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HAP’s Restore CareTrack® Program
If you have a chronic condition, such as asthma, coronary artery disease or diabetes, we support your
relationship with your doctor free of charge.
With Restore CareTrack, you have options to help you take control. They may include:
• Working one on one with a nurse health coach over the phone
• In-home telemedicine monitoring program to help you monitor your medications and condition
through daily sessions
• Behavioral health specialists who will help you identify emotional triggers and behavioral conditions
that can affect your physical well-being and ability to follow your doctor’s treatment plan
• Medication review to ensure that the right medication in the right dosage is taken at the right time
HAP’s Restore Case Management Program
This free program helps members with the personal support they need. With this program, a
registered nurse will work closely with you and your doctor to make sure you’re getting the care you
need, when you need it.
The nurse will be there to help with:
• Scheduling appointments, such as scheduling visits with specialists and treatment facilities
• Information
— Providing a full understanding of each condition
• Medication
— Learn how to manage medications
• Coordinating home visits
—Working with doctors to schedule home visits with registered nurses and therapists when needed
• Medical equipment
— Making sure you get the equipment you need
• Community resources
— Connecting you with community resources that assist with basic everyday needs
For more information about HAP’s Restore CareTrack programs or to refer yourself, please email
Restore@hap.org
or call us at
(800) 288-2902
for CareTrack, or
(313) 664-8324
for Case Management.
Common Terms
Administrative Services Only
– A benefits plan structure in which the employer funds the plan and
assumes financial responsibility for all of the claims and liabilities made against it. The employer
typically hires a third party to administer the plan and process claims and payments.
Affiliated Provider
– A doctor contracted with us to give health care.
Allowable Amount
– The maximum amount on which payment is based for covered health care
services. This may be called “eligible expense,” “payment allowance” or “negotiated rate.” If your
provider charges more than the allowable amount, you may have to pay the difference.
Appeal
– A request for us to review a decision or grievance one more time.
Balance Billing
– When a doctor bills you for the difference between the doctor’s charge and the
allowable amount. For example, if the doctor’s charge is $100 and the allowable amount is $70, the
doctor may bill you for the remaining $30. A preferred doctor may not balance-bill you.
Benefits
– The services a health plan covers, like doctor office visits, routine physicals, etc.
Brand-Name Drug
– A drug protected by a patent with a trade name from the original manufacturer.
The manufacturer keeps the rights to sell the drug for a set period of time. After that time is up, the
formula must be released and other manufacturers can make a generic form of the drug.
Coinsurance
– The percentage of charges for certain covered services that you pay after your
deductible has been met. For example, if your plan specifies a 20 percent coinsurance for an allowable
$100 office visit, and you’ve met your deductible, your coinsurance payment would be $20. The health
plan pays the rest of the allowed amount. (Note: Coinsurance can vary by plan, and some plans don’t
have it at all.)
Copay
– A set amount you pay each time for a covered service, or the purchase of prescriptions or
other medical supplies. The copay amount can vary by the type of covered health care service.
Cost-sharing
– Set arrangements where members pay for designated portions of their covered care.
This may be through copays, coinsurance and deductibles and/or through payroll deductions funding
a part of the premium costs.
Covered Services
– Medically necessary health care services and benefits that have been
preauthorized by an affiliated provider according to your health plan’s accepted policies.