Access to Healthcare NetworkMember Manual<br />
Access to Healthcare Network <br />Chapter 1<br />Welcome to Access to Healthcare Network!<br />
Access to Healthcare Network<br />Your Health – Your Responsibility<br />Your Health – Your Financial Responsibility<br />
Access to Healthcare Network<br />ID Cards<br /><ul><li>You will need to present your AHN ID card at each health care visit.
If you access services without showing your AHN card, you may be responsible for full billed charges, and/or be refused se...
You may also be charged a $25 no call/no show fee.</li></li></ul><li>Access to Healthcare Network<br />AHN Membership<br /...
Membership Dues – Depending on your payment plan, dues are paid every 3 months, 6 months or 12 months.
Dues are NON-REFUNDABLE – AHN does not refund membership dues for any reason, including unavailability of providers.</li><...
Qualified dependents – Live with you and/or depend upon you for most of their financial needs.</li></li></ul><li>Access to...
Access to Healthcare Network<br />Member Manual<br /><ul><li>AHN has developed a Member Manual to help you understand AHN ...
It is your responsibility to read the manual and understand the policies that you must adhere to as an AHN member.
Failure to follow these policies may jeopardize your membership in AHN.</li></li></ul><li>Access to Healthcare Network<br ...
Access to Healthcare Network<br />Contacting your Care Coordinator<br />You will be given the name and extension number of...
Access to Healthcare Network<br />Contact your Care Coordinator when…<br />You don’t know how much to pay<br />You go the ...
Access to Healthcare Network<br />Contact your Care Coordinator when…<br />You have been referred for a radiology or diagn...
Access to Healthcare Network<br />Care Coordination<br /><ul><li>If you do not contact our Care Coordinator for these reas...
Primary Care Home<br />A Primary Care Provider (PCP) will be assigned to you upon joining AHN.<br />You must choose your P...
Access to Healthcare Network<br />What is a Primary Care Provider (PCP)?<br />Your main health care provider<br />Usually ...
Access to Healthcare Network<br />What is the main role of a PCP?<br />To provide preventative care<br />To identify and t...
Access to Healthcare Network<br />Choosing your Primary Care Provider (PCP)<br />You will be able to choose from the list ...
Access to Healthcare Network<br />Changing your Primary Care Provider (PCP)<br />You have the freedom to change your PCP.<...
Access to Healthcare Network<br />Chapter 4<br />After Hours Care<br />
Access to Healthcare Network<br />After Hours Care<br />The main benefit of being a member of AHN is that you will be able...
Access to Healthcare Network<br />After Hours Care<br />If you need medical care and your primary care office is closed or...
Access to Healthcare Network<br />After Hours Care<br />Option 1: Contact your provider’s office and talk to the on-call p...
Access to Healthcare Network<br />Urgent Care Fee<br />You will pay a $70.00 fee which includes most services that you wil...
Remember to get a note from the referring physician so you can get the $400 per day rate.
If you go to Saint Mary’s Urgent Care, you may be referred to a different facility for radiology services.</li></li></ul><...
Access to Healthcare Network<br />Emergency Room Policies <br />There are only two ways you can receive a discounted rate ...
Access to Healthcare Network<br />Emergency Room Policies<br />Condition 1: If you are admitted to the hospital for treatm...
Access to Healthcare Network<br />Emergency Room Policies<br /><ul><li>In an emergency situation your health and safety ar...
Access to Healthcare Network<br />Emergency Room – Fees<br />The AHN discounted fee must be paid at the time of discharge....
Access to Healthcare Network<br />Chapter 5<br />AHN Services – Fees and Policies<br />
Access to Healthcare Network<br />Basic things to remember about AHN:<br />We are not health insurance<br />You must pay a...
Access to Healthcare NetworkServices Not Currently Available:<br />Any and all services at Renown South Meadows<br />Reduc...
Access to Healthcare Network<br />Services Not Currently Available<br />If you access any of these services, you will not ...
Access to Healthcare Network<br />In-Office Procedures<br />Any service obtained through your PCP must be paid at the time...
Access to Healthcare Network<br />Vaccinations<br />Vaccinations can be performed by an AHN primary care provider at a var...
Access to Healthcare Network<br />Prescriptions<br />As a member of AHN, you the following options to access medications:<...
Access to Healthcare Network<br />AHN Prescription Discount Card<br />In order to receive a discount at AHN participating ...
Access to Healthcare Network<br />AHN Prescription Prices<br />
Access to Healthcare Network<br />Canada Prescription Service<br />You may choose to go through our affiliate, licensed in...
Access to Healthcare Network<br />Blood Tests and Other Lab Work<br />Sometimes your PCP will want you to have a blood tes...
Access to Healthcare Network<br />Blood Tests and Other Lab Work<br /><ul><li>You can ONLY have lab work done at Renown He...
Lab work processed by LabCorp or Quest will be charged full price and you will be responsible for the bill. </li></li></ul...
Access to Healthcare Network<br />Lab Pricing<br />Lab work at both Saint Mary’s and Renown outpatient labs are $5 per tes...
Access to Healthcare Network<br />Lab Locations<br />Renown Outpatient Lab is located at 1155 Mill Street in Reno. Park in...
Access to Healthcare Network<br />Pap Smears and Annual Exams<br />You will have two charges, one for the physician and a ...
Access to Healthcare Network<br />Pap Smears and Annual Exams<br />Specimens must be sent to the Nevada State Lab at UNR u...
Access to Healthcare Network<br />Pap Smear Pathology Fees<br />Fees must be paid within a short time after your pap smear...
Access to Healthcare Network<br />Radiology<br />A radiological exams allows your healthcare provider to view the internal...
Access to Healthcare Network<br />Radiology Bills<br />Most radiology testing will be done on an outpatient basis and must...
Access to Healthcare Network<br />Pathology<br />A pathology test is done when your PCP collect a sample of tissue from yo...
Access to Healthcare Network<br />Pathology Bills<br />A bill for pathology will be sent to your Care Coordinator one to t...
Access to Healthcare Network<br />Pathology Bills<br />Pathology rates vary, please contact your Care Coordinator for pric...
Access to Healthcare Network<br />Referrals to Physical/Occupations/Speech Therapy<br />In order to access services, your ...
Access to Healthcare Network<br />Payments – Physical/Occupational/Speech Therapy<br />You must pay either after each appo...
Access to Healthcare Network<br />Durable Medical Equipment (DME)<br />This is a term used for medical devices such as whe...
Access to Healthcare Network<br />Hospital In-Patient and Out-Patient Stays – What is the difference?<br />In-Patient mean...
Access to Healthcare Network<br />Out-Patient Hospitalization<br />Some common reasons for going to the hospital on an out...
Access to Healthcare Network<br />Tests, Surgeries and Procedures<br />Some procedures and tests cannot be done in your he...
Access to Healthcare Network<br />Referrals – Out-Patient Tests<br />(Radiology, EKG, EEG, etc.)<br />Your provider will f...
Access to Healthcare Network<br />Referrals – Out-Patient Procedures and Surgeries (Colonoscopy, Biopsy, etc.)<br />Your p...
Access to Healthcare Network<br />Payment – Out-Patient Procedures and Surgeries<br />Will always involve payment to at le...
Access to Healthcare Network<br />Out-Patient Hospitalization<br /><ul><li>Payment is due before you have the surgery or p...
If payment is not made at least two days prior,  your surgery or procedure it may be cancelled.
We cannot guarantee that you will be able to get a discount for any particular type of surgery or procedure.</li></li></ul...
Access to Healthcare Network<br />In-Patient Hospitalization<br />The discounted rates do not include doctor’s fees. <br /...
Access to Healthcare Network<br />About AHN Hospital Rates<br />Per diem means per day<br />In-Patient fees include: any m...
Access to Healthcare Network<br />Preparing for Surgery<br />The following elements are commonly involved in most surgerie...
The hospital where you will be having the surgery.
The Anesthesiologist you will administer the anesthesia during your surgery.
The Pathologist who will examine any tissue samples removed during surgery.</li></li></ul><li>Access to Healthcare Network...
Access to Healthcare Network<br />What is a Hospitalist?<br />A Hospitalist is a physician, usually an internist, who spec...
Access to Healthcare Network<br />Hospitalists<br />If you are admitted you may see a Hospitalist. AHN does not have a con...
Access to Healthcare Network<br />AHN Pregnancy Programs<br />Please contact your Care Coordinator for more information in...
Access to Healthcare Network<br />Ancillary Care <br />The services that follow do not require a referral from your Primar...
Access to Healthcare Network<br />Dental Services<br />Our primary dental provider is Absolute Dental. <br />If available,...
Access to Healthcare Network<br />Absolute Dental<br />Your first visit will include filling out paperwork, x-rays and the...
Access to Healthcare Network<br />Absolute Dental<br />The price of a standard teeth cleaning is $30.<br />If you have not...
Access to Healthcare Network<br />Private Dentist<br />There is a very limited selection of private dentists in the Access...
Access to Healthcare Network<br />Absolute Dental and Private Dentist Rates<br />The rates for Absolute Dental are lower t...
Access to Healthcare Network<br />Optometry – Eye Exams<br />Discounts are not provided for services or materials arising ...
Access to Healthcare Network<br />Optometry Rates – Frames and Lenses<br />These rates are for Eye Masters only.<br /><ul>...
Access to Healthcare Network<br />Mental Health Providers<br />If you would like to meet with a counselor for confidential...
Access to Healthcare Network<br />Mental Health Providers - Rates<br />Please note: These fees do not apply to Reno Psychi...
Access to Healthcare Network<br />Chiropractors<br />You do not need a referral. <br />Call for an appointment and identif...
Access to Healthcare Network<br />Massage Therapy<br />You do not need a referral<br />Call to make an appointment and ide...
Access to Healthcare Network<br />Acupuncture<br />You can call an acupuncturist directly to set up an appointment.<br />I...
Access to Healthcare Network<br />Naturopathy<br />Naturopathy physicians use natural treatment approaches.<br />Call to d...
Access to Healthcare Network<br />Chapter 6<br />Bills- Payment After the Time of Service<br />
Access to Healthcare Network<br />Bills – Payment After the Time of Service<br />The most important thing to remember abou...
Access to Healthcare Network<br />AHN Guidelines – Payment of Services After the Fact<br />The bill will be sent to your C...
Access to Healthcare Network<br />AHN Guidelines – Payment of Services After the Fact<br /><ul><li>You will have 5 busines...
Failure to pay in full by the fifth business day will jeopardize your membership and you will be responsible for full bill...
Access to Healthcare Network<br />Relationships With Your Providers<br />It is important to have a good working relationsh...
Access to Healthcare Network<br />Appointments with your PCP<br />You should schedule and appointment within 90 days of jo...
Access to Healthcare Network<br />Appointments With a Specialist<br />Call your Care Coordinator when your PCP refers you ...
Access to Healthcare Network<br />Appointment Guidelines – Cancelling appointments<br />Most health care providers require...
If you No Call/No Show twice, even if they are different providers, you will be removed from AHN.</li></li></ul><li>Access...
Access to Healthcare Network<br />Appointment Guidelines – Not bringing payment to your appointment<br /><ul><li>The cance...
Access to Healthcare Network<br />Punctuality<br />It is important to be punctual for all medical appointments.<br />A pro...
Access to Healthcare Network<br />Disenrollment from AHN<br />You will be disenrolled for the following reasons:<br /> Two...
Access to Healthcare Network<br />Disenrollment from AHN, Cont.<br />Failure to pay the $25 cancellation fee within two bu...
Access to Healthcare Network<br />Disenrollment Process – Two late payments<br />You will receive a Certified Return Recei...
Access to Healthcare Network<br />Disenrollment Process – Non-Payment<br />You will receive a Certified Return Receipt Req...
Access to Healthcare Network<br />Disenrollment Process – Inappropriate Behavior<br />If the provider claims that the memb...
Access to Healthcare Network<br />Chapter 8<br />Member Rights and Responsibilities<br />
Access to Healthcare Network<br />Member Rights<br />As a Member of AHN you have the right to:<br />Be treated with respec...
Access to Healthcare Network<br />Member Rights Continued<br />Ask questions about and get information on diagnosis and tr...
Access to Healthcare Network<br />Member Responsibilities<br />As a member of AHN you have the responsibility to:<br />Ens...
Access to Healthcare Network<br />Member Responsibilities Continued<br />Treat all health care providers with respect and ...
Access to Healthcare Network<br />Member Responsibilities Continued<br />Make full payments to AHN health care providers a...
Access to Healthcare Network<br />Member Responsibilities Continued<br />Show up on time for your appointments.<br />Cance...
Access to Healthcare Network<br />Member Agreements<br />Upon enrollment, you are required to sign several agreements. Che...
WELCOME TO AHN!<br />
Access to Healthcare Network Member Manual
Access to Healthcare Network Member Manual
Access to Healthcare Network Member Manual
Access to Healthcare Network Member Manual
Access to Healthcare Network Member Manual
Access to Healthcare Network Member Manual
Access to Healthcare Network Member Manual
Access to Healthcare Network Member Manual
Access to Healthcare Network Member Manual
Access to Healthcare Network Member Manual
Upcoming SlideShare
Loading in...5
×

Access to Healthcare Network Member Manual

1,319

Published on

2011 Access to Healthcare Network Member Manual. Please consult Access to Healthcare Network when reviewing.

Published in: Health & Medicine, Business
1 Comment
0 Likes
Statistics
Notes
  • Hello dear,
    My name is Victoria!
    I am girl with integrity i will like to share to you more about me and it will also be my wish to be in a good relationship if you don't mind contact me direct at this my private email for more important issue and i will do attach more of my lovely picture to you thank you for your receiving i will be happy to read back from you again at my email
    ( victoria9ic@hotmail.com )
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

No Downloads
Views
Total Views
1,319
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
9
Comments
1
Likes
0
Embeds 0
No embeds

No notes for slide

Access to Healthcare Network Member Manual

  1. 1. Access to Healthcare NetworkMember Manual<br />
  2. 2. Access to Healthcare Network <br />Chapter 1<br />Welcome to Access to Healthcare Network!<br />
  3. 3. Access to Healthcare Network<br />Your Health – Your Responsibility<br />Your Health – Your Financial Responsibility<br />
  4. 4. Access to Healthcare Network<br />ID Cards<br /><ul><li>You will need to present your AHN ID card at each health care visit.
  5. 5. If you access services without showing your AHN card, you may be responsible for full billed charges, and/or be refused service.
  6. 6. You may also be charged a $25 no call/no show fee.</li></li></ul><li>Access to Healthcare Network<br />AHN Membership<br /><ul><li>Yearly Income Verification – Your membership contract is valid for one year from the date of the contract.
  7. 7. Membership Dues – Depending on your payment plan, dues are paid every 3 months, 6 months or 12 months.
  8. 8. Dues are NON-REFUNDABLE – AHN does not refund membership dues for any reason, including unavailability of providers.</li></li></ul><li>Access to Healthcare Network<br />AHN Membership<br /><ul><li>Adding dependents – You may add dependents at anytime. A pro-rated amount will be charged based on your payment plan.
  9. 9. Qualified dependents – Live with you and/or depend upon you for most of their financial needs.</li></li></ul><li>Access to Healthcare Network <br />AHN Membership<br />Billing – You will be mailed an invoice for your payment according to your plan choice. If payment is not received, your membership will be deactivated immediately.<br />Billing through an employer – membership dues will be automatically deducted unless otherwise noted by the employer. <br />Dropping your membership – You can choose to drop AHN at any time. If you choose to re-enroll, you will be charged a $15 processing fee.<br />
  10. 10. Access to Healthcare Network<br />Member Manual<br /><ul><li>AHN has developed a Member Manual to help you understand AHN policies and guidelines.
  11. 11. It is your responsibility to read the manual and understand the policies that you must adhere to as an AHN member.
  12. 12. Failure to follow these policies may jeopardize your membership in AHN.</li></li></ul><li>Access to Healthcare Network<br />Chapter 2<br />Care Coordination<br />
  13. 13. Access to Healthcare Network<br />Contacting your Care Coordinator<br />You will be given the name and extension number of your care coordinator. Please write it in your manual for future reference.<br />Calls to your Care Coordinator will be returned within 48 hours.<br />If you need immediate assistance, you can call the main number and ask for the Care Coordination Supervisor or the Member Services Manager.<br />
  14. 14. Access to Healthcare Network<br />Contact your Care Coordinator when…<br />You don’t know how much to pay<br />You go the Emergency Room<br />You have been referred for a procedure or surgery<br />You have been referred to a specialist<br />
  15. 15. Access to Healthcare Network<br />Contact your Care Coordinator when…<br />You have been referred for a radiology or diagnostic test<br />You are going to have an in-office procedure done<br />You have questions about where to receive AHN discounted rates for medical services<br />
  16. 16. Access to Healthcare Network<br />Care Coordination<br /><ul><li>If you do not contact our Care Coordinator for these reasons, you could place your membership with AHN in jeopardy.</li></li></ul><li>Access to Healthcare Network<br />Chapter 3<br />Primary Care Home<br />
  17. 17. Primary Care Home<br />A Primary Care Provider (PCP) will be assigned to you upon joining AHN.<br />You must choose your PCP from a list of providers in our Network.<br />You are encouraged to make an appointment with your new PCP as soon as possible.<br />
  18. 18. Access to Healthcare Network<br />What is a Primary Care Provider (PCP)?<br />Your main health care provider<br />Usually a doctor but may be a physician assistant or nurse practitioner<br />A PCP sees will see you for common medical problems and annual exams<br />
  19. 19. Access to Healthcare Network<br />What is the main role of a PCP?<br />To provide preventative care<br />To identify and treat common medical conditions<br />To assess the urgency of your medical problems<br />To make referrals when necessary<br />
  20. 20. Access to Healthcare Network<br />Choosing your Primary Care Provider (PCP)<br />You will be able to choose from the list of AHN participating PCPs<br />You can select different providers for each member of your family<br />You many not have an out-of-network PCP and remain a member of AHN<br />
  21. 21. Access to Healthcare Network<br />Changing your Primary Care Provider (PCP)<br />You have the freedom to change your PCP.<br />To change your PCP, you must call your Care Coordinator.<br />
  22. 22. Access to Healthcare Network<br />Chapter 4<br />After Hours Care<br />
  23. 23. Access to Healthcare Network<br />After Hours Care<br />The main benefit of being a member of AHN is that you will be able to access a wide range of preventive and low cost services to avoid having to visit the emergency room. <br />Using your membership wisely is good for your health and your pocketbook.<br />
  24. 24. Access to Healthcare Network<br />After Hours Care<br />If you need medical care and your primary care office is closed or you cannot get an appointment, you have several options.<br />
  25. 25. Access to Healthcare Network<br />After Hours Care<br />Option 1: Contact your provider’s office and talk to the on-call physician.<br />Option 2: Go to one of the Urgent Cares listed in the back of your manual.<br />Option 3: Call the 24-hour Health Hotline at 982-5757. <br />Option 4: Go the emergency room.<br />
  26. 26. Access to Healthcare Network<br />Urgent Care Fee<br />You will pay a $70.00 fee which includes most services that you will receive during your visit. <br />Fees for the reading of any radiology exams will be received and paid separately.<br /><ul><li>Any lab work you receive at a Renown Urgent Care sent to LabCorp is not eligible for the AHN discount.</li></li></ul><li>Access to Healthcare Network<br />Urgent Care Fee<br /><ul><li>If you go to an Urgent Care and a physician refers you to the Emergency Room, you are still required to pay the $70.00 Urgent Care fee.
  27. 27. Remember to get a note from the referring physician so you can get the $400 per day rate.
  28. 28. If you go to Saint Mary’s Urgent Care, you may be referred to a different facility for radiology services.</li></li></ul><li>Access to Healthcare Network<br />Emergency Room<br />Emergency Rooms are meant for true emergencies.<br />Consider visiting an Urgent Care before choosing the emergency room.<br />If you believe your life is in danger, please call 911 or go to your nearest hospital’s emergency room.<br />
  29. 29. Access to Healthcare Network<br />Emergency Room Policies <br />There are only two ways you can receive a discounted rate or an ER visit.<br />If you do not satisfy these conditions, you will be responsible for full billed charges.<br />
  30. 30. Access to Healthcare Network<br />Emergency Room Policies<br />Condition 1: If you are admitted to the hospital for treatment or observation.<br />Condition 2: If you are referred by an ER physician or your PCP.<br /><ul><li>If you are told verbally to go to the ER and you cannot get a note, contact your Care Coordinator immediately</li></li></ul><li>Access to Healthcare Network<br />Emergency Room Policies<br />The 24-hour Health Hotline will not count as a physician referral to the ER<br />You will be billed by the ER physician separately, as well an any other physician-associated services.<br />
  31. 31. Access to Healthcare Network<br />Emergency Room Policies<br /><ul><li>In an emergency situation your health and safety are the first priority of the hospital staff. Due to this fact, it is possible you may receive treatment from a non-AHN Provider. AHN cannot assist you with these charges.</li></li></ul><li>Access to Healthcare Network<br />Emergency Room Policies – Exclusions<br />Please be aware that we currently cannot obtain a discount from Renown South Meadows Emergency Room.<br />
  32. 32. Access to Healthcare Network<br />Emergency Room – Fees<br />The AHN discounted fee must be paid at the time of discharge.<br />Any charges owed to an AHN provider must be paid within 5 business days.<br />Any charges owed to a non-AHN provider are not discountable and are the responsibility of the member.<br />
  33. 33. Access to Healthcare Network<br />Chapter 5<br />AHN Services – Fees and Policies<br />
  34. 34. Access to Healthcare Network<br />Basic things to remember about AHN:<br />We are not health insurance<br />You must pay at the time of service<br />You are not allowed to set up payment plans<br />You will not be billed for any services<br />
  35. 35. Access to Healthcare NetworkServices Not Currently Available:<br />Any and all services at Renown South Meadows<br />Reduced lab fees through Urgent Care<br />Hepatology<br />Perinatal Care<br />Maternal and Fetal Medicine<br />Infertility Treatments<br />Neonatology<br />Cosmetic Surgery<br />Pediatric Surgery<br />Bariatric Surgery<br />Lasik Eye Surgery<br />
  36. 36. Access to Healthcare Network<br />Services Not Currently Available<br />If you access any of these services, you will not receive a discount.<br />You will be responsible for full billed charges.<br /><ul><li>We do not guarantee access to any services including surgeries and procedures performed in a hospital</li></li></ul><li>Access to Healthcare Network<br />Receipt for Services<br />Get a receipt for every service paid to an AHN provider.<br />Having a receipt is the best way to confirm that you have fulfilled your financial responsibility.<br /><ul><li>If there is a problem and you do not have a receipt, you may have to pay again.</li></li></ul><li>Access to Healthcare Network<br />Referrals<br />In order to see a specialist, a referral must be faxed to your Care Coordinator.<br />It is you responsibility to remind your provider to send the referral.<br /><ul><li>If you access services without a referral, you may jeopardize your membership with AHN and be liable for full billed charges.</li></li></ul><li>Access to Healthcare Network<br />Primary Care Fees<br />
  37. 37. Access to Healthcare Network<br />In-Office Procedures<br />Any service obtained through your PCP must be paid at the time of service, including any in-office procedures.<br />Any in-office procedures must be priced by your Care Coordinator ahead of time.<br />If you get an unexpected procedure, you must contact your Care Coordinator immediately.<br />
  38. 38. Access to Healthcare Network<br />Vaccinations<br />Vaccinations can be performed by an AHN primary care provider at a variable cost or inexpensively at the Washoe County Health Department.<br /><ul><li>Everything, including vaccinations must be paid and the time of service. Call your Care Coordinator if you don’t know how much to pay.</li></li></ul><li>Access to Healthcare Network<br />Specialty Care Fees<br />
  39. 39. Access to Healthcare Network<br />Prescriptions<br />As a member of AHN, you the following options to access medications:<br />Safeway Pharmacy<br />Scolari’s Pharmacies<br />CVS Caremark Prescription Discount Card<br />
  40. 40. Access to Healthcare Network<br />AHN Prescription Discount Card<br />In order to receive a discount at AHN participating pharmacies, you must present your card which is located on the back of your member card.<br />If you do not present your card, you will be turned away.<br />If you lose your prescription card, contact your Care Coordinator for a replacement. <br />
  41. 41. Access to Healthcare Network<br />AHN Prescription Prices<br />
  42. 42. Access to Healthcare Network<br />Canada Prescription Service<br />You may choose to go through our affiliate, licensed in Nevada for less expensive prescriptions. Call 888-550-5501 for more information.<br />RxAccess4u – Prescription Assistance Program<br />This services may be able to help you obtain free or vastly reduced prescriptions. Call 877-827-2897 for more information.<br />
  43. 43. Access to Healthcare Network<br />Blood Tests and Other Lab Work<br />Sometimes your PCP will want you to have a blood test or other lab work done to gather more information about your health.<br />
  44. 44. Access to Healthcare Network<br />Blood Tests and Other Lab Work<br /><ul><li>You can ONLY have lab work done at Renown Health Main Campus or Saint Mary’s Regional Medical Center in order to receive the discounted price.
  45. 45. Lab work processed by LabCorp or Quest will be charged full price and you will be responsible for the bill. </li></li></ul><li>Access to Healthcare Network<br />Instructions for obtaining your lab work a the AHN discounted rate:<br />Your provider must give you a lab form.<br />Take the lab form to either Saint Mary’s or Renown outpatient labs.<br />Pay the required fee at the time of service.<br />Make sure to get a receipt!!!<br />
  46. 46. Access to Healthcare Network<br />Lab Pricing<br />Lab work at both Saint Mary’s and Renown outpatient labs are $5 per test.<br />Sometimes your provider may request a panel made up of multiple test.<br />Remember that you need to pay at the time of service.<br />
  47. 47. Access to Healthcare Network<br />Lab Locations<br />Renown Outpatient Lab is located at 1155 Mill Street in Reno. Park in the Second Street parking garage, use the entrance marked “Center for Medicine C.”<br />Saint Mary’s Outpatient Lab is located at 235 West Sixth Street in Reno. Enter through the Arlington Street entrance and go directly to the Admitting Desk.<br />
  48. 48. Access to Healthcare Network<br />Pap Smears and Annual Exams<br />You will have two charges, one for the physician and a second for the pathologist.<br />You will pay the physician at the time of service.<br />Your Care Coordinator will contact you with the charge due the pathologist.<br />
  49. 49. Access to Healthcare Network<br />Pap Smears and Annual Exams<br />Specimens must be sent to the Nevada State Lab at UNR using the AHN Lab Request Form.<br />It is your responsibility to ensure that your specimen is sent to the proper location.<br /><ul><li>If the specimen is sent to a lab other than the Nevada State Lab, you will be responsible for full billed charges.</li></li></ul><li>Access to Healthcare Network<br />Annual Exam Fees<br />Your annual exam with your PCP will be $65 - $70 whether it is an initial (new patient) visit or an established patient visit.<br />Your annual exam with a gynecologist will be $130 - $140 if it is an initial visit and $65 - $70 if it is a follow up or an established patient visit.<br /><ul><li>Please remember that an annual exam with a PCP is a different price than a regular office visit.</li></li></ul><li>Access to Healthcare Network<br />Pap Smear Pathology Fees (only when sent to the Nevada State Health Lab)<br />
  50. 50. Access to Healthcare Network<br />Pap Smear Pathology Fees<br />Fees must be paid within a short time after your pap smear is done.<br />Your Care Coordinator will contact you with how much to pay.<br />The bill must be paid within 5 business days.<br />
  51. 51. Access to Healthcare Network<br />Radiology<br />A radiological exams allows your healthcare provider to view the internal structure of your body.<br />Radiology rates vary, please contact your Care Coordinator for pricing information.<br /><ul><li>The member manual has a listing of where you can receive radiological testing. </li></li></ul><li>Access to Healthcare Network<br />Radiology Referrals<br />In order to access any radiology services, a referral will need to be faxed to your Care Coordinator.<br />Accessing services without a referral will jeopardize your ability to access the care you need in a timely manner.<br />
  52. 52. Access to Healthcare Network<br />Radiology Bills<br />Most radiology testing will be done on an outpatient basis and must be paid at the time of service.<br />For radiology inpatient radiology, a bill will be sent to your Care Coordinator who will contact you with the price.<br />You will have 5 days to pay the bill in full.<br />
  53. 53. Access to Healthcare Network<br />Pathology<br />A pathology test is done when your PCP collect a sample of tissue from your body (a biopsy) and sends it for examination. Virtually all hospital based surgeries and exploratory procedures will involve a tissue sample being taken and sent to a pathologist.<br />
  54. 54. Access to Healthcare Network<br />Pathology Bills<br />A bill for pathology will be sent to your Care Coordinator one to two weeks after the specimen is taken.<br />Your Care Coordinator will contact you with pricing.<br />You will have 5 business days to pay the necessary providers in full.<br />
  55. 55. Access to Healthcare Network<br />Pathology Bills<br />Pathology rates vary, please contact your Care Coordinator for pricing information.<br />The pathology bill will not be sent to you. If you would like a copy, please contact your Care Coordinator.<br /><ul><li>You will still be required to pay within 5 business days.</li></li></ul><li>Access to Healthcare Network<br />Physical/Occupational/Speech Therapy<br />Health care providers use physical therapy to treat problems with muscles, joints, the brain, nerves, heart, lungs and the skin surface that are a result of injuries, diseases or other conditions.<br />
  56. 56. Access to Healthcare Network<br />Referrals to Physical/Occupations/Speech Therapy<br />In order to access services, your provider will need to fax a referral to your Care Coordinator. <br />You will be contacted with pricing information so you can schedule an appointment.<br />
  57. 57. Access to Healthcare Network<br />Payments – Physical/Occupational/Speech Therapy<br />You must pay either after each appointment or at the next appointment.<br />Call your Care Coordinator for prices.<br />
  58. 58. Access to Healthcare Network<br />Durable Medical Equipment (DME)<br />This is a term used for medical devices such as wheel chairs, canes , crutches nebulizers and blood sugar testing equipment.<br />Your health care provider will write a prescription if you need to use a medical device.<br />Contact your Care Coordinator if you don’t know the cost of a DME.<br />
  59. 59. Access to Healthcare Network<br />Hospital In-Patient and Out-Patient Stays – What is the difference?<br />In-Patient means you are going to stay in the hospital for 24 hours or more.<br />Out-Patient means that you will be going home the same day.<br />
  60. 60. Access to Healthcare Network<br />Out-Patient Hospitalization<br />Some common reasons for going to the hospital on an out-patient basis are to have a surgery, procedure, test or therapy that is minor enough that you will not have to spend the night.<br />
  61. 61. Access to Healthcare Network<br />Tests, Surgeries and Procedures<br />Some procedures and tests cannot be done in your healthcare provider’s office.<br />These tests and procedures must be done in a hospital setting by a technician or employee of the hospital.<br />
  62. 62. Access to Healthcare Network<br />Referrals – Out-Patient Tests<br />(Radiology, EKG, EEG, etc.)<br />Your provider will fax the referral to your Care Coordinator.<br />Your Care Coordinator will call with pricing and contact information so you can set up an appointment.<br />These services must be paid a the time you get them.<br />
  63. 63. Access to Healthcare Network<br />Referrals – Out-Patient Procedures and Surgeries (Colonoscopy, Biopsy, etc.)<br />Your provider will need to contact your Care Coordinator to schedule you for an Out-Patient procedure.<br />Your Care Coordinator will determine the cost.<br />Contact your Care Coordinator immediately to make sure they are aware of this.<br />
  64. 64. Access to Healthcare Network<br />Payment – Out-Patient Procedures and Surgeries<br />Will always involve payment to at least two providers.<br />They may also include services such as: anesthesia, radiology and pathology.<br />Your Care Coordinator will call you once hey have pricing information for all providers involved.<br />
  65. 65. Access to Healthcare Network<br />Out-Patient Hospitalization<br /><ul><li>Payment is due before you have the surgery or procedure done.
  66. 66. If payment is not made at least two days prior, your surgery or procedure it may be cancelled.
  67. 67. We cannot guarantee that you will be able to get a discount for any particular type of surgery or procedure.</li></li></ul><li>Access to Healthcare Network<br />In-Patient Hospitalization<br />There are two reasons why you would be staying in the hospital overnight: either you need to have surgery or you are ill.<br />
  68. 68. Access to Healthcare Network<br />In-Patient Hospitalization<br />The discounted rates do not include doctor’s fees. <br />These fees will be billed separately at AHN rates. <br />If you wen to the emergency room before being admitted, you will also receive a bill from the ER doctor.<br />
  69. 69. Access to Healthcare Network<br />About AHN Hospital Rates<br />Per diem means per day<br />In-Patient fees include: any medications, diagnostics tests such as lab work and any other treatment received.<br />Fees do no include any doctor fees.<br /><ul><li>Payment is due at time of discharge. Call your Care Coordinator immediately if you are concerned about your bill.</li></li></ul><li>Access to Healthcare Network<br />Preparing for Surgery<br />There are a lot of different doctors and medical services involved in a surgery and can make the process confusing.<br />Call your Care Coordinator if you need to schedule a surgery to help you through the process.<br />
  70. 70. Access to Healthcare Network<br />Preparing for Surgery<br />The following elements are commonly involved in most surgeries:<br /><ul><li>Your Surgeon who performs the surgery.
  71. 71. The hospital where you will be having the surgery.
  72. 72. The Anesthesiologist you will administer the anesthesia during your surgery.
  73. 73. The Pathologist who will examine any tissue samples removed during surgery.</li></li></ul><li>Access to Healthcare Network<br />Staying in the Hospital due to Illness<br />If you need to stay in the hospital, you will need a team of health care providers such as:<br />The hospital and nursing staff.<br />Your primary care doctor who will check on you.<br />If your PCP doesn’t work at the hospital, a Hospitalist will check on you.<br />There may be a specialist involved in your case.<br />
  74. 74. Access to Healthcare Network<br />What is a Hospitalist?<br />A Hospitalist is a physician, usually an internist, who specializes in the care of hospitalized patients.<br />
  75. 75. Access to Healthcare Network<br />Hospitalists<br />If you are admitted you may see a Hospitalist. AHN does not have a contract with all Hospitalists in your area. The rates below only apply to AHN providers.<br />
  76. 76. Access to Healthcare Network<br />AHN Pregnancy Programs<br />Please contact your Care Coordinator for more information in regards to the AHN Pregnancy Programs.<br />
  77. 77. Access to Healthcare Network<br />Ancillary Care <br />The services that follow do not require a referral from your Primary Care Provider.<br />
  78. 78. Access to Healthcare Network<br />Dental Services<br />Our primary dental provider is Absolute Dental. <br />If available, you can choose from a one of our private dentists. <br />Call your Care Coordinator to find out if a private dentist is available.<br />
  79. 79. Access to Healthcare Network<br />Absolute Dental<br />Your first visit will include filling out paperwork, x-rays and the consultation.<br />At the end of the visit, the dentist will go over the treatment plan for future appointments.<br />Expect your first visit to last at least 1 ½ hours.<br />
  80. 80. Access to Healthcare Network<br />Absolute Dental<br />The price of a standard teeth cleaning is $30.<br />If you have not gone to a dentist within the last year, expect to pay more for a deeper cleaning.<br />You will be informed how much to bring to your cleaning appointment after the initial exam is completed on your first visit.<br />
  81. 81. Access to Healthcare Network<br />Private Dentist<br />There is a very limited selection of private dentists in the Access to Healthcare Network. <br />Please call your Care Coordinator for availability.<br />AHN cannot guarantee that one will be available to see you.<br />
  82. 82. Access to Healthcare Network<br />Absolute Dental and Private Dentist Rates<br />The rates for Absolute Dental are lower than a private dentist. <br /><ul><li>If you pay one of our private dentists the Absolute Dental rate, it will be considered a non-payment and it could jeopardize your membership.</li></li></ul><li>Access to Healthcare Network<br />Optometry – Eye Exams<br />Eye Masters is our primary vision provider.<br />The Annual Comprehensive Exam with Eye Masters is $40 for adults and $34 for children.<br />If you visit one of our private providers, the fees associated with those providers may vary.<br />Call your Care Coordinator if you have questions about the optometry fees.<br />
  83. 83. Access to Healthcare Network<br />Optometry – Eye Exams<br />Discounts are not provided for services or materials arising from:<br />Orthopedic or vision training<br />Medical and/or surgical treatment<br />Corrective eye wear required by an employer<br />Services provided as a result of Worker’s Compensation Law<br />Services or materials provided by any other group<br />
  84. 84. Access to Healthcare Network<br />Optometry Rates – Frames and Lenses<br />These rates are for Eye Masters only.<br /><ul><li>Children are considered to be 12 years or younger</li></li></ul><li>Access to Healthcare Network<br />Optometry Rates – Frames and Lenses<br />For a comprehensive list of rates for frames and lenses, refer to your Member Manual or contact your Care Coordinator for pricing.<br />
  85. 85. Access to Healthcare Network<br />Mental Health Providers<br />If you would like to meet with a counselor for confidential individual or family therapy, or would like help with substance abuse or other addictions, you can contact any AHN Mental Health provider directly.<br />
  86. 86. Access to Healthcare Network<br />Mental Health Providers - Rates<br />Please note: These fees do not apply to Reno Psychiatry, who receive specialty rates.<br />
  87. 87. Access to Healthcare Network<br />Chiropractors<br />You do not need a referral. <br />Call for an appointment and identify yourself as an AHN member to receive the discounted rate.<br />
  88. 88. Access to Healthcare Network<br />Massage Therapy<br />You do not need a referral<br />Call to make an appointment and identify yourself as an AHN member to receive the discounted rate.<br />
  89. 89. Access to Healthcare Network<br />Acupuncture<br />You can call an acupuncturist directly to set up an appointment.<br />Identify yourself as an AHN member to received the discounted rate.<br />
  90. 90. Access to Healthcare Network<br />Naturopathy<br />Naturopathy physicians use natural treatment approaches.<br />Call to directly to make an appointment and identify yourself as an AHN member.<br />
  91. 91. Access to Healthcare Network<br />Chapter 6<br />Bills- Payment After the Time of Service<br />
  92. 92. Access to Healthcare Network<br />Bills – Payment After the Time of Service<br />The most important thing to remember about Access to Healthcare Network is that all services are paid at the time they are received. <br />However, some services cannot be paid at the time they are received such as: pathology or follow-up lab work.<br />
  93. 93. Access to Healthcare Network<br />AHN Guidelines – Payment of Services After the Fact<br />The bill will be sent to your Care Coordinator.<br />Your Care Coordinator will contact you in regards to: how much to pay, who to pay, and when to pay.<br />If you need help with your bill, call your Care Coordinator<br /><ul><li>If you would like a copy of the bill, please </li></ul>ask your Care Coordinator.<br />
  94. 94. Access to Healthcare Network<br />AHN Guidelines – Payment of Services After the Fact<br /><ul><li>You will have 5 business days to pay the discounted rate in full from the time you were contacted by your Care Coordinator.
  95. 95. Failure to pay in full by the fifth business day will jeopardize your membership and you will be responsible for full billed charges.</li></li></ul><li>Access to Healthcare Network<br />Chapter 7<br />AHN Guidelines and Protocols<br />
  96. 96. Access to Healthcare Network<br />Relationships With Your Providers<br />It is important to have a good working relationship with your health care provider<br />When you meet with your providers, give them your undivided attention and be sure they do the same for you.<br />Be honest with your providers so they can treat you appropriately.<br />
  97. 97. Access to Healthcare Network<br />Appointments with your PCP<br />You should schedule and appointment within 90 days of joining AHN.<br />Establishing care will make it easier and faster to see your provider for future appointments.<br />Your Primary Care Provider’s information is printed on the front of your AHN card.<br />
  98. 98. Access to Healthcare Network<br />Appointments With a Specialist<br />Call your Care Coordinator when your PCP refers you to a specialist.<br />Your Care Coordinator will give you the contact information you will need to schedule your appointment.<br />If you need to schedule a follow-up visit, you will be able to call the specialist’s office directly.<br />
  99. 99. Access to Healthcare Network<br />Appointment Guidelines – Cancelling appointments<br />Most health care providers require 24 – 48 hours notice for cancellations.<br />AHN providers can charge $25 cancellation fee if you do not give at leas a 24 hour notice.<br /><ul><li>Failure to pay this fee within 2 business days will be considered a non-payment and you will be removed from AHN.</li></li></ul><li>Access to Healthcare Network<br />Appointment Guidelines – No Call/No Show<br />If you do not call or cancel your appointment you will be charged a $25 no show fee.<br /><ul><li>Failure to pay this fee within two business days will be considered an non-payment and you will be removed from AHN
  100. 100. If you No Call/No Show twice, even if they are different providers, you will be removed from AHN.</li></li></ul><li>Access to Healthcare Network<br />Appointment Guidelines – Not bringing payment to your appointment<br />If you show up to your appointment without the necessary payment, the provider will not see you and ask you to reschedule.<br />The provider’s office will consider this a non-cancellation without a 24 hr. notice and will charge you the $25 cancellation fee.<br />
  101. 101. Access to Healthcare Network<br />Appointment Guidelines – Not bringing payment to your appointment<br /><ul><li>The cancellation fee must be paid within two business days or you will be removed from AHN.</li></ul>Please note: After any combination of two cancellations without enough notice, or two failures to bring your payment, you will be disenrolled from AHN.<br />
  102. 102. Access to Healthcare Network<br />Punctuality<br />It is important to be punctual for all medical appointments.<br />A provider may ask you to come early to your first appointment to fill out paperwork.<br />If you show up on time and have to wait more than half hour, let the office staff know that your are still there.<br />
  103. 103. Access to Healthcare Network<br />Disenrollment from AHN<br />You will be disenrolled for the following reasons:<br /> Two late payments to AHN providers. <br />One non-payment to AHN providers.<br />Inappropriate behavior with a provider or AHN staff.<br />Not giving adequate notice for appointment cancellations more than once.<br />
  104. 104. Access to Healthcare Network<br />Disenrollment from AHN, Cont.<br />Failure to pay the $25 cancellation fee within two business days.<br />Failure to comply with AHN payment policies.<br />Falsification of income documentation.<br />Using an alternate health insurance product in conjunction with your AHN membership.<br /><ul><li>If you are dismissed for any reason, you will not be refunded any of your membership fees.</li></li></ul><li>Access to Healthcare Network<br />Disenrollment Process – Late payment or a No Call/No Show<br />If you make one late payment to an AHN provider you will be issues a Warning Letter for Non-Compliance with AHN policies.<br />
  105. 105. Access to Healthcare Network<br />Disenrollment Process – Two late payments<br />You will receive a Certified Return Receipt Requested letter disenrolling you from AHN.<br />All providers associated with your care will be notified you are no longer an AHN member.<br />You will not be allowed to join AHN again.<br />AHN providers can send you to collections.<br />AHN providers can dismiss you from their practice.<br />
  106. 106. Access to Healthcare Network<br />Disenrollment Process – Non-Payment<br />You will receive a Certified Return Receipt Requested letter disenrolling you from AHN.<br />All providers associated with your care will be notified you are no longer an AHN member.<br />You will not be allowed to join AHN again.<br />AHN providers can send you to collections.<br />AHN providers can dismiss you from their practice.<br />
  107. 107. Access to Healthcare Network<br />Disenrollment Process – Inappropriate Behavior<br />If the provider claims that the member is inappropriate any of the following measures may be followed:<br />Member will be issued a Warning Letter.<br />Member will be transferred to a new provider.<br />Member will be disenrolled immediately.<br />
  108. 108. Access to Healthcare Network<br />Chapter 8<br />Member Rights and Responsibilities<br />
  109. 109. Access to Healthcare Network<br />Member Rights<br />As a Member of AHN you have the right to:<br />Be treated with respect.<br />Be referred to healthcare providers regardless of race, color, sex, national origin, handicap, religion or sexual orientation.<br />Change your primary care provider (PCP)<br />Discuss your health concerns with your providers.<br />
  110. 110. Access to Healthcare Network<br />Member Rights Continued<br />Ask questions about and get information on diagnosis and treatments.<br />Be involved in decisions about your health care.<br />Contact AHN to obtain information and to get answers regarding questions and complaints.<br />
  111. 111. Access to Healthcare Network<br />Member Responsibilities<br />As a member of AHN you have the responsibility to:<br />Ensure that your membership fee is paid.<br />Take charge of your own health and your own health care.<br />Follow the plan of treatment prescribed by your health care providers.<br />
  112. 112. Access to Healthcare Network<br />Member Responsibilities Continued<br />Treat all health care providers with respect and dignity<br />Protect your AHN ID Card.<br />Show your AHN ID Card before accessing services.<br />Inform your health car providers if you are no longer an AHN member.<br />
  113. 113. Access to Healthcare Network<br />Member Responsibilities Continued<br />Make full payments to AHN health care providers at the time of service.<br />Inform AHN staff of any changes in your health care coverage, income, employment status, address and/or telephone number.<br />Inform AHN providers of any changes in your health care coverage, income, employment status, address and/or telephone number.<br />
  114. 114. Access to Healthcare Network<br />Member Responsibilities Continued<br />Show up on time for your appointments.<br />Cancel appointments at least 24 hours in advance.<br />Notify AHN if you change your PCP.<br />Arrange for transportation to and from your scheduled appointments.<br />File grievances and complaints in accordance with the Member Agreement.<br />
  115. 115. Access to Healthcare Network<br />Member Agreements<br />Upon enrollment, you are required to sign several agreements. Check the back of your Member Manual for a copy of all the Member Agreements and Waivers.<br />
  116. 116. WELCOME TO AHN!<br />
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×