Our goal is to provide you with quality health care and still control the rising costs of care. We are the state's first Preferred Provider Organizations (PPO).
In this world, there is no magic formula that applies to health care expenses. The more that a company pays out in claims, the higher the cost of providing health care benefits. That's where the Ohio Health Choice PPO Network comes in. Simply stated, Ohio Health Choice uses the bargaining power of over 370,000 members to negotiate discounts from more than 28,000 physicians and 199 hospitals, statewide. These discounts, combined with our other managed care products, result in major savings for both the individual and the company. Savings achieved by the company come back to you in the form of lower premiums, better benefits, and reduced out-of-pocket expenses.
Freedom of Choice
On this Web site you will find a listing of all of our contracted health care providers. These are the "preferred providers" which make up our various network products. You do not have to restrict yourself to using only a contracted provider, but you should definitely consider it. When network providers are used, it will usually save you money out of your own pocket, and also reduce the company's expenses. If the amount a company pays out in claims is reduced, they are better able to control the cost of providing you with quality coverage. It's just that simple.
Over 28,000 Choices
With over 28,000 physicians in our networks, there is a good chance that your personal physicians are already members. If you find that they are not members, please let us know and we will contact them on your behalf to see if they are interested in joining. Please keep in mind that a physician must have admitting privileges to an Ohio Health Choice hospital and meet other credentialing standards to be considered. Their participation will help ensure maximum savings. If you decide to use a physician who is not in the network, you will still have the option of using an Ohio Health Choice hospital or other health care provider.
You will want to keep our network in mind when an Ohio Health Choice physician refers you to another provider for lab tests, X-rays, hospitalization, specialized care, etc. If you suspect that the recommended provider is not in the Ohio Health Choice network, simply explain to your doctor that you will receive better benefits if you use a contracted provider. If you are unsure whether any provider is currently part of the Ohio Health Choice network, you can call the Ohio Health Choice Customer Service Department at 1-800-554-0027.
Seven More Advantages
Here is a summary of how Ohio Health Choice helps control costs without sacrificing quality or convenience, through discounted fees and managed care.
1. You always have the freedom to use the provider of your choice inside or outside of the network.
2. You do not have to select a gatekeeper or primary care physician with whom you must remain or get approval from, when you want to see specialist or other health care providers.
3. There is no balance billing. Any network provider will accept the Ohio Health Choice fee schedule as payment in full. You will only be responsible for co-payments, co-insurance or deductibles as specified in your company's benefit plan.
4. There is no up-front billing. Providers are prohibited from collecting their fee in advance (except if there is a designated co-payment, co-insurance or deductible). Please address this with your provider or request that they contact Ohio Health Choice if you are asked for payment other than the co-payment, co-insurance or deductible at the time of service.
5. You can have confidence in Ohio Health Choice providers, knowing that each has been screened for proper licensing and other applicable credentials.
6. Ohio Health Choice providers will submit claims forms to your insurance company on your behalf. You just need to present your medical ID card at the time of service.
7. You have easy access to the Ohio Health Choice Referral System for help in locating a provider in your neighborhood. Contact Ohio Health Choice Customer Service at 1-800-554-0027.
Benefits and Claims
Remember, your health care plan is featuring the networks of Ohio Health Choice. Ohio Health Choice is not an insurance company or claims payor. We do not maintain data on your eligibility or benefits, or pay claims. For answers to these types of questions, you need to consult your payor. Your human resources department will instruct you where to call, or consult the number listed on your ID card or plan booklet.
Health Care Glossary
Balance Billing - The process of a provider trying to collect from a patient the difference between what is allowed per the Ohio Health Choice contract and what they normally charge. Balance billing is not permitted when an Ohio Health Choice member and a network provider are involved.
Co-Insurance - A fixed percentage of the amount allowed to the provider for which the insured is responsible, after meeting their deductible.
Co-Payment - Some plans have a benefit where there is a set amount you pay when visiting certain providers.
Deductible - A fixed annual out-of-pocket sum the insured must meet before the insurance company will apply eligible benefits to claims.
Fee Schedule - An established rate which a provider will be reimbursed for services rendered, also referred to as maximum allowable.
Gatekeeper - A primary care physician who must give you a referral when you want to see a specialist or other health care provider. Some plan designs require the use of a gatekeeper. Please consult your benefit booklet.
Managed Care - The process of controlling health care costs while helping to ensure the quality of care.
Network - Used to describe providers who are participating in the Ohio Health Choice PPO Network.