2021 takecare Health Plan Information

BAS Customer Service You have access to a Customer Service Team who can:

• Answer coverage questions

• Assist in locating providers

• Book appointments

• Break down claim charges for members

The customer service team can be reached by dialing 866-806-0195.

BAS Personal Assistant & Advocacy Service If you have a Catastrophic Illness or Injury, you have access to a Personal Assistant Service:

• Provides access to coordinating care

• Answers questions about your coverage

• Works with your provider

Your Plan has partnered with Advanced Medical Pricing Solutions (AMPS) to help combat rising healthcare costs by paying Providers what is fair and reasonable for healthcare services.

How Does AMPS Help Control Costs?
AMPS audits each and every claim submitted by your Plan. AMPS backs up the price with a Physician Review to find additional savings. By utilizing Physicians, AMPS uses their expertise to identify unreasonable charges and billing errors. AMPS billing review and pricing processes will result in lower costs for your Plan, which also means lower out-of-pocket costs

You will receive an EOB when a claim for service is processed by BAS and paid to the provider. The EOB will reflect payment to the provider and what your responsibility is for the services.

If your EOB and Bill don’t matchCall BAS IMMEDIATELY: 866-806-0195

When the provider doesn’t agree with the amount paid by the plan for services and bills you the difference.

If your EOB and Bill don’t matchCall BAS IMMEDIATELY: 866-806-0195

REMEMBER: 96% of the time there isn’t an issue with balance billing.

There is no In-Network or Out-of-Network benefit differential for Hospital, Facility and Provider claims under this plan.

A reference-based pricing plan is designed to keep your medical costs low and competitive. Reference based pricing refers to the way that our health plan pays doctors, hospitals, and other healthcare providers for medical services that you incur. This allows TakeCare to manage health care costs while still continue to provide quality benefits to employees and their families.

There is no network- you now have the freedom to go to any doctor, hospital or facility you choose (excluding Kaiser), but certain providers will be more familiar with reference based pricing than others. Use BAS’s provider search tool or call BAS at 866-806-0195 for help with locating providers who are historically more accepting of this type of plan.

What network is being used for doctors and hospitals?
There is no network. You now have the freedom to go to any doctor, hospital or facility you choose*. (Excluding Kaiser)

What to do when you visit a Provider?
Present your Health ID Card and remind his/her office to call BAS at 866-806-0195 to verify eligibility and benefits. Providers can also visit the 24/7 Health Portal www.ProviderPlatform.com or utilize our 24/7 IVR with Fax Capabilities (708-647-3401). Instructions will be on the back of the ID Card under “Eligibility Verification”.

What should I do if my Provider doesn’t recognize my insurance?
The Provider will need to call BAS at 866-806-0195. The phone number will also be on the back of the Health Insurance ID card. Make sure you present your ID card at every visit/service. BAS will verify your eligibility and benefits.

What should I do if a facility requests payment up front?
The only out-of-pocket expense that you should pay to the facility in advance of, or at the time of service is a copay (if applicable). You will be able to contact BAS Member Services at 866-806-0195 to confirm copay and/or deductible amounts. Do not pay anything other than your copay up front. The facility should call BAS.

What is a balance bill?
A balance bill is when a provider bills a member for the difference between what the health insurance allows for a service versus what the provider chooses to charge. In other words, if your provider bill is greater than what your patient responsibility shows on the Explanation of Benefits (EOB) sent by BAS, this would indicate a balance bill. You are not responsible to pay anything more than what is stated on your EOB. You are still responsible for cost sharing items such as deductible, copays and coinsurance.

What should I do if I receive a balance bill?
If you receive a bill from your Provider, this could be a physician or a facility, you need to compare it to the EOB you received from BAS. If you are asked to pay more money than what is shown as patient responsibility on your EOB, you need to call BAS at 866-806-0195.

What happens when I contact BAS about a balance bill?
BAS has a dedicated customer service team to assist you. If you have a balance bill, BAS will engage AMP’s Balance Bill Support team to work directly with your provider regarding the balance bill.