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PPO: FAQs

Do I need to select a Personal Care Physician (PCP)?
As an Alliance Health and Life (Alliance) PPO enrollee, selecting a PCP is recommended but not required. A PCP will coordinate your medical treatment whether it is lab work, x-ray services or specialty care. It is important to develop a relationship with a PCP so that he/she learns your medical history and can provide you with the most appropriate and effective health care.

How do I select a PCP?
If you do not have a PCP, there are several methods for selecting a PCP:

  • Visit our Provider Search & PCP Select tool.
  • Call our automated services line toll-free at: (877) 427-3678 and press option 4 (you can make PCP changes 24 hours a day with this line). You will need to know the PCP's Physician Code when you call. This information can be found in the Provider Search & PCP Select tool or in your Provider Directory.
  • Call a Client Services Specialist toll-free at (888) 999-4347.

How can I find out if my physician is affiliated with Alliance?
We have over 2,700 PCPs affiliated with us so there is a good chance your physician is already with us! To make sure your physician is Alliance-affiliated; check out our Provider Search & PCP Select tool and enter the physician's name. If you don't see your physician listed, contact us about having him/her join Alliance.

If I need specialty care, what do I do?
As an Alliance PPO enrollee,you can self-direct to affiliated or non-affiliated providers for specialty care. If you receive services from a provider not affiliated with Alliance, you will have higher cost-sharing amounts (such as co-insurance and deductibles). Remember, all of your preventive care must be received from an Alliance-affiliated physician.

What about emergency services?
You have worldwide coverage for emergency services; so around town or around the world you are covered. You don't need to call us, just go to the nearest emergency room or call 911 for assistance. If you are admitted to the hospital after an emergency, you'll need to contact us at the number on your ID card within 48 hours of the admission.

Address Change:

I recently moved. What is the easiest way to change my address?
The quickest and easiest way to change your address is on our Web site. You can update your mailing and e-mail address. For security reasons, newly registered enrollees will be unable to change their address for five business days after registering for Web site access. Be sure to inform your employer (if applicable) and physicians of your address change as well.

Benefit Information:

What cost-sharing amounts are associated with Alliance PPO plans?
As an Alliance PPO enrollee, the three main types of costs you are responsible for are co-insurance, copays and deductibles.
Co-insurance is the percentage of charges that you are responsible for paying when you receive covered services. For example, if your Group Health Insurance Policy states that Alliance will pay 80 percent of allowable charges for covered services (after your deductible and/or copays have been met) then the remaining 20 percent is your co-insurance.
A copay is the amount you pay at the time of service. Typically copays are for physician office visits and prescription medications.
Your deductible is the fixed amount that you must pay before your health benefits begin to cover medical services. After the deductible is met, covered services are payable at the allowable charge, based on the specific provisions of your Group Health Insurance Policy. Services must be a "covered" benefit to be applied towards the deductible.

Do I need to inform Alliance if I have other health insurance?
Yes. Use Coordination of Benefits to update your information regarding other health insurance.

Where can I get a summary of my benefits?
Most employers provide a summary of benefits to employees. Contact your employer's benefits office to request a copy. You can view a benefit summary or your Group Health Insurance Policy and Riders.

Claims:

Will I have to submit claims for any services I receive?
As an Alliance PPO enrollee, you don't have to submit claim forms for services provided by affiliated providers. For example, if you see your physician for an annual checkup, your physician will bill us and you will only pay your cost-sharing amounts. If you need to be seen by a provider not affiliated with Alliance (such as an emergency while out of our market area) you may be required to pay for services up-front and submit a claim for reimbursement. If this happens, you can simply mail a copy of the claim to us along with a copy of the proof of payment.

How can I check the status of my claims?
You can check the status of your claims on our Web site. You'll be able to access medical and pharmacy claims for the last 18 months.

What should I do if I receive a bill incorrectly from a provider?
If you receive a bill, contact Client Services or use the Billing Assistance Tool.

Can I e-mail someone if I have a question about a claim?
To ensure that your privacy is protected, we recommend that you use our Customer Message Center to send us your question.

Students Away At School:

My child will be going away to school in the fall. Is he/she covered while away?
Yes, your child is covered through our Students Away program.

If my child requires outpatient counseling while out of state at school, is he/she covered through the "Students Away" program?
As an Alliance PPO enrollee, your son/daughter can self-refer to affiliated or non-affiliated providers for outpatient counseling. If they receive services from a provider not affiliated with Alliance, they will have higher cost-sharing amounts (such as co-insurance and deductibles).

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