What are the advantages of using Network providers?
The last thing you want to worry about when you receive medical services is whether your bill will be paid. That’s just one of the reasons why it’s to your advantage to use a WEA Trust Network provider.
Not only are your covered expenses promptly paid when you use a Network provider, but you'll avoid some other potential problems as well. You'll realize the following advantages when using a Network provider:
Save you and your health plan money
Using a Network provider not only reduces your out-of-pocket costs in the form of lower deductibles, coinsurance, and/or copayments, it helps keep premium costs down as well. Network providers agree to provide their services at a reduced rate; this means that it takes fewer premium dollars to purchase necessary medical care. While you don’t pay your provider directly for these services, the Trust uses your premium dollars to pay your claims. Being able to buy more for less helps to limit premium increases.
Avoid reasonable and customary fee limit issues
Medical providers have the right to charge any amount they want for the services they provide. However, we have negotiated fee agreements with Network providers that we and they find reasonable. When you receive services from Network providers, you can be assured that they have agreed to accept our payment as payment in full, less any applicable deductible, coinsurance, and copayment amounts. You don’t have to worry about unnecessary out-of-pocket expenses if your provider’s charge exceeds our reasonable and customary fee limits.
Reduce the risk of medical necessity disputes
Your group health policy provides reimbursement for those covered health care services that we determine are both medically necessary and medically appropriate.
While we cannot guarantee you protection from having any out-of-pocket costs, our contracts with Network providers give us added leverage to resolve many medical necessity and appropriateness issues that may arise. If you have such a dispute with a Network provider, please contact us and we will attempt to resolve the issue on your behalf.
Network providers adhere to industry coding standards
Most medical procedures are assigned codes that are recognized by both providers and insurers. These codes identify the services that a patient receives and help us determine our payment.
Most providers adhere to national coding standards, such as those established by The Centers for Medicare and Medicaid Services (CMS). For instance, CMS developed the National Correct Coding Initiative in an effort to promote national correct billing and coding standards. Network providers recognize and accept these standards and bill their services accordingly.
When you receive services from a non-network provider and there is a question about how services were coded, you may end up being financially responsible for the bill if the provider doesn’t follow the industry standards that are generally accepted by both insurers and the medical community as a whole.
While non-network providers shouldn’t bill you for services that they coded incorrectly, there is a chance that they will. If this happens, the Trust has no leverage to negotiate with non-network providers on your behalf. That’s why it’s to your advantage to use Network providers who do adhere to industry standards. Any disputes about medical coding are settled directly by the Trust and the Network provider.
If using a Network provider is an important part of your health care decision, call our Customer Service Department at (800) 279-4000 to verify that the provider you are seeing is a Network provider before you receive care. Or, check “Find a Doctor” under the Tools section at our Web site, weatrust.com.
If your provider does not belong to the Network and you’d like for him or her to join, urge your provider to give our Provider Services Department a call at (800) 279-4000 to inquire about possible participation.
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| Visit our Find a Doctor feature to confirm your provider is a Network provider.
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