{"id":18413,"date":"2012-11-16T18:51:59","date_gmt":"2012-11-16T18:51:59","guid":{"rendered":"http:\/\/utu.org\/?p=18413"},"modified":"2012-11-16T18:51:59","modified_gmt":"2012-11-16T18:51:59","slug":"save-money-by-using-in-network-providers","status":"publish","type":"post","link":"https:\/\/www.smart-union.org\/save-money-by-using-in-network-providers\/","title":{"rendered":"Save money by using in-network providers","gt_translate_keys":[{"key":"rendered","format":"text"}]},"content":{"rendered":"
The national railroad plans (\u201cplan\u201d) allow you to see any doctor in your plan administrator\u2019s network, including specialists, without a referral. This means that you have the freedom to choose a physician or specialist without first seeing a primary care physician.<\/p>\n
There are two levels of coverage under the plan. Your level of coverage is determined each time you receive care and whether you use an in-network provider or an out-of-network provider. Your out-of-pocket costs under both levels of coverage may include office visit copayments, deductibles, and coinsurance whether you are using services under the Managed Medical Care Program (MMCP), the Comprehensive Health Care Benefit (CHCB) or the Mental Health and Substance Abuse Care Benefit (MHSA).<\/p>\n
MMCP and MHSA benefits<\/span><\/strong><\/span>\u00a0<\/strong><\/p>\n \u2022 \u00a0In-network:<\/span> <\/em><\/strong>This level of benefit will apply when you use a physician, specialist, laboratory or other provider who is a member of your plan administrator\u2019s network. When you use in-network providers, your out-of-pocket expenses, deductibles, and coinsurance will be lower than if you use out-of-network providers.\u00a0 Remember, there is no penalty for seeking treatment from a specialist without a referral, providing you with quicker, easier access to health care.\u00a0<\/p>\n \u2022 Out-of-network:<\/span>\u00a0 <\/em><\/strong>This level of benefit will apply when you use a physician, specialist, laboratory or other provider who is not a member of your plan administrator\u2019s network.\u00a0 The plan provides coverage if you use an out-of-network provider, but your out-of-pocket expenses, deductibles, and coinsurance will be higher than if you use an in-network provider. In addition, you will be responsible for any amounts in excess of the covered charges. Covered charges are those charges determined to be usual, customary and reasonable for a particular service in a particular ZIP code area. Additionally, out-of-network providers may require you to pay for services at the time of service which means you will have to file your claim with the plan in order to be reimbursed.<\/p>\n CHCB benefit<\/span><\/strong><\/span>\u00a0<\/p>\n Under CHCB, the plan pays a percentage of eligible expenses for covered health services. You will pay lower deductibles and out-of-pocket expenses if you use preferred providers, who are health care providers the plan has special arrangements with who agree to discount their charges. By using a provider where a special discount arrangement exists, the amount of the eligible expense that is your responsibility will generally be less than if non-preferred provider is used because the eligible expense will not be subject to a usual, customary and reasonable charge determination for a particular service in a particular ZIP code area.\u00a0 The covered charge will be based on the discounted charge, after your calendar year deductible is satisfied, leaving you with a lower out-of-pocket expense. Your medical ID card shows if you are entitled to these discounts.\u00a0 If you are, you must make sure the provider sees your ID card and knows that you are covered under one of these discount programs.<\/p>\n Locating in-network providers online for your medical health care needs is easy.\u00a0 Simply follow the instructions outlined below for the plan administrator of your health benefits.<\/p>\n MMCP and CHCB benefits<\/span><\/em><\/strong>\u00a0<\/strong><\/span><\/p>\n Plan administrator:\u00a0 Aetna<\/span><\/strong><\/span>\u00a0<\/strong><\/p>\n Customer service:\u00a0(800) 842-4044\u00a0 (Railroad Employees National Health & Welfare Plan); (888) 332-8742\u00a0 (National Railway Carriers \/ United Transportation Union Health & Welfare Plan)<\/p>\n \u25ba Go to www.aetna.com<\/a><\/p>\n \u25ba Click on \u201cFind a Doctor\u201d<\/p>\n \u25ba Under \u201cSearch by Location\u201d, fill in required items<\/p>\n \u25ba Click on \u201cSearch\u201d<\/p>\n \u25ba You may also search by entering the Provider or Facility name<\/p>\n <\/p>\n Plan Administrator:\u00a0 Highmark BCBS<\/span><\/strong><\/span><\/p>\n Customer service:\u00a0(866) 267-3320<\/p>\n \u25ba Go to www.highmarkbcbs.com<\/a><\/p>\n \u25ba Under \u201cFind Providers\u201d click on \u201cFind a Doctor, Hospital or Other Medical Provider\u201d<\/p>\n \u25ba Under \u201cI Want to Find A\u201d complete all of the required fields<\/p>\n \u25ba To select a plan: if MMCP benefits, select \u201cBCBS PPO\u201d; if CHCB benefits, select \u201cBCBS Traditional\u201d<\/p>\n \u25ba Click on \u201cSubmit\u201d\u00a0\u00a0 <\/sup><\/p>\n \u00a0<\/strong><\/p>\n Plan Administrator:\u00a0 UnitedHealthcare<\/span><\/strong><\/span>\u00a0<\/strong><\/p>\n Customer service:\u00a0(800) 842-9905\u00a0 (Railroad Employees National Health & Welfare Plan); (888) 445-4379 \u00a0(National Railway Carriers \/ United Transportation Union Health & Welfare Plan)<\/p>\nHow to locate in-network providers<\/strong><\/span><\/h3>\n