 |
 |
|
|
|
|
| Health FAQs |
|
|
| General Information |
|
|
|
|
| Coverage Information |
|
|
|
|
Q. How can I find a doctor that is
in my Preferred Provider Organization (PPO) network?
A. If you are in a PPO Plan, contact your PPO to find a doctor; the
PPO's phone number, mailing address, and internet address, if any,
are provided on your ID card.
View
example of ID Card View list
of PPO websites
Disclaimer for Texas PPO Networks
|
Q.
How can I find out the amount of my deductible? How many dependents
have to meet the deductible before the family deductible is met?
A. The first page of the Certificate booklet and/or the Schedule of
Benefits outlines the deductible amounts relevant to you and your
family (if applicable). Information on the number of dependents
that are required to satisfy the family deductible is located in
the section entitled "Family Maximum".
Q. What is the name of my Preferred
Provider Organization (PPO)?
A. If your plan includes a Preferred Provider Organization (PPO),
the name of the PPO will be located on your ID card and on the
first page of the Certificate booklet.
View
example of ID Card
Q. How do I read your Explanation of
Benefits?
A. View
the diagram and description of the EOB here
Q. What address do I use for claims
processing?
A. The Address and instructions for claims processing are located
on the member's ID card.
View example of ID Card
Q. How does my policy pay?
A. The Certificate booklet contains a Schedule of Benefits
describing the percentages that are payable for covered events. The
Covered Expenses section outlines what services are eligible and if
any limitations apply.
Q. What is a Preferred Provider
Organization (PPO) plan?
A. A Preferred Provider Organization (PPO) is a group of hospitals,
physicians, and other health care providers who have signed an
Agreement with American National to treat patients and charge for
their services according to a negotiated fee schedule. The
negotiated fee schedule is part of the formal Agreement. Insureds
do not have to get involved in the fee negotiations. Routinely, the
negotiated fees are significantly less than the fees patients
otherwise pay. The providers who are involved in such Agreements
are referred to as "participating providers".
Most health plans that American National offers have financial
incentives for our insureds to use the participating providers of a
specific PPO. We refer to such plans as "PPO Plans". If an insured
has a PPO plan and does not choose to use a participating provider,
American National will pay a lesser benefit, as specified in the
PPO policy/certificate.
Q. How does a PPO Plan benefit me?
A. The providers who participate in a PPO have generally agreed to
reduce the fees they charge American National insureds. The fee
reductions benefit both American National and its insureds. We
normally pay less to a PPO provider than we pay to a non-PPO
provider. So, of course, we build into our PPO plans some financial
incentives for our insureds to use PPO providers ("in-network"),
instead of non-PPO providers ("out-of-network"). When our insureds
go to PPO providers, they will generally find that the provider's
charge is less than a non-PPO provider's charge and that American
National pays a greater percentage of the total charge. The PPO's
lower charge + American National's greater benefits level for PPO
services = less money out of our insureds' pockets.
Note: If an insured receives services from a PPO provider, and such
services are not eligible for benefits under the PPO plan, then the
PPO provider may be free to charge his/her normal fee for such
services - the charge may not be subject to the PPO Agreement which
American National has with the PPO.
Q. Is my doctor a PPO doctor?
A. Look at your ID card to find the name of your PPO, then view
their website to determine if your doctor is in the network. If
your PPO does not have a website, a phone number will be on your ID
card. Call that number to find out if your doctor is in the
network.
View
example of ID Card View list
of PPO websites
Q. How can I get my PPO to include
my health care providers?
A. The PPOs with which American National contracts accept
"nominations" from our insureds with respect to adding providers to
the PPO. Accordingly, if there are nonparticipating providers you
would like to join the PPO, just find the PPO's telephone number on
your ID card and call the PPO's Provider Relations personnel to
discuss how to encourage your providers' participation.
View
example of ID Card
Q. What will happen if I forget to
pre-certify?
A. Your insurance plan specifies a penalty for failure to
pre-certify. Please refer to your Certificate booklet for penalty
amounts.
Q. How do I file a claim?
A. If you do NOT have a PPO Plan, simply mail a copy of your bills
to American National's Claim Department, PO Box 696520, San Antonio, TX, 78269-6520. Be sure to write your policy number on your bills.
If you are in a PPO Plan, click
here for an explanation of filing a claim in a PPO Plan.
Q. How do I report healthcare fraud and abuse?
A. If you believe you have been a victim of healthcare fraud or
abuse or if you would like to report any suspicious healthcare
activity concerning your policy, please contact our Special Investigations
Unit at 800-899-6503. You may also write to us at : American National,
Special Investigations Unit, One Moody Plaza-13th Floor, Galveston TX 77550. You may also
email us.
Q. If I am a provider in New Jersey, how do I learn more about claim adjudication?
A: Please select the following email link to obtain additional information
adj.meth@anico.com
Q. What is the effective date of my
coverage?
A. The first page of the Certificate booklet contains the effective
date of the member's coverage.
Q. Do we have dental coverage under
our policy?
A. If the policyholder requested dental coverage, the Certificate
booklet will contain a Dental Schedule of Benefits. This schedule
will be located at the beginning of the booklet.
Q. Do I have coverage for routine
physical exams?
A. Please refer to the Schedule of Benefits located in the
Certificate booklet to determine your specific coverage.
Q. What is covered under the Office
visit Co-Pay?
A. Please refer to the section entitled "Doctor's Office Visit
Co-payment" and/or "How the Preferred Provider Plan Works" as they
identify the services that are eligible under this provision, if
covered by your plan.
Q. Does my plan cover a yearly
mammogram and/or is it included in my Well Care Benefits?
A. To determine if your plan covers this type of benefit, you would
need to speak with a Customer Service Representative at American
National. Call 1-800-899-6503.
Q. Do I have vision coverage, if so
what is covered?
A. If your plan contains vision coverage, there will be a Schedule
of Vision Benefits listed in the Certificate booklet.
Q. I live in Louisiana and have a Preferred Provider Organization (PPO) plan. Where can I find links to the participating hospital's in-network physicians?
A: There are three PPO's currently utilized in Louisiana. Please follow the link below to your respective PPO provider list.
www.Viant.com
www.MultiPlan.com
www.PPOplus.com
|
|
|
