Tag Archives: in-network

Children's Preventive Care

Your Children’s Preventive Care and Physicals

Getting your kids to their physicals and checkups, where they can get covered children’s preventive care and screenings, helps them be their healthiest. It’s important not only that you know what’s recommended for their ages and what they need to stay up to date, but also that you get them to the doctor for this on the right schedule.

What Happens at Their Physical

Your child needs to have regular wellness visits with their doctor to focus on their development, health, and wellness. At the appointment, some of the basics your doctor will cover are:

  • Checking that your child is developing at a healthy rate and tracking their health information and history
  • Getting a physical exam
  • Staying up to date with their preventive care
  • Getting education and counseling
  • If needed, setting health goals

Visit Schedule

Your baby needs to go to well-baby visits at:

  • 1 month old
  • 2 months old
  • 4 months old
  • 6 months old
  • 9 months old

Children need to visit their doctor at:

Adolescents and teens should visit the doctor at least once a year:

Choose a visit from the lists above to learn more about what will happen at that visit.

Children’s Preventive Care

Certain children’s preventive care and screenings are always covered, depending on timing and what your doctor recommends.

Newborns

  • Gonorrhea preventive medication
  • Hearing screening
  • Hemoglobinopathies or sickle cell screening
  • Hypothyroidism screening
  • Phenylketonuria (PKU) screening

Babies and Small Children

0 to 11 months
  • Behavioral assessment
  • Blood pressure screening
  • Height, weight, and body mass index (BMI) measurements
  • Medical history
  • Tuberculin testing
  • Oral health risk assessment
  • Iron supplements for children ages 6 to 12 months at risk for anemia

Children

1 to 4 years
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Oral health risk assessment
  • Iron supplements for children ages 6 to 12 months at risk for anemia
  • Autism screening for children at 18 and 24 months
  • Developmental screening for children under age 3
5 to 10
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Oral health risk assessment

Adolescents/Teenagers

11 to 14
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Hepatitis B screening for adolescents at high risk
  • Alcohol and drug use assessments
  • Cervical dysplasia screening for sexually active females
  • Depression screening
  • Sexually transmitted infection (STI) prevention
  • counseling and screening for adolescents at higher risk
15 to 17
  • Behavioral assessment
  • Blood pressure screening
  • BMI measurements
  • Medical history
  • Tuberculin testing
  • Hepatitis B screening for adolescents at high risk
  • Alcohol and drug use assessments
  • Cervical dysplasia screening for sexually active females
  • Depression screening
  • Sexually transmitted infection (STI) prevention
  • counseling and screening for adolescents at higher risk

General

  • Obesity screening and counseling
  • Hematocrit or hemoglobin screening
  • Lead screening for children at risk of exposure
Dental and Vision

Plans that meet the Affordable Care Act’s essential health benefits also include some vision and dental coverage:

  • Dental exam every 6 months
  • Cleanings, fluoride treatments, and X-rays
  • Fluoride chemoprevention supplements for children without fluoride in their water source
  • Yearly vision screening for all children
  • Most people can get help with their child’s glasses or contacts on their plan too

You can also buy extra dental coverage to add to your plan for a low monthly cost.

Immunizations

Vaccines, or shots, are an important part of your children’s preventive care. These should be delivered on a specific schedule to make sure your kids are protected at every age. Shots that are listed more than once at different ages include multiple doses to finish the vaccine.

Newborn
  • Hepatitis B
1 to 2 month
  • Hepatitis B
2, 4, and 6 months
  • Diphtheria, Tetanus, Pertussis (DTaP)
  • Haemophilus influenza type b (Hib)
  • Polio
  • Pneumococcal conjugate
  • Rotavirus
6 to 18 months
  • Hepatits B
  • Polio
  • 2 flu shots (6 months or older)
12 months and older
  • 12 to 15
    • Hib
    • Pneumococcal conjugate
    • Measles, Mumps, Rubella (MMR)
    • Varicella (Chickenpox)
  • 12 to 18
    • DTaP
  • 12 to 23
    • Hepatitis A
18 months and older
  • Hepatits A
  • Flu shot once a year
4 to 6 years
  • DTaP
  • Polio
  • MMR
  • Varicella
  • Flu shot once a year
11 to 12
  • Tdap (booster to DTaP)
  • Meningococcal A, C, W, and Y (MenACWY)
  • Human Papillomavirus (HPV) – 2 doses
  • Flu shot once a year
16 years
  • MenACWY
  • Flu shot once a year
18 years
  • Meningococcal B (MenB) – Talk to your child’s doctor to find out if they need this vaccine.
  • Flu shot once a year

Visit the Centers for Disease Control and Prevention (CDC) and enter your child’s birth date to get a customized shot schedule.

Know What’s Covered

Learn more about what immunizations are covered for your children. And log in to Your Health Alliance or search by your or your child’s member number to see what children’s preventive care your family’s plan covers.

You can use our general preventive care guidelines and prescription drugs to get an idea of what our plans cover.

If you’re not sure what’s covered and what you’ll need a preauthorization for, you can check your coverage and preauthorization lists at Your Health Alliance.

Now that you’re ready for your children’s physicals, log in to Your Health Alliance if you need to set a Primary Care Provider (PCP) for your child or start searching for doctors in our network.

Insurance Awareness

Insurance Awareness

Wednesday was National Insurance Awareness Day, so we helped raise insurance awareness this week with education and info about your plan.

Insurance may seem like a luxury, but without it, the cost of a broken arm is typically more than $2,500 dollars. If you have to stay in the hospital, it’s around another $7,400.

Broken Arm Costs

 

Under the ACA, you have certain benefits that are always covered, like yearly checkups and more.

Essential Health Benefits

 

If you’re on an HMO, you have to see doctors in your plan’s network, and if you’re on a PPO, you’ll save when staying in-network.

Choosing a primary care provider (PCP) gives you personal care, and your yearly visit keeps your preventive care up to date.

Your Yearly Preventive Care and Physical

 

The average ER visit costs more than the average American’s monthly rent. Know where to go when you’re sick and save.

Know Where To Go

 

Not sure what your insurance does after you get care? See a claim’s journey and make sense of what you get in the mail later, the EOB.

A Claim's Journey

 

Are you getting ready for Medicare? Learn about the parts, your eligibility, and enrolling.

Prepare for Medicare

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Finding Doctors & Personalized Care

Finding Doctors Made Easy

Finding doctors and care that’s covered on your plan, like from a Primary Care Physician (PCP) or a clinic in your service area, is key to helping us pay for the care you get.

For some plans, like HMOs, you must go to a doctor in your provider network. And for some plans, like PPOs, although you can go to out-of-network doctors, going to doctors in your plan’s network can help you save.

Log In

The best way to find doctors in your network is to log in to Your Health Alliance, our one-stop member website. If you’ve never used Your Health Alliance before, you’ll have to register for an account first.

On Your Health Alliance, when you choose Find a Doctor or Hospital from the very top menu on your dashboard, you’ll see a list of all the providers you can use on your plan. From there, you can filter these or search by doctor or hospital name to find what you’re looking for.

Plan Details Search

If you can’t log in to Your Health Alliance, you can also find a doctor by looking at your plan’s network through our Plan Details Search.

You can find this feature by choosing learn how to use your benefits on HealthAlliance.org’s home page. This takes you to our Member Benefits & Forms page. The first bullet under Using Your Benefits, What Your Plan Covers, will take you to the search.

On the search, you just need to enter your member number from your ID card to see a list of all your plan’s documents, which will include your network of doctors. You can find your member number here:

Finding Your Member Number

Finding Doctors

You can also search for doctors on HealthAlliance.org. Choose Find a Doctor from the top menu to start your search.

Once you’re here, you can search for your network or by a doctor’s name, or you can look at a list of all our directories.

The best way to find your network is to search with your member number from your ID card. (The above image can help you find your member number.)

Or you can find your network by choosing your state and plan type and directory. If you have our insurance through your employer, you’ll choose employer groups. If you’re on a Medicare plan, you’ll choose that. If you shopped for and bought our insurance for yourself (and it’s not a Medicare plan), you’ll choose individual and families from the list.

Then you’ll choose your directory. Your directory is based on what type of plan you have. If you or your employer bought your plan from a public exchange, like Healthcare.gov or a state exchange, it will say public in your directory name. If you bought it directly from us, it will say direct.

It will also say your plan type, like HMO, PPO, or POS. If you bought a plan in a specific market, like Riverside or Methodist, it might say that, too. Your plan policy or plan documents can tell you what the name of your plan is to help you know which plan type you have.

Once you’ve chosen one of these, you can also add filters, like doctor or location info, to find certain providers.

Now that you’ve searched and found your network, you’ll see details for each of the doctors in your plan’s network, like address, if they’re taking new patients, and more. You can also add filters at this point to narrow your search.

And if you’re shopping for a new plan, we’ve made it easy to find doctors on those plans by connecting you to their networks while you’re shopping.

Still need help finding doctors or have questions about our providers? It’s no problem! Our Customer Service is here to help! Just contact us.

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Medicare Advantage Mythbusting

Long View: Medicare Advantage Truths Might Just Change Your Mind

As I travel around the Illinois countryside, I hear the same misinformation about Medicare Advantage over and over. To tackle some of that, here’s a Q and A.

Question: When I join a Medicare Advantage plan do I lose my Medicare coverage?

Answer: No. If you have a Medicare Advantage HMO or PPO plan, a private health insurance company that has a contract with Medicare, like Health Alliance Medicare, provides the services instead of Original Medicare. People who disenroll from Medicare Advantage plans revert to Original Medicare. In either case, no one loses Medicare coverage.

 

Question: Will I be able to stay with my current doctors?

Answer: Probably, especially with Health Alliance Medicare. That’s why it’s important to check any plan’s provider directory to confirm your doctors work with the plan. People who select a Preferred Provider Organization (PPO) plan can use out-of-network providers, but they typically pay more when they receive services.

 

Question: We travel and might need to use the emergency room. Will Medicare Advantage plans only cover me for emergency care when I’m close to home?

Answer: No. Medicare Advantage plans cover out-of-area emergency and urgently needed care.

 

Question: If something serious happens and we need lots of services, could we predict how much we would pay for care?

Answer: Yes. Medicare Advantage plans have an annual Out-of-Pocket Maximum (OOPM), also called a Yearly Limit. When a Medicare Advantage member reaches that limit, the health plan pays 100 percent for Medicare-approved services. This amount doesn’t include the premium and other limited expenses. You can estimate what your expenses would have been last year on the Medicare Advantage plan you are considering.

 

Question: Medicare Advantage sounds good for me, but wouldn’t the premium be too costly for my 88-year-old mom?

Answer: Not at all. One of the best things about Medicare Advantage plans is the premium is the same no matter the member’s age. You and your mom would pay the same monthly premium if you had the same plan, unless either of you could get extra help paying for coverage based on your income.

 

Question: Would I have to deal with all the paperwork I get when I receive services from Original Medicare plus a Medicare Supplement plan?

Answer: No. You would have much less paperwork with a Medicare Advantage plan. In fact, that’s one reason Medicare Advantage plans exist, and I’m all for less paperwork.

 

Remember, the Medicare Annual Enrollment Period, or AEP, runs from October 15 to December 7. That’s the only time most people can change their coverage for the following year.

If you are thinking about a change for yourself or a loved one, you will have to do a bit of research. Trusted resources like Area Agencies on Aging and your local senior center can help.

Please consider Health Alliance Medicare a resource, too.

We all want to make well-informed choices that don’t depend on myths and misinformation.

Getting a Great Deal

Getting the Best Deal

“I’m always looking at ads to see who’s got the best deal,” Melissa Whitman says.

Who doesn’t love saving money? But how are great deals and health insurance connected? They may be more similar than you think, at least when you see doctors in the Health Alliance network.

“Many of our members are surprised how much they save by staying in-network,” says Melissa, a Health Alliance claims manager. “Going out-of-network can cost members twice as much, and the even more unfortunate part is they often don’t realize that until after their visit or procedure.”

With thousands of doctors and hospitals in-network (and the list growing daily), you don’t need an eye for a good deal. We have people like Melissa for that. Melissa can help with just about anything related to getting your covered care paid for.

Stepping into her cubical proves instantly there’s a lot more to Melissa than claims processing. Her family. Pictures of smiling faces decorate every open space.

“We’re always together. Cooking out,” she said. “In the summer they’re at my pool, and we just got done mushroom hunting.”

Melissa has quite the eye for those hard-to-find morels. For as long as she can remember, mushroom hunting has been an annual adventure.

“The whole family goes. Even my 89-year-old grandma gets her mushroom stick and gets in the woods,” says Melissa with a laugh.

She sums herself up simply. “I’m a city girl. I love my work, my family, and a taste of the country,” she says.