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Article / How Do You Spend Your Healthcare Dollars?

How Do You Spend Your Healthcare Dollars?.

Did you know?

Carpenters Health Plan is experiencing an increase in out-of-network providers claims. Members are using more and more providers who are not a part of Carpenters Health Plan's network of providers and facilities. Not only does this cost you, the member, more money for copays and deductibles when you use an out-of-network provider or facility, but it costs significantly more for the Plan as well.

As with all health plans, the St. Louis – Kansas City Carpenters Regional Health Plan has a different level of benefit that is paid when an out-of-network provider is used. Using an out-of-network provider or facility is substantially higher for the health plan because there is not a contract in place to allow the Plan to control what is actually payable. As a member, your out-of-pocket is significantly higher as well. Out-of-network providers can bill whatever they want and the Plan has very little control on how they bill you.

The benefit level reimbursed for out of network is 50% after you meet a specific out-of-network deductible of $600 individually. Refer to your Medical Schedule of Benefits for more information on copays and deductibles. It is your responsibility to verify the provider you visit is In-Network. If your doctor refers you to another provider or if you choose a provider, the responsibility is yours alone to ask and verify that the provider is in your network. Here are a few ways to make sure the providers you are using participate in the Network:

  1. Call Aetna/Meritain and ask them to verify if a provider is in the network at 1.866.209.3061. 
  2. Visit carpdc.org/BenefitServices and scroll to the bottom of the page. Click on the Aetna logo. Enter the zip code of the provider you were referred to or want to use. You can select the number of miles radius to search. You may select the appropriate category and search. If your provider is the network, it will display in the results. 
  3. Call your provider directly and ask if they are in the Aetna/Meritain Network. Providers will sometimes say that they "accept or bill our insurance." This is not the same as being in the network. 
  4. Pay attention to the provider's response! When a provider asks for you to pay upfront – they are usually not in the network. Contracted providers are required to bill the plan first before billing you except for a defined copay.

Using In-Network providers saves you money in two ways:
  1. by reducing your out-of-pocket costs for copays and deductibles, and
  2. by reducing the amount of the service (a) billed to the Plan and (b) paid by the Plan. This ultimately reduces Health Plan spending and leaves more money on your paycheck!

If you have any questions about your provider or a provider you are referred to, please call Carpenters' Benefit Office at 314.644.4802 or toll-free 877.232.3863, option 1.