PPO Participant Education Brochure
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Eight Key Advantages
1. You always have the freedom to use the provider of your choice, inside or outside the Network.
2. Most often, 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 a specialist or other health care provider. You should however obtain verification through your Benefit Plan administrator.
3. There is no Balance Billing of discount amounts. All Network providers will accept our fee schedule as payment in full. You will only be responsible for Co-payments, co-insurance or deductibles as specified in your 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). Please address this with your provider or request that they contact 4MOST if you are asked for payment, other than the Co-payment, at the time of service.
5. You have confidence in all 4MOST providers knowing that each has been screened for proper licensing and other applicable credentials.
6. Most 4MOST providers do not require claim forms. Usually, you need only to present your Benefit Plan ID card and the claim will be submitted on your behalf.
7. You have easy access to the 4MOST referral system. For help in locating a provider, please contact us at 888-258-6477 or www.4most.com.
8. You are doing something about controlling health care costs!
Precertification
Your Benefit Plan may require you to precertify for hospital admissions and/or other procedures. Please consult your summary plan description, insurance certificate, plan document or Human Resources Department for a complete explanation of your Precertification requirements. Additional verification can be obtained through your Benefit Plan administrator.
Benefits and Claims
Remember, a Benefit Plan features the 4MOST Health Network. 4MOST Health Network is not a Benefit Plan, insurance company or claims payor. We do not maintain data on eligibility or benefits, or pay claims. For answers to these types of questions, please consult your Benefit Plan. Your Human Resources Department will instruct you where to call or consult the number listed on your ID card or in your summary plan description, insurance certificate, plan document or plan booklet. The questions that should be addressed to 4MOST are those that concern the provider Network only.
