What is the penalty for using a non-preferred provider (within the Municipality of Anchorage)?
If you use a health care provider within the Municipality of Anchorage that is a not a preferred provider, the Plan will base your reimbursement on the preferred provider rate and will then reduce your regular reimbursement percentage by 20% for the first $50,000 in covered charges. In addition to these reductions, a $1,000 penalty will be imposed to each inpatient admission to a non-preferred provider. For example, you live in Anchorage and need to have outpatient physical therapy. The preferred provider charges the Plan the negotiated rate of $100 for this type of treatment. A non-preferred provider in Anchorage charges $200 for this type of treatment. You have already met your deductible for the year and the Plan usually reimburses at 85%. If you have this treatment at the preferred provider, the Plan will pay $85 ($100 X 85%). Your out-ofpocket expense will be $15. If you have treatment at the non-preferred provider, the Plan will pay $65. First, the $200 expense is marked down by
Related Questions
- if I cancel my current provider before june of 2010, I will be charged a $250 dollar penalty. I cannot afford this, what can I do?
- What is the penalty for using a non-preferred provider (outside the Municipality of Anchorage)?
- What is the penalty for using a non-preferred provider (within the Municipality of Anchorage)?
