Page 22 - EPO_Member_Kit

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Doctor Compensation
Part of our partnership with doctors includes fair compensation for services. Our providers receive
payment for their services using a method called fee-for-service, which means that each time you
are seen for medical care, a bill is sent to Alliance. The doctor is paid according to a set fee
schedule that has been established by Alliance and agreed upon in advance by the doctor. This
payment method is based on actual payment practices throughout the United States.
Medical Technology
Medical Advances
The medical field is full of new medications, procedures and technologies that are seen on TV,
heard about on the radio or read about on the Internet. While you want to be in the know as an
informed health care consumer, we want to make sure
we are meeting the needs of our enrollees and keeping
up too. We want to keep up with the times and be on
top of these advances too so that you can receive the
most appropriate and responsible treatment for your
specific ailments. How do we do it? We make changes
in benefits and coverage based on new advances in
medicine and medical technology when needed. The
process begins when we become aware of a procedure
or treatment that isn’t currently a covered benefit and
our doctors start their investigation. Our medical staff
gathers information for a complete assessment. This
information includes evaluations and input from other
medical professionals who are experts on the topic. After all the information is gathered, the
procedure or treatment goes through an extensive evaluation process. The medical field is
constantly changing and growing and we make every effort to keep up with the pace.
The final step includes a review of the procedure or treatment by the Benefit Advisory Committee
(BAC). Medical professionals review and finalize all benefit policy decisions.