What is a preferred provider?

Preferred providers are doctors, hospitals and other health care providers who have agreed to provide medical services at negotiated rates and at designated standards.

Must I use a preferred provider?

For retirees and their dependents, no. You may use any qualified licensed provider for services covered under the plan. However, to avoid penalties, active employees and their dependents must use a preferred hospital in Anchorage or outside Alaska. To find the services covered under the plan, please see your health benefits booklet.

Why would I use a preferred provider?

While there is no requirement to use a preferred provider other than the hospitals for active employees and dependents, there are advantages. Preferred providers will file your claims for you and since they may provide services for a discounted rate, using one can lower the cost to you and to the plans.

What if I don't use a preferred provider?

Non-preferred providers may ask you to pay for services up front and file a claim for reimbursement, although many do not have this requirement. Claims from a non-preferred provider are reimbursed based on the recognized charge, what may be referred to as the usual, customary, and reasonable (UCR) charge. If the provider you use charges…

• Less than or the same as the recognized charge: both you and your plan will pay according to the plan co-pay percentages and deductibles using the actual amount charged; or,
• More than the recognized charge: after you and the plan pay according to the plan copay percentages and any deductible using the recognized charge guidelines, you may be asked to pay the amount charged by the provider that exceeded the recognized charge.

How do I find a preferred provider?

The plans include access to preferred providers through the MultiPlan (formerly Beech Street) network and their affiliates. There are several ways to locate a preferred provider:

1. Use the provider locator at AlaskaCare Provider Locator . You may search for a provider by name, specialty or location. Instructions for making the best use of the provider locator are available at AlaskaCare Provider Search Instructions
2. Call HealthSmart at (877) 517-6370 or MultiPlan at (866) 720-3725 for additional assistance.

My doctor isn’t a preferred provider – now what?

You may encourage your doctor to become a preferred provider. You and/or your provider can simply contact MultiPlan at the number listed above. If your provider does not choose to join the network, you may make a choice whether to continue as a patient or change to a preferred provider.

What is the recognized charge?

Claim information is collected in a specific geographic area for each procedure code. Then a dollar amount is calculated that would cover 90% of the claims submitted, in full, disregarding the highest and lowest amounts charged.

For example, if 100 claims were filed for a service, 90% - 90 total claims – would be covered in full while the remaining 10% - 10 claims – would have some amount that is not covered because the provider charged more for the service than the vast majority of other similar providers.

Further, recognized charges for procedures performed in Juneau are based on charges submitted by providers from throughout Southeast and Western Alaska and the Kenai Peninsula. The recognized charges for procedures in this area are set at a level sufficient to pay 90% of all claims received for identical services, in full.

Some types of procedures, such as surgery, are based on statewide claims data. If there is not enough claim data to determine a particular recognized charge, the Claim Administrator may consider such factors as the:

• Prevailing charges in a greater geographic area
• Complexity of the service or supply
• Degree of skill needed
• Type of specialty of the provider, or
• Range of services or supplies provided by a facility.