FAQs for Alliance Members
I've heard I'll need a personal care physician (PCP). What does that mean?
EPA and POS members are required to select an Alliance -affiliated personal care physician (PCP) to manage your health care. Your PCP will guide you through the medical system and coordinate your medical care among the various specialists within his or her affiliated medical center/hospital affiliation/PO/PHO.
What if I'm in an EPO or PPO plan, do I still need a PCP?
EPO and PPO members are not required to select a PCP to coordinate their care but we recommend that you establish a relationship with your physician. All preventive services must be received from an affiliated, in-plan provider.
How can I find out if my physician is affiliated with Alliance?
We have over 2,000 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 PCP Search & Select application and enter the physician's name. If you don't see your physician listed, contact us about having him/her join Alliance.
What's a medical center/hospital affiliation/PO/PHO?
When you join Alliance and select your PCP, you become part of that PCP's medical center/hospital affiliation/PO/PHO. A medical center is made up of many physicians (PCPs and specialists) who are under one roof, a one-stop shop for services. A hospital affiliation/PO/PHO describes providers grouped together to serve you. These providers work in private offices and may also include a hospital that is linked. All terms refer to the team of physicians that you will seek all care from, routine and specialty.
If I need specialty care, what do I do?
EPA members will need an approved referral from their PCP to see a specialist.
POS members can self-refer to affiliated or non-affiliated providers for specialty care. If a POS member sees a specialist without a referral or receives services from a provider not affiliated with Alliance, they will have higher out-of-pocket expenses (such as coinsurance and deductibles). Routine OB/GYN services do not need a referral.
EPO members do not need a referral for specialty care, but they must receive services from in-plan physicians. EPO members do not have out-of-plan benefits.
PPO members can self-refer to affiliated or non-affiliated providers for specialty care. If a PPO member receives services from a provider not affiliated with Alliance, they will have higher out-of-pocket expenses (such as coinsurance and deductibles). Preventive care must be received from an affiliated physician.
What about emergency services?
Never fear, Alliance is here. You have worldwide coverage for emergency services so around town or around the country 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.
Will I have to submit claims for any services I receive?
As an Alliance member, 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 would just pay your copay. If you need to be seen by a provider not affiliated with Alliance (such as an emergency while out of our service area) you may be required to pay for services up-front and submit a claim for reimbursement. If this happens, you would simply mail a copy of the claim to us along with a copy of the proof of payment.
What sort of costs are associated with Alliance plans?
As an Alliance member, 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% of allowable charges for covered services (after your deductible and/or copayments have been met) then the remaining 20% 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 drugs.
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.
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