AlaskaCare Employee News | Quarterly Newsletter | Spring 2023
Alaska Department of Administration sent this bulletin at 03/30/2023 01:34 PM AKDTHaving trouble viewing this email? View it as a Web page.
Spring 2023 | #107
|
|
|
|
There are many important factors to consider when choosing your medical care providers. In addition to ensuring that you’ve chosen a provider well-equipped to deliver the services you need, in order to maximize your AlaskaCare benefits you should consider whether or not that provider participates in the Aetna network of preferred providers. Network providers have contracted with Aetna to deliver medical services and supplies at a pre-agreed-upon price and have also agreed not to bill you for any amount over that price. Out-of-Network providers have not agreed to a price for your services in advance, and often charge a higher rate than your health plan has determined to be reasonable. In some circumstances, out-of-network providers can bill you for any amount between how much they have billed and how much your plan will pay. This is called balance billing. Remember, using a network provider is an easy way to avoid balance bills. What changed for Plan Year 2023? The AlaskaCare Employee Health Plan changed how much the plan will pay out-of-network providers effective January 1, 2023. AlaskaCare changed the recognized charge for out-of-network providers for most professional medical services from the 90th percentile of the prevailing charge rate for that service in the geographic area where the service was furnished to 185% of the Medicare allowed rate for that service. If you receive services from an out-of-network provider, you may continue to do so, but your out-of-pocket costs may increase. If your out-of-network provider's bill is higher than what your plan will pay, you might have to pay the difference. Network providers have agreed to a discounted price for services and will not bill you for more than that amount. The Aetna network now includes many Alaska healthcare providers that were previously out-of-network. We’ve been able to contract with these providers to expand the number of network providers that offer our members services at a discounted rate. Why should I consider visiting a network provider? Visiting a provider who participates in the Aetna network is one of the best ways to get the most value out of your AlaskaCare health coverage. Network providers have agreed to provide you with services at a discounted rate and will file all claim forms for you. If you use a network provider, you will not be billed for any amount between what the provider bills, and how much the plan will cover (balance billing). My provider is not in Aetna’s network—what should I know? You are free to visit any provider you prefer, even if they are out-of-network. Your AlaskaCare health plan will still pay its share of your medical costs. If a provider has no contract with your health plan, they're considered out-of-network and there are no limitations to what they can charge for services. If you receive services from an out-of-network provider they can charge you the full price, which is often higher than the in-network discounted rate. An out-of-network provider may choose to bill you directly for any amount between what they charged and what the plan allows in addition to your deductible and coinsurance amount. This is called balance billing. It's important to know when you get emergency care or are treated by an out-of-network provider at a network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. Learn more about your rights and protections against surprise balance bills here. How Can I find a Network Provider? Aetna has a nationwide network of providers that accept your AlaskaCare health plan. If you need help finding a provider near you that is in the AlaskaCare network, here are some helpful resources. Call the Aetna Concierge at (855) 784-8646. The concierge can provide you with a list of network providers in your area. Use the Aetna mobile app, or go online and visit Aetna’s DocFind Tool. This change is specific to the AlaskaCare employee health plan’s out-of-network reimbursement calculation and is not a change in available providers or your AlaskaCare health benefits. |
|
New in 2023: Making the Precertification Process Easier
|
|
AlaskaCare removed penalties and benefit reductions for failure to precertify services! This means that if you or your provider did not obtain a required precertification, but your care is otherwise eligible for coverage, you won’t have to pay more. Precertification is a process to confirm the services being recommended by your provider are covered expenses under the terms of the AlaskaCare Employee Health Plan (Plan) and are medically necessary.
Effective January 1, 2023, the AlaskaCare plan removed the benefit reduction for failure to obtain precertification for certain medical services obtained from out-of-network providers, making it easier for members to access their benefits. Know before you go! If you’re seeking care from an out-of-network provider, check with Aetna to determine if you need precertification, this is important information to know before you receive care. If you do not precertify a medical service delivered by an out-of-network provider before your appointment, and the services are not covered, you are responsible for the expenses. The full list of services requiring precertification can be located here or by calling the Aetna concierge at (855) 784-8646. |
|
|
|
AlaskaCare members received new Aetna medical and vision-audio ID cards in January 2023. The cards are ready to use as soon as they arrive, no action is required on your part. You can use the physical ID card you received in the mail or optionally register on Aetna.com to use a digital version available on your mobile device. Don’t forget to show your provider your new card! What’s New
What Other Information is on My Card? The front of the card displays the Issuer number, member ID number, and subscriber and dependent information. The back of the card displays information on your deductible and out-of-pocket maximums, provider network information as well as information on how to contact Aetna Member Services for any questions. Don’t Forget to Show your Provider your New Card! Your member ID card is proof that you have health benefit coverage. Providers use the information from your member ID card to confirm they are part of your plan’s network and to bill your health plan for your care. Keep your member ID card handy when you go to the doctor, the hospital, or the pharmacy. If you have any questions about your Aetna ID card, contact the Aetna Concierge at (855) 784-8646. |
|
|
|
You likely have already received your SurgeryPlus benefit cards in the mail. SurgeryPlus provides you with access to excellent and affordable care for many planned surgical procedures. After you meet your deductible, SurgeryPlus covers your medical and travel costs associated with surgery, so you’ll pay less for your procedure when you use your SurgeryPlus benefit. Your coverage includes:
|
|
Alaskans Can Join Free Programs for Better Health
|
|
Ready for a change? The Alaska Department of Health has a new health action campaign called Fresh Start. The campaign connects Alaska adults with free programs that can help participants make changes at any time in their lives to feel better. These programs help Alaskans meet many health goals: lose weight, lower blood sugar to prevent or manage diabetes, lower blood pressure, or stop smoking or vaping.
All of these free programs are found on one website that’s easy to use: freshstart.alaska.gov. Thousands of Alaskans have joined these programs. They’ve lost more than 4,600 pounds in total through the online Fresh Start program focused on weight loss. They’ve worked with coaches through Alaska’s Tobacco Quit Line to stop smoking, vaping, or chewing tobacco. Visit freshstart.alaska.gov to find a free health program that’s right for you or someone you know. Contact doh.freshstart@alaska.gov with questions or to request printed materials. |
|
Know Your Benefits: Preventive Care Covered at 100%*
|
|
Keep Your Health in Check Save now and later by being proactive and seeking preventive care. Preventive care received from an in-network provider is covered in full—no deductible or coinsurance! Preventive services include routine screenings and checkups, as well as counseling to prevent illness, disease, and other health problems. Making sure to have annual preventive doctor’s visits will help you save as these services are not considered preventive when applied to a visit for diagnosis, monitoring, or treatment of an illness or injury. Preventive Care Services Include:
All other medical benefits are subject to normal cost-sharing (e.g., deductible, coinsurance, and copayment). Call your doctor today to make a routine preventive care appointment. For assistance finding an in-network provider, call the Aetna Concierge at (855) 784-8646 or search online using Aetna’s DocFind Tool. *The AlaskaCare employee medical plan covers preventive services in full when received from an in-network provider or when the use of an out-of-network provider has been pre-certified. Normal cost-sharing applies when preventive services are received from an out-of-network provider. |
|
2023 AlaskaCare Employee Health Plan Booklets
|
|
Plan Booklets are available for all members of the AlaskaCare health plans, they are designed to help you understand your plan and the benefits it provides. Your plan booklet includes a benefit summary and information about plan coverage, how benefits are paid, travel coverage, precertification, what expenses are covered, and more. For your convenience, the Plan Booklets are available on the AlaskaCare website. You can view the booklets online or download them to your computer. |
|
|
||||
|
Your input is valued and important. Below is a list of ways to contact us with your feedback. Also, a full list of AlaskaCare health plan and partner contact information can be found on our website. AlaskaCare – Plan Administrator
|
