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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 is your claim paid quicker when you use a Network provider, you’ll avoid some other potential problems as well.
Avoid unnecessary out-of-pocket expenses
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 and coinsurance payments. You don’t have to worry about unnecessary out-of-pocket expenses if charges exceed our reasonable and customary fee limits.
Any disputes are handled by the Trust and the provider
Your group health policy provides reimbursement for those covered health care services that we determine are both medically necessary and medically appropriate.
When your health care services are covered by your policy, you won't have to worry about out-of-pocket expenses associated with a dispute about the necessity or appropriatness of the services you receive. These types of disputes are handled between the Trust and the network provider.
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 (NCCI) in an effort to promote national correct billing and coding standards. The NCCI is a list of codes that should not be billed in addition to other specific codes. 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 a non-Network provider 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 without your involvement.
If your provider does not belong to the Network and you’d like for him or her to join, urge your provider to call us and ask for the Provider Services Department.
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| Visit our Find a Doctor feature to confirm your provider is a Network provider.
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