Transcript Slide 1
Provider Freedom True Freedom of Choice No Networks – No Penalties Overview • Problems with PPOs • Provider Freedom is the solution • How Provider Freedom benefits you • How Provider Freedom works 2 Who is Allied * Home Office - Overland Park, Ks. * 2nd generation business * Founded 1970 * Proprietary systems * Company culture Innovation Stability Service 3 What is a PPO Plan? Managed Care • First PPO network in mid 1980s - Early networks small local and regional health plans Grew to national networks as health plans grew and merged Provides discounts to retail health care costs • Percent discounts off retail • Per diem schedules • Fixed rate for service 4 Problems With PPO Plans Poor Discounts Limited provider choices • Which hospital? • Which doctor? Penalties, Penalties, Penalties • Out-of-network • Non-network providers within in-network hospitals • Out of area Multi-State Employers Tough to switch health plans 5 Provider Freedom is the Solution! True freedom of provider choice No networks Better than PPO discounts No penalties 6 A Proven Model Tested Nationwide Proven Discounts High Consumer Satisfaction 7 How Provider Freedom Benefits You and Your Client Very popular with employers/ employees Reduces employer’s costs Easier to change health plans Eliminates network penalties 8 Provider Freedom Reduces Monthly Costs Benefit plan cost reductions up to 10% as compared to traditional PPOs 60% of Funding Advantage cases issued with Provider Freedom 9 How Does Provider Freedom Work? Data ISight Payment Model Cost plus “fair and reasonable” discounts No balance bill owed by member 10 Cost Plus Reimbursements Fair and Reasonable Reimbursement Calculations Facility Charges – Peer group hospital data plus profit and overhead Physicians – Database of actual physician payments 11 Learning to use Provider Freedom We educate members when they get ID card We educate providers Members pay only normal copays, deductible and coinsurance No balance bill guaranty 12 No Balance Bill Guaranty “…covered person not responsible for any attempt by the medical provider to collect unpaid medical charges because of the discount taken…” Excludes Deductibles, copays, coinsurance Medical care not covered by plan Improperly filed claim Late claim filing Call Allied National Customer Service for balance bill issues: 800-825-7531 13 Provider Freedom Provider Claim Payment Acceptance 92.0% 4.0% 3.5% 0.4% 0.1% - Accepted as paid - Call and accept - Adjust and accept - Adjust to retail - Balance bill 14 Provider Freedom Your initial provider appointment using Provider Freedom Present your ID card Majority of providers currently accept the card Allied pays claims to over 250,000 providers If your provider is uncertain about the Provider Freedom plan, call Allied Customer Service: 800-825-7531 15 Provider Freedom Available plan option with Allied Funding Advantage Standard for Short Term Medical Plus and Allied Cost Saver 16 Provider Freedom Available with Funding Advantage in these states: California, Georgia, Iowa, Illinois, Indiana, Kansas, Missouri, Nebraska, Nevada, Ohio, Oklahoma, South Carolina, Tennessee, Texas 17 We’ll be happy to answer your questions now. Questions? Need More Information? Allied National, Inc. Toll Free: 888-767-7133 Fax: 913-945-4396 [email protected] www.alliednational.com http://twitter.com/alliednational 4551 W. 107th St., Suite 100 Overland Park, KS 66207-4037 11147s1213