Vision
The vendor we utilize to administer vision benefits for plans that have vision included.
What is VSP?
The vendor we utilize for administering pediatric dental and adult buy-up dental plans.
What is Dominion Dental?
The vendor we utilize to use their network and to process some of our alternative care claims.
What is ASHN? (American Specialty Health Network)
The benefit quote for MBR ID 113059446-00 to see Dr. Vanessa Esteves.
What are:
Alt Care OV: $45 CP, ded waived up to the $7900 OOPM
Diagnostics: 30% coinsurance, ded waived up to the $7900 OOPM
What it means if a rider is black in the benefit summary look up tool.
What is benefits are embedded in the medical policy/benefits?
Whether or not MBR ID 100246056-00 has routine vision benefits.
What is no? (Rider is grayed out)
The tool we utilize to find dental providers for members who have dental coverage included on their plan.
What is the provider directory?
The network we'd use for a member being seen by an acupuncturist in Texas, who is on a plan that has access to coverage outside of Oregon/SW WA.
What is First Health?
The chiropractic benefit for MBR ID 113241371-00.
What is:
No chiropractic manipulation benefit
Alt Care OV: $13,100 ded then CIF
Diagnostics: $13,100 ded then CIF
Rehab: $13,100 ded then CIF, with a limit of 30 visits PCY combined w/ OT/ST
The grace period length of time that members eligible for APTC have to pay their premiums before their plan is terminated.
What is 90 days?
Whether or not MBR ID 113122012-00 has routine vision benefits.
Hint: Pay attention to the type of plan........
What is no? (Standard plan - member is over the age of 19 - therefore no adult vision benefits)
What we would do if a provider was calling with questions on a dental claim.
What is transfer to Dominion Dental?
The benefits we need to quote for a naturopath visit.
What are alternative care OV and diagnostics?
Whether or not MBR ID 112876049-00 can see Dr. Jennifer Rose for her periodic health exam and have it be CIF.
What is no?
Member is on a connect plan and must see her medical home on file for annual physical to be CIF. If member see Dr. Jennifer Rose (naturopath), it falls to the Alt Care OV benefit - $45 CP, ded waived which applies to the $7900 OOPM.
The department that OPR (Overpayment Recovery aka Refunds) is a sub department of.
What is OFT? (Operation Financial Transactions)
Quote the benefits for MBR ID 112832139-00 (gr # 107979) going in to see Dr. Lance Anderson (185th Ave, Hillsboro) for an infection in her eye.
What are:
Specialist OV: $15 CP, deductible waived, which applies to the $2000 OOPM
Diagnostics: 10% coinsurance, deductible waived, which applies to the $2000 OOPM
Whether or not MBR ID 113337316-00 has dental benefits.
What is no? (Member is on a standard plan - dental is not covered)
The benefits we need to quote for a member calling in for chiropractic benefits.
What are: Alternative Care (chiro), Alt Care OV, diagnostics and rehab.
Whether or not MBR ID 100185415-00 can see Dr. Paul Nicolai and be covered.
What is no?
Member is on a grandfathered plan; no alternative care coverage. Therefore an office visit with a naturopath provider is not covered.
Whether or not wigs are covered on individual plans.
What is yes? Member must be receiving chemotherapy or radiation therapy for this benefit to apply - 1 wig PCY.
The vendor who has discounts available for eye exams and LASIK correction procedures.
Who is TruVision?
The dental benefit quote for MBR ID 113151766-01.
What are: Let me hear those benefits! :)
The difference with an Alternative Care Plus Plan.
What is: Members can see any willing provider for chiropractic manipulation and acupuncture, but if the member gets any other ancillary services (IE xray/rehab), those services will apply to the applicable benefit based on the network of the provider.
The chiropractic benefit quote for MBR ID 100501427-00 seeing Dr. Joseph Medlin (Killingsworth St).
What are:
Chiropractic manipulation: $25 CP, ded waived, does not apply to OOP, with a limit of 15 visits PCT combined w/ acupuncture
Alt Care OV: $30 CP, ded waived, up to the $6000 OOPM
Diagnostics: 20% coinsurance, ded waived up to the $6000 OOPM
Rehab: 20% coinsurance, ded waived up to the $6000 OOPM, with a limit of 30 visits PCY combined w/ OT/ST
Whether or not QFC is a preferred pharmacy for any PHP plan.
What is yes?