What is a preferred hospital?

A preferred hospital is a facility that has agreed to provide medical services at negotiated rates. The preferred hospital in Anchorage is Alaska Regional. Other preferred hospitals are available outside the State of Alaska and can be found using the AlaskaCare Provider Locator.

Who is affected?

Members of the AlaskaCare Employee Health Plan are required to use the preferred provider hospital for hospital services in the Anchorage area or outside the State of Alaska or they will be assessed a 20 percent penalty. In addition, the out-of-pocket maximum that otherwise applies under your Plan will be doubled.

Members of the AlaskaCare Retiree Health Plan are not required to choose a preferred provider so there is no penalty for their use of a non-preferred hospital. However, the discounts offered by Alaska Regional help minimize costs to members and to the plan.

What if I use the emergency room at a non-preferred hospital?

For medical emergencies, as defined by the plan, no penalty will be assessed for members of the AlaskaCare Employee Health Plan.

What if the services are not available at Alaska Regional or other preferred hospitals?

Services that are not available at Alaska Regional can be continued at Providence, without fear of diminished reimbursement/claims payment. However, in most areas outside the State of Alaska, sufficient preferred hospitals exist and members of the Employee plan will be assessed a penalty if a preferred hospital was available to provide the service.

I’m a retiree; why should I use Alaska Regional or another preferred hospital?

Retiree members who choose Alaska Regional or a preferred hospital outside Alaska will experience high-quality care while saving the retiree health trust’s money. Saving retiree health trusts funds is in everyone’s best interest.

Why was this change made?

This change is the result of months of detailed analysis and extensive negotiations undertaken by the Alaska Department of Administration, the State’s independent health plan consultants, and Wells Fargo Insurance Services. This new agreement will provide AlaskaCare members access to high quality healthcare services, provided by their doctor of choice, at an award winning facility at competitive prices.

Was healthcare quality and capacity part of the evaluation criteria?

Yes. Healthcare quality and capacity were major considerations in the evaluation. Alaska Regional Hospital is an excellent institution that has won many awards for healthcare quality. They’ve also been first to market with many innovative solutions and possess competent and seasoned senior management who understand the Alaska marketplace. Alaska Regional Hospital has the capacity to handle the increased volume associated with the AlaskaCare Health Plans. They are also considering expanding - which means additional beds, operating rooms, services, and staff in the future.

How did the pricing from Alaska Regional Hospital and Providence Alaska Medical Center compare?

Represented in percentages, Alaska Regional’s discount offer to the AlaskaCare Plans is almost double Providence’s. A thorough comparison of the baseline charges was conducted by the State’s independent health consultants who determined that, based on AlaskaCare historical spending patterns, Alaska Regional’s baseline charges were lower than Providence’s. Additionally, Alaska Regional’s discount proposal offered significantly better terms to AlaskaCare Plans than did Providence’s.

Since both Providence and Alaska Regional Hospital are listed as members of the MultiPlan (formerly Beech Street) Network, aren’t they both preferred providers?

No. Both hospitals are participating in the MultiPlan Network, which means you will receive a discount from each facility, but only Alaska Regional Hospital is the AlaskaCare preferred Anchorage hospital provider. This is due to the negotiated discounts achieved through the work of the AlaskaCare third party administrator, HealthSmart (formerly Wells Fargo TPA), on behalf of the State. You are free to choose either hospital, but AlaskaCare will only pay the higher reimbursement percentage for charges incurred at the AlaskaCare preferred provider hospital, Alaska Regional.

Will I be subject to penalty or higher co-pay if I seek care at Imaging Associates of Providence or another stand-alone imaging center in the municipality of Anchorage?

Imaging Associates of Providence (IAP) is a separate imaging center from Providence Medical Center and you will not be subject to penalties if you receive care at IAP or any other stand-alone imaging center in the Municipality of Anchorage.  However, please be aware that our AlaskaCare members will receive substantial discounts through our relationship with Alaska Regional which extends to their imaging services as well as their inpatient services.  We know the discounts bring value to both the plan (overall cost) and the members (lower co-pay total) alike.