Personal Alliance PPO FAQs
Do I need to select a personal care physician (PCP)?
As a HAP Personal Alliance PPO member, you do not need to select a PCP. But we do recommend getting a go-to doctor. This doctor will know all about your health and medical history. He/she will be able to help you with the most appropriate and effective health care. This doctor will also help you find a specialist when need be.
How can I find out if my doctor is in the HAP Personal Alliance network?
We have over 2,700 doctors within our network, so there is a very good chance your doctor is already a HAP doctor. To make sure he/she is, check out our Doctor Search tool. Simply enter the doctor's name. If you don't see your doctor listed, contact us about having him/her join our network.
When can I log in and access the member portal at hap.org?
Once you receive your member ID card, you can register on the website using your ID number. Current members may do this immediately after registering on the website.
If I need specialty care, what do I do?
As a HAP Personal Alliance PPO member, you can choose any doctor within the HAP network for specialty care. If you receive services from a doctor outside the network, you will have higher cost-sharing amounts (such as copays, coinsurance and deductibles). Remember, all of your preventive care must be received from a doctor within HAP's network.
What about emergency services?
You have worldwide coverage for emergency services. Wherever you go around town or around the world you are covered. And there's no 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 the back of your ID card within 48 hours of the admission or the service won't be covered.
I recently moved. What is the easiest way to change my address?
The quickest and easiest way to change your mailing or email address is to call Customer Service at the number on the back of your ID card. For security reasons, newly registered members will be unable to change their address for five business days after registering at hap.org. Be sure to inform your doctor of your address change as well.
What cost-sharing amounts are associated with HAP Personal Alliance PPO plans?
The three main types of costs you are responsible for as a member are coinsurance, copays and deductibles.
Coinsurance is the percentage of charges for certain covered medical services that you pay after your deductible has been met. For example, if your 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 coinsurance.
A copay is a set amount you pay each time for a covered medical service, or the purchase of prescriptions or other medical supplies. The copay amount can vary by the type of covered health care service.
Your deductible is the amount you owe for certain covered medical services before your health plan begins to pay for them. There are per person (individual) deductible amounts and family deductible amounts.
What is an out-of-pocket limit?
The most you will pay for the combined total of all copays, coinsurance and deductibles for covered services in a benefit period (usually a calendar year). Once you meet your out-of-pocket limit, HAP pays all of the allowed amount for covered services. It does not include your monthly premium or non-covered services.
Do I need to inform HAP Personal Alliance if I have other health insurance?
Yes. Simply log in at hap.org using your ID number and use the Coordination of Benefits tool to update your information regarding other health insurance. New members can do this once they receive their ID cards and register on the website.
Where can I get a summary of my benefits?
You can view a summary of benefits and coverage when you log in at hap.org using your ID number. The summary will give you a high level overview of what your health plan covers and what you will pay to get covered services. New members can do this once they receive their ID cards and register on the website.
Will I have to submit claims for any service I receive?
As a HAP Personal Alliance PPO member, you don't have to submit claim forms for services provided by network doctors. For example, if you see your doctor for an annual checkup, he/she will bill us. You will only pay your cost-sharing amounts. If you need to be seen by a doctor outside of the network (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, along with proof of payment, to:
Alliance Health & Life Insurance Company
2850 West Grand Boulevard
Detroit, MI 48202
How can I check the status of my claims?
You can check the status of your claims when you log in at hap.org using your ID number. You'll be able to access medical and pharmacy claims from the last 18 months.
What should I do if I receive an incorrect bill from a doctor?
If you receive a bill that you feel is incorrect, call Customer Service at the number on the back of your ID card.
Can I email someone if I have a question about a claim?
To ensure that your privacy is protected, we recommend that you log in at hap.org using your ID number and send us your question through our Customer Message Center.
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 a HAP Personal Alliance PPO member, your son/daughter can go to any doctor or health care provider for outpatient counseling. If he/she receives services from a provider outside our network, higher cost-sharing amounts may apply (copays, coinsurance and deductibles).