The In’s and Out’s Of Accessing The Network With Your Arizona Health Plan. Good Neighbor Insurance provides both group and individual health care coverage in Arizona, as well as travel insurance for those vacationing overseas and for expats residing overseas. We are happy to be able to share the following information for our clients who currently have individual coverage.
The first essential health benefit as defined by the Affordable Care Act, is “Emergency Services” (Trips to the emergency room).
This is care you receive for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness. Typically, this is a trip to the emergency room, and includes transport by ambulance. You cannot be penalized for going out-of-network or for not having prior authorization.
What about NON-Emergency services?
What do our clients need to know about these types of services?
Carry your membership card everywhere.
Make copies. It’ll save huge amounts of hassle if you have an unexpected doctor or hospital visit.
Understand your plan’s doctor and hospital network.
Insurance companies negotiate participation and payment rates with a network of providers to control costs.
“A lot of these exchange plans, in order to stay affordable, have much smaller networks than people are used to,” says Nancy Metcalf, a senior editor for Consumer Reports. For many new members, “just because their friend has a plan and can go to a particular hospital doesn’t mean that they necessarily can.”
You can check a plan’s directory — either online or often part of the documents you receive when you enroll — to find out if specific physicians are part of your network. You can call doctors’ offices to confirm, too.
Stay in the network!
The health law says that, once you join a qualified plan, you won’t pay more out of pocket per year than $6,350 for an individual and $12,700 for a family.
But this applies only to in-network care. Whether you’re in an HMO that pays almost no out-of-network benefits or a PPO that covers some, the pocketbook protections don’t apply if you use a non-network doc or hospital. Non-network providers also frequently bill you far more than what they charge patients in their networks for the same procedure.
Save paperwork. Make sure you really owe what doctors and hospitals bill you for. If you have any concern, it really is worth it to make a call and get them to explain what they did for you. Call us at 480-633-9500 with any questions we may have missed or email us at info@gninsurance.com. Our agents are here to serve you!
