Forward health requires information to enable the programs to authorize and pay for medical services provided to eligible members.

AllianceMed asks and receives the “contract” each employee has with the insurance company (S.P.D. Summary Plan Description). Each plan may have some degree of limitations on their out of network benefits. We know that those policies can be overcome.

Balance billing is a type of healthcare billing that occurs when an out-of-network provider bills a plan member for the difference between the out-of-network provider’s charge and the amount paid by a member’s benefit plan for the out-of-network service, and this difference exceeds the member’s defined liability from the Plan. This means that if the defined out-of-pocket for the member was 20% of the provider’s charge and the member pays more than 20% – not due to a deductible application – this is a balance bill. This situation happens when a provider does not participate in a member’s provider network. AllianceMed has a legal process of collecting the patients responsibility for out of network services. Our Patient Choice Team speaks with all surgical candidates and informs them of their individual insurance policy.

Several plans pay a percentage of Medicare rates. These restrictions are normally not disclosed in the S.P.D. (Summary Plan Document) as a proper methodology to price a claim. AllianceMed fights these fictitious stipulations.

The Dr. and Healthcare provider should make all clinical decisions. By paying for premium benefits the insurance company has no right to dictate protocols. We hold insurance companies accountable to pay reasonable and customary. If they feel they have paid too much, AllianceMed will handle the situation.