With a network of over 300,000 physicians nationwide, and over 50,000 ancillaries (lab, x-ray, imaging, durable medical equipment, home health care, nursing homes etc.), members can save on medical services utilizing the contracted provider networks.

Members who sign up for our Medical Savings Program will appreciate the significant  reductions in the cost of services provided at doctors’ offices.

How to use:

2. Make an appointment
When you contact the provider’s office to make an appointment, please let them know you have an approved provider network and will provide further information at the time of your appointment with the Doctor Letter. If the provider would like to know which network they are affiliated with prior to the appointment, have them call provider relations.

3 Bring your ID card and "dear provider" letter
Members must always present their identification card and the Doctor Letter, which is included in this fulfillment package.  Give the letter to the receptionist when you arrive at the participating physician’s office. If the provider’s office has any questions, have them call provider relations.

Physician Office Visit 20% Savings Guarantee: How Does It Work? The member calls to find the closest and most appropriate provider. The member calls the healthcare provider to make an appointment. The member must present their card and the “Dear Provider” letter at the time of appointment. The provider will call the toll-free number on the I.D. card to verify that you are an eligible member (i.e., the cardholder or resident of the cardholder’s household) and to calculate the contracted rate for the services provided. Members must pay the contracted rate in full at the time of billing for the services.

Our Guarantee of Savings

If a member did not receive at least a 20% savings on the total physicians’ usual billed charges for services provided in a network physician’s office, excluding cosmetic, lasik and infertility procedures, the member will be reimbursed the difference.

For example: The patient goes to a physician and the office bill is $100. The physician’s office calls the automated re-pricing number and receives a contracted rate of $90. The member pays $90 at the time of service. The member then submits the Member Guarantee Form with the required paperwork. The member will be reimbursed the difference of $10.00 for a total savings of 20%. Remember, the member must present the I.D. card at the time of service Some providers may file a claim form. In those instances, the member will receive a letter with a statement explaining the contracted rate. The member must pay the contracted rate to the ancillary provider within 30 days.

If the member did not receive a savings of at least 20% of the total physician charges or the provider requests full billed charges and the patient did not receive the contracted rate, the member will then send a completed Member Guarantee Form, written reason for inquiry, a copy of the payment made to the doctor and a HCFA

The member’s inquiry will be reviewed with the provider and processed and a statement explaining the negotiated rate will be sent to both the provider and the member. The provider must reimburse the member the difference between what the member paid and the contracted rate. If the member did receive a savings from the provider and followed all the correct procedures, however, the savings was less than 20%, the member will be issued a check for the difference between the amount of savings received from the provider and 20% of the total physician charges.

All 20% inquiries must be made within 3 months of the date of service. The 20% guarantee does not apply to any facility or hospital charges, only the physician office visits. The member MUST present their I.D. card at the time of service to obtain the guaranteed 20% savings.

THIS PROGRAM IS A REFERRAL AND DISCOUNT PLAN AND DOES NOT WARRANT PROFESSIONAL SERVICES, NOR IS IT RESPONSIBLE FOR THE CARE RECEIVED. THIS PROGRAM MAKES NO WARRANTIES EXPRESS OR IMPLIED CONCERNING SERVICES OR CARE PROVIDED. DISCOUNTED OR PROFESSIONAL SERVICES ARE NOT AVAILABLE IN OR WHERE PROHIBITED BY LAW.

NOTE: THE PHYSICIANS NETWORK IS NOT INSURANCE; IT IS A MEMBER REDUCED FEE FOR SERVICE PROGRAM THAT PROVIDES DISCOUNTS AT CERTAIN PROVIDERS. IN ORDER TO RECEIVE THE SPECIAL PRICING, YOU MUST PAY IN FULL AT THE TIME OF SERVICE AND VERIFY THAT THE PROVIDER IS AN ACTIVE PARTICIPANT OF OUR NETWORK.
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