Skip to content
Login
Email
(509) 662-2116
Facebook Twitter Instagram YouTube LinkedIn

Health Insurance Open Enrollment FAQ - updated 9.17.21

Health Insurance Open Enrollment FAQ - updated 9.17.21

(0) Comments

Which health insurance providers receive in-network benefit coverage from Confluence Health?
 
 
Confluence Health is contracted with the below list of insurance payers and plans. Insurance plan coverage can change at any time. Please review your network status, insurance plan benefits, copays, annual deductible, and coinsurance to be informed about your coverage. If you have any questions, please contact your plan to confirm that care at Confluence Health will be covered prior to receiving services. Benefit plans may utilize a network that Confluence Health does not participate with.
 
In-Network Plans/Payers Accepted at Confluence Health:
 
How can I learn if my current health insurance provider will provide network coverage at Confluence Health in 2022?
 
Call your carrier's customer service number or call Confluence Health’s patient services department at (509) 436-4020 and visit their website to determine if your insurance carrier is in network.
 
What is the difference between in-network and out-of-network benefits?
 
In-network Providers are contracted with health insurance carriers to offer discounted rates. These discounts are passed down to members in the form of lower cost when you seek care from an in-network provider. For example, a $25 dollar copay to see an in-network Specialist vs $50 to see an out-of-network specialist or paying 20% coinsurance for an in-network procedure vs 50% for an out-of-network procedure.
 
Additionally, out-of-network providers may not accept usual and customary rates as payment in full and therefore balance bill the member. Balance billing is when a provider bills you for the difference between the provider's charge and the allowed amount.
 
On a Preferred Provider Organization (PPO) or Point of Service (POS) plan an employee may still be able to seek care with out-of-network providers, but their out-of-pocket costs are generally higher when doing so. On the other hand, if their medical condition requires specialty care that is not available in-network then their in-network provider can submit a preauthorization to the insurance company to allow an out-of-network provider at in-network member cost-sharing. Emergency care while traveling is also normally covered with in-network member cost-sharing. Before seeking out-of-network care for a non-emergent condition it is always best to check with customer service to understand and know what to expect with the increased member cost-sharing.
 
Which health insurance providers receive out-of-network benefit coverage from Confluence Health?
 
If Confluence Health is not contracted with your company’s insurance provider, they will still bill the insurance provider as a courtesy to your employees. However, your employees will be financially responsible for any portion of the bill that the insurance company does not pay.
If your insurance provider will become out of network in 2022 with Confluence Health, it is important your employees understand how this will impact their coverage and their financial responsibility associated with an out-of-network benefit charge.
 
What is an “out-of-network” benefit charge and how will that impact out of pocket maximums?
 
An out-of-network benefit is when an employee seeks care from an out-of-network provider. When in doubt employees should always call the carrier's customer service number to verify in or out-of-network benefits. Out-of-network benefits sought without a preauthorization from the health plan normally result in higher out of pocket expense, and a higher deductible and maximum out of pocket expense, for the employee. 
 
Do “out-of-network” benefit charges apply to maximum out of pocket expenses?
 
Normally yes on a PPO or POS Plan but the maximum out of pocket for out-of-network care is normally higher than the in-network max. Health Maintenance Organization (HMO) plans do not offer out-of-network benefits without an approved preauthorization.
 
If my company selects an insurance plan and Confluence Health is no longer an “in-network” provider, can we cancel the plan and select a new insurance provider for my employees?
 
Most plans will have some sort of “termination” clause, and different plan types (fully insured, self-funded) will likely have unique cancellation requirements. It is important your company reviews the termination clause before taking action.
 
What if the insurance plan selected for my employees goes out of network during the contract period?
 
Most small groups 50 and under employees can change carriers at any time and some carriers will give members deductible credits so that they are not negatively financially impacted by the change. Large Groups 51+ employees can also do midyear changes but don’t do so as nimbly or often as small groups.
 
What should my company do before terminating an insurance plan contract with an out-of-network provider?
 
If a company must terminate a health insurance contract because the preferred health care provider is no longer accepted as in-network, review the contract termination clause, determine the last date of coverage, and ensure that a new plan will be in place with no lapse of coverage for employees.
 
Where can I go to learn more information about selecting a health insurance plan that is most suitable for my company and employee needs?
 
There are several local and trusted commercial health plan brokers that can help employers weigh various carrier options. 
 
The following agents are members with the Wenatchee Valley Chamber of Commerce:  
 
Additional agents who can assist local businesses include:
Everett Gahringer of Eastman Insurance
Kelly Allen Agency of Kelly Allen Agency
Tracy Greene of Tracy Greene Insurance
Yvette Davis of Davis Commercial Service

Leave a Comment
* Required field