AmeriPlan® The Dental Insurance Alternative

Commonly Asked Questions and Answers on the new AmeriPlan Health®:  

Can I purchase the medical plan without the DVPC included?  

No, presently the medical plan is only sold as a unit with DVPC.

Can AmeriPlan Health® be used in conjunction with health insurance plans?

Yes it can, but it is always at the doctor’s discretion to accept both. As with our Dental Program (DVPC) benefits, your insurance should always be the primary form of payment.

How can I refer my personal physician to AmeriPlan®? If a member calls the AmeriPlan Health® Customer Service number (800-472-3995) the referral will be taken over the phone or the referral can be faxed. A patient’s name must always be associated with provider referrals.

The procedure for referring physicians is the same as for referring dentists and chiropractors. Every member is given the referral forms in the New Member Packet that is similar to the dental referral card. A member may also send a referral to referral@ameriplanusa.com.

Why would a medical professional want to participate in the AmeriPlan® Consumer Driven Health Care (CDHC) Program?

Are fees still calculated based on Medicare fees?

The rates that the provider will charge are determined based upon either a set fee schedule that the provider has contracted with the physician network, or as a percentage off of their billed charges. In general, discounts will vary between 20% – 50%. Labs and Diagnostics will have discounts of up to 80%.

Does my member have to pay when they are in the office?

YES. The member shall pay in full at the time services are rendered. The office will call the AmeriPlan Health® repricing agents, who will conduct a phone repricing and tell the office staff how much to collect from the member once the discounts have been applied. The agent will then fax the repriced claim to the provider’s office and mail an Explanation of Benefits (EOB) to the provider and the member. This way the member can have documentation of their discounted pricing.

What is an EOB?

An E.O.B. is an insurance industry acronym abbreviation for Explanation of Benefits or E.O.B. This is a statement of benefits which lists the codes of the procedures performed at the office, along with normal fees and the amount the member saved. Members receive these statements from the providers’ offices following their visit.

Do the providers understand the member must pay at the time services are rendered?

When the verification call is placed to the physician’s office, the AmeriPlan Health® Customer Service Representative will tell the provider they must call to reprice the bill over the phone and they should collect payment at the time of the visit.

When members arrive for their appointment, how do you ensure the provider will understand how the plan works?

The Customer Service Representative will call the provider’s office prior to the member’s appointment to ensure that the doctor is accepting new patients, to make sure they understand that the members are self-pay at the time of service and to contact the repricing agent for assistance with the bill. A fax is sent to the physician’s office as a follow-up.

In addition, the Customer Service number is on the member’s ID card, and the provider is welcome to contact Customer Service if they have any questions on the program.

A member wants to know if their doctor is currently in the network. How will Customer Service determine this and what will they tell the member?

A database of network medical providers is maintained and available to AmeriPlan Health® members. (This is also available on the website.) The Customer Service Representative can search for a desired provider by name, specialty, and a local zip code. If the provider is in network, the Customer Service Representative will ask if they plan on visiting said provider. If so, Customer Service will contact the provider’s office on behalf of the member. If the doctor is not part of the network, they will offer the member another provider in the same specialty and area. This is done so that the member may make the most of the program. The member can also submit a Provider Referral/Nomination form so that they can refer/nominate their doctor, who will then be contacted regarding joining the AmeriPlan Health® network.

How often do you check with providers to see if they are still participating in your program?

Can you please explain the Karis (Hospital Advocacy) program and what the discount percentage will be?

The Hospital Advocacy Program will stay exactly the same. The service is designed to help members with their medical bills, which total $2,500 for a single incident. Charges can be incurred from multiple providers. The patient advocate pursues a wide range of options, from government entitlement programs to negotiating settlements and payment plans.

NOTE:   The percentage saved varies on a case-by-case basis.

What does my member do when they need to see a physician?

Can I look up the Network websites to find providers?

NO.   You must use the AmeriPlan Health® search engine only. We already have all of the providers in our database, which is regularly updated.

Might there be areas with very few providers?

There will be some secondary type markets with minimal or no providers. There should not be any major markets with the same issue. We have access to the largest number of “Discount” providers of any program offered. However, there are only a limited number of “Discount” medical providers in the U.S. In a continued effort to provide our members and IBO’s with the best program available, we will be continuously analyzing various areas to see if we need to “plug in” one of our other networks.

Will my members receive a guaranteed discount?

All members should receive a 20% “minimal discount”. If a 20% “minimal discount” is not received, the member should call into Member Services and file the appropriate paperwork so the issue can be researched and resolved. All members will receive an EOB mailed to them which will have the discounted amount.

Does an AmeriPlan® Independent Business Owner (IBO) have to be a member of AmeriPlan Health® Medical Program (Consumer Driven Health Care or CDHC) in order to sell it?

No.

How do I locate an AmeriPlan Health® provider?

Are ongoing dental/medical problems (conditions) included?

Yes. Since AmeriPlan® is NOT INSURANCE OR A HEALTH ORGANIZATION, all ongoing dental/medical problems (conditions) are included except for contracted treatment plans including orthodontic treatment in progress.

Is there a deductible to be met from any of the health benefits?

There are Instate Savings, no Paperwork to fill out, and no limits on visits to AmeriPlan® network providers.

Will all areas have specialists and ancillary services?

Yes. However, some specialists and ancillary providers may not be available in a particular geographic region.

Can AmeriPlan Health® Benefits be used with Medicare/Medicaid?

No. Medicare does not allow their providers to charge a Medicare patient a different price.

Are doctors reimbursed by AmeriPlan® for their services?

No. As with all of our health benefits, the provider receives the full discounted fee from the member at the time services are rendered.

Can anyone join AmeriPlan Health®?

Yes.

Can members downgrade from AmeriPlan Health® to the Dental Program (DVPC)?

Yes.

If the doctor’s office has lab facilities, can these be utilized rather than having to go to another lab?

Yes. The lab services will be billed at the contracted network discount.

Do members receive a fee schedule?

No. Fees will vary by zip code.

Do members receive a separate card for AmeriPlan Health®?

Approved members receive four cards: two AmeriPlan Health® (CDHC) ID cards and two Dental Program (DVPC) cards.

Are there benefits for emergency services?

Yes. Emergency services may or may not be contracted with AmeriPlan Health®. Depending on the extent of the charges, these services may be eligible for the Hospital Advocacy Program.

What is the difference between a limited patient visit, an intermediate visit and an extended visit?

A limited patient visit is one where the member is seen for a problem-focused visit with minor problems (physician time 10 minutes), i.e. recheck for a cold.

An intermediate patient visit is more involved with low to moderate severity, and will require a longer visit with the provider, i.e. sore throat.

An extended patient visit is where the member is having a physical examination or consultation for a chronic illness or consideration for surgery, etc. (moderate to high severity).

Will maternity be included?

All medical needs are included as long as we have contracted providers offering this service.

Will the member’s privacy be protected?

Yes. AmeriPlan® is compliant with all HIPAA regulations.

Does medical include hearing tests and hearing aids?

Yes. Hearing Services will be included under our Ancillary Services providers.

Is there a waiting period for new members?

No. Members can use the program as soon as they receive their membership cards.

Can a member pay with cash, personal check or personal credit card for services?

Yes.

Does the member have a choice of which hospital will be used?

Yes. The Hospital Advocacy Representative will negotiate with any hospital of the member’s choice.

What is the discount members receive on dental fees?

Members can save 20%-65% on all restorative and cosmetic work (fillings, crowns, braces, etc.) and up to 80% on preventative work (teeth cleaning, x-rays, etc.) performed by a general dentist. Specialist fees are discounted 15%-25%.

How much is the Dental Program (DVPC) membership fee?

How much more does the Pharmacy, Vision and Chiropractic benefit cost?

The Prescription Drug, Vision and Chiropractic Benefits are Included with the Dental Program (DVPC) Membership at no extra cost.