How It Works
Vpass Medical Bill Reduction Program includes a service called Patient Advocacy
that goes to work for you when you incur medical or dental bills for a related
incident. The service provides you with a personal negotiator who will go to
work on your behalf to help you wade through the difficult world known as
medical billing. Instead of being left to sift through this complex process on
your own, your negotiator will assist and inform you along the way, mediating
between you and the provider(s) to reach a solution for your outstanding medical
bills.
Benefits Advantage™
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Claims Assistance: Personal Health Advocates help sort out and solve
claims and related paperwork problems and assist Members with coverage and
benefits issues.
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Fee Negotiation: When necessary, Health Advocate can attempt to negotiate fees with healthcare providers and review questionable bills to catch duplicate and/or erroneous charges.
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Grievance Advice: As appropriate Health Advocate will provide advice and/or assistance to Members when filing a complaint or grievance with their health insurer.
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Coverage Advantage™: The Personal Health Advocate can help Members through the coverage review process and, when necessary, can also assist in identifying alternative coverage options.
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RxAdvocate™: The Personal Health Advocate can assist Members with prescription drug issues including formulary and benefit questions.
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Health Cost Estimator™: Health Cost Estimator assist Members with estimating the total cost of non-emergent medical procedures, pre-treatment.
Physician Locator:
Personal Health Advocates can help Members identify physicians, hospitals, dentist and other healthcare providers for needed services.
Advocates of Excellence:
Personal Health Advocates can help identify leading medical institutions, Centers of Excellence and medical providers to assist Members in need of complex medical care. Our Personal Health Advocates can also help Members schedule appointments with these providers, as required.
Health Advocate CareQuest:
This Service locates resources and makes arrangements for Members in need of special services that typically fall outside the realm of traditional healthcare benefits. The Member is responsible for payment for any services that they use beyond those covered by their insurance plan.
MAX Fee Negotiator: MFN consists of the following features:
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Easy Access by Members -
Members call Health Advocate's toll free number.
- Specialized Negotiation Unit - Elgible members are given access to a Specialized Negotiation Unit (SNU). SNU professional staff will attempt to netotiate a reduction
in the Member's out-of-pocket share of medical and dental bills including but not limited to bills from physicians, hospitals, surgery centers,
radiology and other diagnostic service providers, and various ancillary medical providers ("Providers"). The SNU will attempt to netotiate any medical
or dental bill regardless of insurance or benefit status (e.g., insured, underinsured, non-covered service, out-of-network service). In addition, the SNU will attempt
to negotiate Provider discounts and/or payment terms prior to a Member receiving care, e.g., non-covered services and out-of-network care.
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Fee Benchmarking Databases -
The Specialized Negotiation Unit will consult with various public and proprietary databases and reference tools in order to optimize savings to Members.
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Quick Pay Fund -
Health Advocate has created Quick Pay Fund to help facilitate expedited reimbursements to qualified provider payments. Under the appropriate circumstances, and in Health
Advocate's sole discretion, payment may be tendered by Health Advocate to an eligible Provider on the Member's behalf. In such instances,
Health Advocate will advise the Member in writing of Member's obligation to reimburse Health Advocate payment in full for advanced payments and the terms upon which payment is to
be made, e.g., major credit card, or HSA debit card by the Member.
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Provider Acceptance -
Health Advocate will secure a written release from the Provider signing off on the terms and conditions on the Member's behalf.
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Savings Result Statement -
Health Advocate will provide Member with a written statement summarizing the outcome of the negotiation with Provider and
outlining any applicable terms and conditions of the required payment due to Provider. Member will be financially responsible for making payment in accordance
with terms and conditions outlined. Member will be advised that in the event he/she does not adhere to such terms and conditions, Provider is not obliged to
accept less that what Provider originally billed.
Instructions
It's easy to start accessing your discounts.
- Join in the Patient Advocacy Program at
special member pricing.
- Call Member
Services at the toll free number listed on your ID card. Let them know your name
and tell them the group number and member number listed on your ID. Also tell
them you are a Vpass member and that you are calling about Patient Advocacy
Program.
They will verify eligibility and get some personal information to initiate a
case. You will then be assigned a personal negotiator, who will
discuss with you, all options and the best way to make use of
available funds. Depending on your financial resources, your negotiator may
pursue a variety of options including helping you apply for financial assistance
or negotiating a settlement or payment plan with the provider(s).
Note
Patient Advocacy does not provide funds to pay for bills. Patient Advocacy is
a best efforts service and despite their diligent efforts, some providers refuse
to make accommodations to help resolve outstanding medical bills.
Terms of Use
ID valid for (2) weeks from date printed. You may print a new one as often as
needed while membership is active.
Disclosures
a. The
discount medical card program is NOT health insurance.
b. The
plan provides discounts at certain health care providers for medical services.
c. The plan does not make payments directly to the providers of medical services.
d. The range of discounts for medical or ancillary services provided under the plan
will vary depending on the type of provider and medical or ancillary services received.
e. The plan member is obligated to pay for all health care services but will receive
a discount from those health care providers who have contracted with VantageAmerica
Solutions, Inc., a discount medical plan organization.
Managed and Administered
by:
VantageAmerica
Solutions, Inc.
1275 Milwaukee Avenue
Glenview, IL 60025
www.vantageamericasolutions.com
ATTENTION MARYLAND RESIDENTS
Some discounts under the Physician and Hospital Referral Plan benefit are not applicable
in Maryland. Discounts are not available for all In-Patient Procedures and certain
Out-Patient Procedures under Maryland law. Out-Patient Procedures at network hospitals
such as laboratory and diagnostics services are eligible for the discount.
The program and its administrators
have no liability for providing or guaranteeing service by providers or the quality
of service rendered by providers. This program is not available in Montana, Vermont,
Massachusetts, Arkansas, Kansas, Washington, Hawaii, Florida, Indiana, Nevada, Oklahoma,
South Carolina, and Puerto Rico. *Medicare statement applies to MD residents when
pharmacy discounts are part of program.
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