Why do claims have to be sent to Sagamore first before being forwarded to my health plan administrator?
A. When you use the services of a Sagamore network medical provider, the claim (bill) is sent to Sagamore to be re-priced based upon the fee that was negotiated with that provider. The re-priced claim (bill) is then forwarded to the payor (the insurance company or third party administrator) for processing based on the specific benefit provisions of the plan. Sagamore providers are obligated to write off the difference between their billed charge and the re-priced amount for covered services. The amount to be “written off” or “discounted” by the provider is normally spelled out in the Explanation of Benefit (E.O.B.) provided to both the provider and the member.
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