit.
 
9     Reconcile You Benefits 
Track your medical services and the benefit plan actions to reconcile the physician and hospital bills with Plan payments. Match every medical provider bill with every benefit plan payment to determine if any provider bills are appropriate and accurate and to look for any "balance bills".
 
10    Use Your Deductible Wisely 
Many Plans have a carry-over deductible, anything spent toward the deductible in October, November or December counts toward your deductible starting in January. If you can delay services that will be applied toward your deductible to these three months, it will help ease the deductible impact in the new year. Check to see if your plan has the carryover provision and, if so, plan accordingly.


 
[ Part 3 ]

Notice: This information is prepared exclusively for the use
of clients of
The Employee Benefit Service Center

Longtime member of the Society of Professional Benefit Administrators (SPBA)

SAS 70 compliant


 
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