The key to using your plan wisely is to arm yourself with information and get involved! With AHP, it's easier than you think. Here are some guidelines to follow that will help maximize your benefits, and save money.
Talk to your doctor about your benefits. Let the doctor know your pre-certification requirements, deductibles, and prescription and medical co-pays. The more informed you both are, the more you can work together to keep your costs down.
It is very important to utilize in-network physicians and facilities. The out-of-pocket costs for in-net- work doctors are significantly less than out-of-network. If your doctor refers you to a specialist, make sure they are also in the network.
Talk to your doctor about whether you can use a therapeutic alternative to your current name brand medications. Also, generic medications offer the same benefits as the name brand drugs and result in much lower out-of-pocket costs. If there is an over-the-counter drug that is on our OTC drug list that your doctor is comfortable with you taking, you can switch and get 102-day supply of the covered OTC drug for FREE!
Pre-certification is required for all in-patient hospitalizations, out-patient surgeries and sleep studies. Pre-certification is ultimately your responsibility, so even if your doctor or the facility tells you that they will take care of it, call Q-Elements prior to your procedure to confirm it has been approved. They can be reached at 1-877-202-6379, option 3. Claims will be denied if there is no pre-certification of the above mentioned procedures and if they are pre-certified retroactively, they will be paid at 50%.
Read the explanation of benefits that we send to you. If you do not receive an EOB from us, but you receive a bill from your doctor, call to make sure we have received the claim. If you see a charge is denied on your EOB check the reason. Is it because it was a duplicate claim or because there was insufficient information provided by the doctor to us? Don’t pay the doctor until you are sure we have paid what we are going to pay because you could end up paying the doctor more than you owe and getting that money back can take some time.
If you don’t know whether something is covered, ask us! Send us an email or give us a call, we are here to help you. Worried that a test or procedure isn’t necessary? Unnecessary tests and procedures increase your out-of-pocket costs, so talk to your doctor about your concerns.