Commonly Asked Questions and Answers on the new AmeriPlan Health®:
Can I purchase the medical plan without the Dental Plus program included?
No. Presently in most states, the medical plan is only sold as a unit with AmeriPlan Dental Plus™. Florida is the only exception, where the medical plan is sold separately due to state regulations.
Can AmeriPlan Health® be used in conjunction with health insurance plans?
Yes it can, but it is always at the doctor's discretion to accept both. As with our Dental Plus™ Program benefits, your insurance should always be the primary form of payment.
How can I refer my personal physician to AmeriPlan®?
The procedure for referring physicians is the same as for referring dentists and chiropractors. Every member is given the referral forms in the New Member Packet that is similar to the dental referral card. A member may also send a referral to referral@ameriplanusa.com. If a member calls the AmeriPlan Health® Customer Service number (866-977-2477) the referral will be taken over the phone or the referral can be faxed. A patient's name must always be associated with provider referrals.
Why would a medical professional want to participate in the AmeriPlan® Consumer Driven Health Care (CDHC) Program?
There are many reasons, the most important are: Patient care and treatment is put back into the physician's hands. Economic Advantages The provider gets paid at the time of care. Most insurance plans make the physician wait up to 120 days for payment. Office administrative costs are reduced. - No paperwork to complete. - No paperwork to file and follow-up. - No invoices to issue to patient or third-party payer Net increase in revenue vs. insurance HMO or PPO. The provider is part of an affiliation of like-minded professionals, without being "under the thumb” of managed care. AmeriPlan Health® is providing members with comprehensive, quality, discounted healthcare.
Are fees still calculated based on Medicare fees? The rates that the AmeriPlan Health® Proprietary Network provider will charge are determined based upon either a set fee schedule that the provider has contracted with the physician network, a percentage off of their billed charges or a percentage above Medical payable fees. In general, discounts will vary between 20% – 50%. Labs and Diagnostics will have discounts of up to 80%. The rates that the assigned (outside) network provider will charge are determined based upon either a set fee schedule that he or she have contracted with the physician network, or a percentage off this or her billed charges. In general, discounts will vary between 20-50%.
Does my member have to pay when they are in the office?
YES. The member shall pay the discounted rate, in full, at the time services are rendered. The office will call the AmeriPlan Health® Customer Service Representative, who will conduct a phone recalculation and tell the office staff how much to collect from the member once the discounts have been applied.
Do the providers understand the member must pay at the time services are rendered?
When the verification call is placed to the physician's office, the AmeriPlan Health® Customer Service Representative will tell the provider they must call to recalculate the bill over the phone and they should collect payment at the time of the visit.
When members arrive for their appointment, how do you ensure the provider will understand how the plan works?
The Customer Service Representative will call the provider's office prior to the member's appointment to ensure that the doctor is accepting new patients. They will also make sure the office understands that the members are self-pay at the time of service and to contact the Customer Service Representative for assistance with the bill. A fax is sent to the physician's office as a follow up. In addition, the Customer Service phone number is on the member's ID card and the provider is welcome to contact a Customer Service Representative should they have any questions about the program. A member wants to know if their doctor is currently in the network.
How will Customer Service determine this and what will they tell the member?
A database of network medical providers is maintained and available to AmeriPlan Health® members. (This is also available on the website.) The Customer Service Representative can search for a desired provider by name, specialty, and a local zip code. If the provider is in network, the Customer Service Representative will ask if the member plans on visiting said provider. If so, Customer Service will contact the provider's office on behalf of the member. If the doctor is not part of the network or currently not taking new patients, they will offer the member another provider in the same specialty and area. This is done so that the member may make the most of the program. The member can also submit a Provider Referral/Nomination form so that they can refer/nominate their doctor, who will then be contacted regarding joining the AmeriPlan Health® network.
How often do you check with providers to see if they are still participating in your program?
The Customer Service Representatives will call the provider's office prior to sending the member to see him/her, and verify that he or she is accepting new patients and still participating in the program. The only exception would be if the provider has already confirmed within the previous 90 days. In this situation, a fax is sent to the office letting them know the member will be calling to make an appointment and reiterating how the program works. If the previous verification was completed more than 90 days ago, the Customer Service Representative will call the doctor's office and speak to someone again to verify that they are: accepting new patients are still participating in AmeriPlan Health® and they know to contact the repricing agent for recalculation of the fees
Can you please explain the Hospital Advocacy program and what the discount percentage will be? The Hospital Advocacy Program remains exactly the same. The service is designed to help members with their medical bills, which total $2,500, or more, for a single incident. Charges can be incurred from multiple providers. The patient advocate pursues a wide range of options, from government entitlement programs to negotiating settlements and payment plans. There is a three-day waiting period from the active date of your membership to utilize this program. NOTE: The percentage saved varies on a case-by-case basis. What does my member do when they need to see a physician? For the First Appointment Member must call AmeriPlan Health® Customer Service at 1-866-977-2477 and verify the provider is in network or taking new patients. If the provider is in the proprietary network, member will be instructed to proceed with appointment call. If the provider is from the assigned network, the Customer Service will call the member back. (This could take up to 48 hours on non-emergency needs.) Member may be directed immediately to a network providers' office or will be called back with verification.
Can I look up the Network websites to find providers?
NO. You must use the AmeriPlan Health® search engine only. We already have all providers in our database, which is regularly updated.
Might there be areas with very few providers? There will be some secondary type markets with minimal or no providers. There should not be any major markets with the same issue. We have access to the largest number of "Discount” providers of any program offered. However, there are only a limited number of "Discount” medical providers in the U.S. In a continued effort to provide our members and IBO's with the best program available, we will continue to contract proprietary network providers in these areas.
If I am A Member, Will I receive a discount?
All members should receive a 15% "minimal discount”. If a 15% "minimal discount” is not received, the member should call into Member Services and file the appropriate paperwork so the issue can be researched and resolved. All members will receive an EOB mailed to them which will show the discounted amount.
How do I locate an AmeriPlan Health® provider? There are two ways to locate a provider. Instructions are included in the Member Information Guide that will be received with the identification cards. The two ways to locate a provider are as follows: A provider locator is available at: www.Everyonebenefits.com/saveonhealthcare
Call AmeriPlan Health® Customer Service at the listed number in your guide.
Are ongoing dental/medical problems (conditions) included?
Yes. Since AmeriPlan® is NOT INSURANCE OR A MANAGED CARE ORGANIZATION, all ongoing dental/medical problems (conditions) are included except for contracted treatment plans including dental and orthodontic treatments in progress.
Is there a minimum payment to be met from any of the health benefits?
There are immediate savings, no paperwork to fill out and no limits on visits to AmeriPlan® network providers.
Will all areas have specialists and ancillary services?
Some specialists and ancillary providers may not be available in a particular geographic region.
Can AmeriPlan Health® Benefits be used with Medicare/Medicaid?
No. Medicare does not allow their providers to charge a Medicare patient a different price.
Are doctors reimbursed by AmeriPlan® for their services? No. As with all of our health benefits, the provider receives the full discounted fee from the member at the time services are rendered.
Can anyone join AmeriPlan Health®? Yes.
Can members downgrade from AmeriPlan Health® to the AmeriPlan Dental Plus™ Program? Yes.
If the doctor's office has lab facilities, can these be utilized rather than having to go to another lab? Yes. The lab services will be billed at the contracted network discount.
Do members receive a fee schedule? No. Fees will vary by zip code.
Do members receive a separate card for AmeriPlan Health®?
Approved members receive four cards: two AmeriPlan Health® ID cards and two AmeriPlan Dental Plus™ cards.
Are there benefits for emergency services? Yes. Emergency services may or may not be contracted with AmeriPlan Health®. Depending on the extent of the charges, these services may be eligible for the Hospital Advocacy Program.
What is the difference between a limited patient visit, an intermediate visit and an extended visit?
A limited patient visit is one where the member is seen for a problem-focused visit with minor problems (physician time 10 minutes), i.e. recheck for a cold. An intermediate patient visit is more involved with low to moderate severity, and will require a longer visit with the provider, i.e. sore throat. An extended patient visit is where the member is having a physical examination or consultation for a chronic illness or consideration for surgery, etc. (moderate to high severity).
Will maternity be included?
All medical needs are included as long as we have contracted providers offering this service.
Will the member's privacy be protected? Yes. AmeriPlan® is compliant with HIPAA regulations.
Does AmeriPlan Health® include hearing tests and hearing aids? Yes. Hearing Services will be included under our Ancillary Services providers.
Is there a waiting period for new members? No. Members can use the program as soon as they receive their membership cards.
Can a member pay with cash, personal check or personal credit card for services? Yes.
Does the member have a choice of which hospital will be used? Yes. The Hospital Advocacy Representative will negotiate with any hospital of the member's choice.
What is the discount members receive on dental fees?
Members can save 20%-65% on all restorative and cosmetic work (fillings, crowns, braces, etc.) and up to 80% on diagnostic work (exams, x-rays, etc.) performed by a general dentist. Specialist fees are discounted 15%-25%.
How much is the AmeriPlan Dental Plus™ membership fee? Individual membership is only $11.95 per month. An entire household membership is $19.95 per month. Family membership includes all residents in the household including parents, children, relatives, significant others and all permanent residents of the household.
How much more does the Pharmacy, Vision and Chiropractic benefit cost?
The Prescription Drug, Vision and Chiropractic Benefits are absolutely FREE with the AmeriPlan Dental Plus™ Membership. |
