Tag Archives: out-of-network

Insurance Awareness

July 2, 2017 Health Alliance Leave a comment

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.

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

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.

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.

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

Benefits, Education, Engagement, Enrollment, Technology

Finding Doctors Made Easy

May 17, 2016 Health Alliance Leave a comment

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 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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Benefits, Education, Enrollment, Long View, Series

Long View: Medicare Advantage Truths Might Just Change Your Mind

October 1, 2014 Long View Leave a comment

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.

Health Alliance Blog