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A. Sales packets and member welcome packets will include provider directories. Q.
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A. You can call WellDyne for help filing your claim. In addition, if your preferred pharmacy does not currently participate in the CFPAF network, it can contact our claims administrator, Welldyne, and ask to join the network. For more details visit
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Yes. During the implementation period your account will be set up to include fee schedules for Medicare, Medicaid, any in-network carriers and self-pay. You can then use the ClearGage Payment Accelerator to manage out-of-network carriers.
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An in-network dentist is a dentist that has agreed to contract with your health insurance company to provide services at a set rate. This type of dentist visit will normally not require an upfront fee if you have a dental PPO or managed care plan.
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Yes. The member may be billed for non-covered services and any co-pays at the time of service.
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If your plan has two levels of coverage for In-Network(INN) or Out-of-Network(OON), there can be large difference in your cost. Example for XYZ Insurance: INN specialist visit is covered with a $25 copayment. OON specialist is covered at 80%
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Im assuming you are talking about a PPO plan with Delta, because if you have a Deltacare HMO-type plan, I don't believe you would get any benefits for going out-of-network. A PPO plan will pay, but at a lower rate for out-of network. Also, you can
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For “True Emergencies” the member should seek care at the nearest facility and emergency benefits will apply regardless of if the facility or treating physician is in or out of network. For after hours treatment of cold/flues and other non life-
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There are several advantages when you go in-network. Generally You don't need to submit claim forms and wait to be reimbursed by your plan. Your network provider obtains any needed precertification for you. In most cases, you only pay a copayment (
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There are several advantages when you go in-network. Generally You may not need to pay a deductible, or your deductible may be lower than it would be for out-of-network expenses. You don't need to submit claim forms and wait to be reimbursed by
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