Choosing Which Facility to use

Facilities in the Anchorage Area or Outside Alaska

Attention! The network facilities in the Anchorage area have changed and it could impact how much you pay.

The AlaskaCare Employee plan has expanded its partnership with Alaska Regional Hospital. The partnership includes the Surgery Center of Anchorage and provides members with access to quality services at a lower cost. Most other Anchorage facilities, including hospitals, surgery centers, and free-standing imaging centers, are now out-of-network. Members will pay more when using those facilities. You should call the Aetna Concierge at the number on the back of your insurance card before obtaining services if you have any questions. It is more important than ever to use a preferred facility to avoid costly balance bills and increased cost share.

  • Preferred hospitals and facilities have partnered with the State to control health care costs by setting a fair, predetermined rate for medical services.

  • Other hospitals and facilities in the municipality of Anchorage that have not partnered with the State are now out-of-network, even if they were network providers in the past. If you use an out-of-network facility, your out-of-pocket maximum will double, and the benefit percentage the plan pays will be reduced by 20%.

  • The State will pay a fair, predetermined amount to out-of-network providers set at 185% of the rate of Medicare. This is called the allowed amount. (Read below to find out why we chose Medicare.)

  • For out-of-network imaging centers in the municipality of Anchorage, the plan’s allowed amount will be 50% of billed charges. This will also apply to Imaging Associates LLC, Providence Imaging Center, and Diagnostic Health Alaska in the Mat-Su Valley area.

  • Out-of-network providers can charge any amount they choose, so if the facility does not accept the allowed amount, they can bill you for the rest. This is called balance billing.

  • Because health care charges for the same services can be higher from one facility to the next, the balance bill you receive from an out-of-network facility may be very large.

  • Penalties are not applied in the case of emergency treatment or for services not offered at Alaska Regional Hospital.
It’s important to use a preferred facility to avoid large balance bills.

It is important to use a preferred facility when you obtain services in Anchorage or outside of Alaska. To ensure you receive the best value from your AlaskaCare Employee plan, choose from one of the following Anchorage network facilities:

  • Alaska Regional Hospital
  • Surgery Center of Anchorage
  • Pacific Cataract and Laser Institute
  • Anchorage VA Medical Center
  • Geneva Woods Birthing Center
  • Alaska Psychiatric Institute
  • Providence Transitional Care
  • St. Elias Specialty Hospital

Alaska Regional Hospital is the only hospital in the municipality of Anchorage for which all the hospital-based physicians are in-network. (Hospital-based providers are anesthesiologists, radiologists, emergency room doctors, hospitalists, and pathologists.) This means there shouldn’t be any surprise balance billing when you receive care at Alaska Regional Hospital.

Although almost all surgeons in Anchorage have privileges at Alaska Regional Hospital or the Surgery Center of Anchorage, not all surgeons are in-network. This means they may charge you an amount that exceeds the allowable amount under the AlaskaCare Employee plan (see below example).

All facilities in the Anchorage area that are not listed above are out-of-network!

When you use an out-of-network facility, the plan benefit percentage for most facility fees at the out-of-network facility will be reduced by 20%, and in most cases, your annual out-of-pocket limit will double. The plan benefit percentage (coinsurance) is the allowed amount that the plan will pay after you meet your deductible.

The allowed amount for out-of-network facilities services will be 185% of Medicare rates. Remember, out-of-network facilities can charge any amount they choose. So, if the facility does not accept the 185% of Medicare rate, they can balance bill you for the rest.

Below is an example of the difference in out-of-pocket costs between using an in-network, preferred provider facility, and an out-of-network (OON) facility in Anchorage for someone who has elected the AlaskaCare economy medical plan:

-- ARH (Preferred) OON Facility
Billed Charges $27,000 $27,000
Network Facility Rate in-network or Plan Allowed $22,950 $22,950
185% of Medicare for OON
Deductible $600 $600
Coinsurance 70% 50%
Plan Coinsurance Total $15,645 $11,175
Member’s coinsurance 30% 50%
Member Coinsurance Total $6,705 $11,175
Out of Pocket Maximum (includes deductible) $2,850 $5,700
Potential Balance Bill (Billed charges – Plan Allowed) $0 $4,050*
Member Pays $2,850 $9,750
Plan Pays $20,100 $17,250

* In addition to your cost share portion of the plan allowed amount, OON facilities may balance bill you the difference between their billed charges and the plan’s Medicare-based rate for the services.

If you need emergency treatment, please go to the nearest emergency room without regard to the network. Penalties are not applied in the case of emergency treatment or for services not offered at Alaska Regional. Before receiving services in Anchorage that you believe are not offered at Alaska Regional, or if an out-of-network facility sends you a balance bill for the emergency services, contact the Aetna Concierge at (855)-784-8646a> for assistance.

Information on network facilities options outside of Alaska contact the Aetna Concierge at (855)-784-8646 or visit the custom DocFind online. It is important to use the custom AlaskaCare DocFind tool when searching for facility options; Aetna’s public DocFind will not accurately reflect AlaskaCare’s preferred facilities.

Most Alaska hospitals and facilities outside of the Anchorage area are network providers, but outside of Alaska there are some out-of-network facilities, so its important to check before receiving services. For a list of network providers, please contact the Aetna Concierge at (855)-784-8646 or visit the custom DocFind to help you find a provider that is part of the AlaskaCare network.

Why out-of-network facilities are paid at 185% of Medicare

We use Medicare as our base because they are the largest payer in the county, and they have established a standard measure that accounts for differences like size, location, and the types of patients treated. The Medicare rate is set to pay facilities for their costs plus a profit. The specific percentage chosen most closely corresponds to the network rates AlaskaCare receives from our preferred facility agreement with Alaska Regional Hospital.