| You
Wanted to Know!
We understand that you have questions
concerning your healthcare and related issues.
These frequently asked questions and answers will
put many of your concerns to rest by providing
the information you need. Just click on the category
of questions that applies to you, and begin learning
more about BHP.
General
FAQs
Why is BHP’s “local
presence” such a big deal?
Our local presence is important because
it means that we’re here – just
like you are. We know the same people and businesses
– we know what makes the community tick.
We know how much procedures should cost here,
and we work to keep local dollars at home, where
we can all benefit. We’re standing right
next to you to help assure you get excellent
healthcare right here in your community.
What is a
provider, and how many are included in Berkshire Health Partners’s network?
A provider is a hospital, physician, health care
facility, or other medical professional that
has
contracted with BHP to provide services at negotiated
fees. The BHP network includes 3900+ physicians,
460+ ancillary providers such as medical equipment
suppliers and home health care agencies, and
22 hospitals working in Berks, Schuylkill, Northern
Lancaster, Montgomery,
Lehigh, Carbon, Northern Bucks, and Northampton counties.
How can I
get a list of doctors who are BHP participants?
Just click on the “Find a Provider”
button on this website to view or print a complete
list of BHP providers. Or, you can call us at
610-372-8044 or send an email to request a provider
directory to skrapitsm@bhp.org.
We’ll make sure you get the information
you need.
What is a
primary care physician?
A primary care physician is a doctor who serves
as your first contact with the medical system.
A primary care physician also is called a personal
care physician or primary care provider.
What is BHP’s
relationship with insurance companies and third
party administrators (TPAs)?
BHP works with your insurance company or TPA
to coordinate the delivery of your health care.
We
send our recommendations for the quality
care to you, your providers, and your insurance
company or TPA. Final authority for determining
whether a requested procedure and/or admission
will be covered rests with your insurance company
or TPA. Please verify your benefits before receiving
any medical treatment.
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Provider
FAQs
Thanks to your valued feedback,
we’ve been able to identify the following
most frequently asked questions by our providers:
Is Berkshire Health Partners an insurance company?
No, we are not. BHP is a provider network consisting
of physicians, hospitals, and ancillary providers,
such as medical equipment suppliers. In addition,
we provide claims pre-pricing and utilization
management services. We also assist provider offices
in working with our contracted payors.
Where can
BHP members go for lab work and/or x-rays?
BHP members should use BHP participating hospitals
or hospital satellite locations for the highest
benefits. Benefit reductions (deductibles and/or
coinsurances) may apply if non-network facilities
are used.
Do BHP members
need referrals?
No, with the exception of members in the Reading
School District Managed Care Option Plan.
Who do I
call with questions, concerns or suggestions?
Provider feedback is BHP's most valuable resource.
Call us at (610) 372-8044, Monday through Friday
between 8 a.m. and 5 p.m. Please remember that
BHP is your provider network. Help us to help
you by staying in close contact.
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Employer
FAQs
How is Berkshire Health Partners able to keep my costs down and still
make sure I get excellent coverage for my employees?
As an employer, you can choose from several nationally
respected and financially sound insurers. This
creates competition for your business and provides
an incentive for insurers to offer their best
rates and service
plans. As a result, you’re assured excellent
health care right here in your community.
How do I
know my employees will receive the best quality
healthcare?
Berkshire Health Partners acts as an employee's advocate.
We credential all physicians in accordance with
NCQA criteria, so you can be sure you and your
employees will receive the kind of care you expect
– and deserve.
What about
additional charges for provider services?
Don’t worry. BHP has a vast, established
network of contract providers who have agreed
to accept negotiated payments for particular services.
There are never additional charges when using
the services of a BHP contracted provider. Your
employees should know, however, that additional
charges may be realized if they choose to use
a provider who is not in the BHP network.
How do I
know which type of plan to choose for my company?
We offer a variety of self-funded and fully insured
options for businesses through our contracts with
insurance companies and third party administrators.
Through our relationships with local brokers,
we will work with you to examine the unique features
and benefits of Preferred Provider Organization
(PPO) programs. That way, you can choose the type
of coverage you want for you and your employees.
You, and they, always have the choice.
Can Berkshire Health Partners design a plan that considers the financial
concerns of my particular company?
Yes. BHP's preferred brokers will work with your
company to structure a plan designed specifically
for the needs of your business. You’ll have
a lot of choices concerning co-pays, deductibles,
and so forth. For example, your policy could include
deductibles ranging from nothing to $1,000; coinsurance
percentages between 100 percent and 50 percent;
doctor office co-pays of $10, $15, or $20; and
out-of-pocket maximums of up to $1,000 per individual.
What sort
of support services does Berkshire Health Partners
provide for employers?
BHP offers the personal support of an Employer
Relations Coordinator who will assist you with
claims, questions, provider directories, and
on-site meetings with your employees. Medicus
Resource
Management, a division of BHP, will work with
you to make sure the precertification guidelines
of your
healthcare plan are smoothly administered. Medicus
provides on-site concurrent review of some
cases,
local specialists and consultants, case managers
to work as personal consultants with your employees,
and a local medical director to guide and assist
you.
How can I
get more information or set up an appointment
with a BHP representative?
Just call the BHP office at 610-372-8044, or e-mail
the following information to skrapitsm@bhp.org. Please
provide: your name; title; company; company address,
including city, state and zip code; phone number
(with extension); fax number, and e-mail address.
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IndividuaL
FAQs
Do I need
to choose a physician when I join the plan?
No. You do not need to choose a physician when
you become a member of BHP. However, it is always
a good idea to establish a relationship with
a physician of your choice who will be available
for your healthcare needs.
Do I need
a referral form or approval from a Primary Care
Physician (PCP) when I want to see a specialist?
No. You may see a BHP participating specialist
of your choice. Keep in mind that you receive
the highest level of benefit when you choose a
BHP physician listed in our directory.
What if my
physician is not listed in the directory?
If your physician is not listed in the directory,
you may check the "Find a Provider"
section of this website which is updated monthly.
Your physician may have joined BHP since the last
printing of the BHP Provider Directory or the
last Internet update. If you find that your physician
is not currently a member of BHP, please see the
"Recommend
A Provider Join BHP" section of this
website and complete the Network Enhancement Request
Form.
Can I use
a physician or hospital that is not a BHP provider?
Yes. You can access any physician or hospital
you choose, but prior approval through Medicus
is required before you receive services from an
out-of-network provider. Keep in mind that your
out-of-pocket expenses will be less if the provider
you select is a BHP member. It is always your
choice, however, to stay within the network or
to seek care from another provider.
How will
my physician or hospital know I belong to BHP?
Your employer will give you an identification
card that you should present whenever you see
a participating provider.
What services
are covered by BHP?
Covered services are defined by your company’s
benefit plan. Please contact your employer’s
insurance company or third party administrator
for this information.
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Who do I call if...
I believe
my claim was processed incorrectly, or I have
a question about my health plan benefits?
Call your insurance company or third party administrator
at the telephone number listed on your ID card.
I have a
concern about a network provider and/or want to
discuss a problem?
Call Berkshire Health Partners at (610) 372-8044.
What is Berkshire Health Partners’s address and telephone number?
Berkshire Health Partners
50 Commerce Drive
Wyomissing, PA 19610
(610) 372-8044
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