Health care plan changes out-of-network pay rates
by Michelle Saport |
The University of Alaska health care plan changed how costs are paid to out-of-network providers beginning July 1, the start of fiscal year 2016.
Prior to FY16, Premera paid out-of-network health care providers at rates based on Alaska medical service prices. Under this model, there was little incentive for providers to join Premera's network of providers or to keep costs down.
Under the new model, Premera pays 125 percent of what the federal Medicare program would pay for the same services. This shift saves the plan money but may catch members unaware when the amount left over after Premera pays the providers is higher than expected. This may be especially surprising for members who regularly visit a provider and are seeing the increase for the first time under the new payment arrangement.
The percentage the plan pays has not changed. If it was 80 percent of the allowed amount for in-network and 60 percent for out-of-network providers before, it's the same now. What has changed is the allowed amount to which that 80 percent or 60 percent is applied. Here's an example, along with additional information about the changes.
If you are using an out-of-network provider, it's important to discuss balance billing with them or to use UA's patient advocacy service, PatientCare, for individualized assistance in health management and care provider research. Contact PatientCare at 1-866-253-2273.
You can also call Best Doctors at 866-904-0910 to find other treatment options or get help finding an expert who is in the Blue Cross network. Getting services from an in-network provider will always be the better deal. Premera has the largest network of providers in Alaska. To find an in-network provider, log in at Premera.com and use the Find a Doctor tool. Or call customer service at 1-800-364-2982; you can find the number on your member ID card.
More information on other aspects of the UA Choice healthcare plan is available in the November issue of the UA newsletter Statewide Voice.
A version of this article originally appeared in the UAF Cornerstone.