1. What is a PPO?
A PPO (Preferred Provider Organization) is a group of physicians, hospitals, and ancillary providers that have agreed to accept a reduced fee schedule for medical services. These cost savings are passed on to insurance carriers and employers as reductions in medical expenses and/or reduced premiums. The medical providers in the network benefit from a steady patient load and reduced claims administration since the PPO is essentially a clearinghouse for many, many payors to the providers.

2. Where do I submit claims for medical services?
YOU DON'T! For services rendered by a NCPPO and HealthLink physician, all claims submissions are handled directly between the physician's office and NCPPO and HealthLink. (For out-of-network claims, please check your Benefit Plan or membership ID card for information on claims submission.)

3. How can I determine if my physician is in the NCPPO and HealthLink network?
NCPPO and HealthLink has an online Physician/Hospital Locator function. This information is updated daily, but you should always check with the provider's office and/or contact NCPPO and HealthLink to verify that the physician's network affiliation has not changed. Click here to go directly to the Physician/Hospital Locator.

4. What do I do if my physician requires payment "up-front"?
Verify that the physician is an NCPPO and HealthLink participating physician. If so, advise the physician that payment will be made directly to the physician. If applicable, pay the co-pay only. NCPPO and HealthLink does not determine benefits, but there could potentially be some out-of -pocket expenses.

5. My doctor is sending me a bill. Who should I call?
In certain circumstances it may be appropriate for a physician to bill an unpaid amount for services rendered. Check your Explanation of Benefits (EOB) that you receive from your insurance carrier or administrator for the service date in question for any outstanding balance and reasons. If you still have a question, please call us with the date of service and the provider's name or tax identification number. We will be happy to look into the matter for you.

6. How do I determine my benefits?
Reference the benefits booklet issued to you by your insurance carrier/payor. If you still have questions, check the back of your membership ID card for the telephone number to call for customer service inquiries.

7. Must I precertify care?
Precertification requirements vary. Insurance carriers do offer health insurance plans that have precertification requirements. It is best to check with your Employee Benefits Plan for detailed information regarding your specific health insurance plan.

8. What should I do if I have an emergency during non-business hours?
If you have a medical emergency during non-business hours, seek medical attention at the Emergency Department of the hospital closest to you.

9. If I am traveling and require medical attention, what should I do?
The provider of service will probably require that payment be made at the time the service is rendered. Present your enrollee ID card to the provider so that a copy (front and back) can be made.

Instruct the provider to mail the claim to the claims mailing address indicated on the enrollee card. The provider should note that you paid in full so that your insurance carrier/payor will issue payment directly to you. Additionally, some benefit plans contain Travel Reciprocity programs. We encourage you to check with your health insurance carrier/payor for specific instructions.