Q. How does the Freedom+ Plan work?

A. Bills submitted by physicians who are in network will have the customary PPO discounts applied. 

 

All bills submitted by facilities or providers who are out of network are repriced using a multiple of Medicare allowable price. This is often referred to as Medicare “plus” reimbursement. For physicians and physician services, reimbursement is at 125% of Medicare allowable. For facilities, reimbursement is at 150% of Medicare allowable. 

 

Q. Will my doctor or hospital accept the Freedom+ Plan?

A.  You are free to use the services of any provider. You may visit any physician or health care facilities without restrictions. You also may visit a physician in your network. Just present your card at the beginning of your visit as you would any other benefit coverage card. There is a number on the card your provider can call to verify benefits.

 

Q. How does Allied's Medicare “plus” reimbursement compare to normal PPO fees?

A. There is no such thing as a normal Preferred Provider Organization (PPO) fee or discount. Every provider has a unique fee or discount schedule negotiated with every PPO. The one thing you do get from a PPO, regardless of the discount price, is that the provider has agreed to accept that discounted price.

 

Q. Will my local doctors and hospital accept Allied's Medicare “plus” reimbursement?

A. Our experience is that virtually all providers will accept these Medicare “plus” reimbursement levels. The level is such that it is profitable for the provider, and in many cases, is a higher reimbursement than they receive from the dominant insurer(s) in your area who have forced very low reimbursement levels on the providers.

 

Q. Will I have any problems making an appointment with my local providers if I have Allied’s Freedom Plan?

A. Physicians in your network have agreed to accept your coverage. 

 

Out-of-network provider’s appointments also usually happen without problem. There may be times when the provider needs more information than the ID card provides so that they can properly book the appointment. Simply have the provider call Client Services at 800-714-3432, press 3, and we'll go over the plan details with them. 

 

On very rare occasions, we have providers who are still unwilling to accept Medicare “plus” reimbursement. They may ask you to pay the entire bill at the time of service. If this does happen to you, please contact us immediately and we will take every step possible to resolve the problem. 

 

If you have already paid your visit upfront, please submit your bill to us for reimbursement. 

 

Q. Will I ever be balanced billed?

A. A balance bill is a medical bill from a health care provider who is billing a patient for the difference between the total costs of services being charged and the amount the insurance pays. 

 

A fee agreement is reached 100% of the time when you choose a physician in the PPO network and you will never receive a balance bill. You may be balance billed for services provided by an out-of-network providers or facilities, but you will not be responsible for the bill. 

 

Our pledge to you as a member is that we will resolve every balance bill you may get as a result of a discount we've taken. We will do whatever is required to resolve that balance bill.

 

Q. What do I do if I get balanced billed?

A. Freedom+ Plan members are responsible only for copays, deductibles and coinsurance as shown in the Explanation of Benefits. Members are not responsible for any balance billing from providers who might not accept the Medicare “plus” reimbursement levels of the plans. Allied National provides a legal support service for members who are being subjected to balance bill collections. If a member receives a balance bill, they should call Allied National's Elite Experience team at 866-332-1987 or email elite@alliednational.com.

 

Q. If I go out of network, can I end up paying a provider more under this plan than with a strictly PPO plan?

A. Remember, even with a PPO plan there is no way to know in advance how much you're going to have to pay. Any bill from any one provider could be higher for the same service than from some other provider. That is still true under Freedom+. What we do know is that the Freedom+ Plan discounts (after all settlements and negotiations) average more than 60% off of retail charges. In fact, plan prices for Freedom+ are lower than most PPO plans for that reason. We pass the savings on to the employer and member.