BENEFITS

BECOMING A SAVVY HEALTHCARE CONSUMER

Navigating healthcare can be an extremely daunting process. There are confusing terms and restrictions and if you don’t do it effectively it can cost you a small fortune. Health care cost is the number one cause of bankruptcy1. You may think these individuals who turn to bankruptcy because of health care costs had already been categorized as low economic standing. However, the majority of the time these were middle-class individuals, who had insurance, owned homes, and/or had college degrees. No one is above an unexpected medical emergency; the question is: can you afford it? Will you have to choose between your health and having a home? No one should have to ask themselves this question, but in America, many will have to.

Money, lots of money. It’s the reason we have the health care system we have. It’s setup to make the right people lots of money. When it comes to our health, we seek services first and ask questions later. Now we have a whole system that hides the cost of services while being difficult and confusing to navigate, so we don’t know where to start or what questions to ask.

What can we do? There are a lot of advocacy groups out there fighting back to bring real change to the healthcare system and save people from medical debt. We are proud to join the fight with progressive and innovative solutions while bringing health care savings to our employees. It starts with education and the right tools.

We are all responsible for the decisions and actions we take that impact our healthcare. Just like anything else you purchase, you should know what you’re getting, why you’re getting it, and how much it costs. It will take some work, but it will save you a ton. Read below to find out how:

BE PROACTIVE

Don’t wait for your health to decline before receiving care. It is imperative to see a doctor regularly, a provider can spot the signs of something larger going on and give you time to take action on it.

See Ark Family Health:

Your membership to Ark Family Health is included in your plan! Use it!

Not only do their providers go above and beyond for our members, but there are no out of pocket costs for you.

In an Urgent Situation:

Call Ark

Ark’s providers are available 24/7 to assist with any urgent needs.

They can handle just about anything an Urgent Care can.

Sign up for Kempton & TrueScript portals

Kempton Portal Instructions

Kempton - Member Portal Registration Guide pdf download.

Website: https://www.kemptongroup.com/

Your registration code is: Your Social Security Number + 01 (example: 11111111101)

TrueScript Portal Instructions

TrueScripts - Member Portal Registration Guide pdf download.

Website: https://memberportal.truescripts.com/

You will need your Kempton Member ID (this is not your social security number) printed on your Kempton card. If you need your Kempton Member ID, please reach out to Heather Heitzman.

IMAGING SERVICES

Imaging through Ark is free!

As an established patient they can coordinate with any specialty providers recommending imaging to provide the script so you can utilize the cost savings you have through Ark!

Imaging services referred outside of Ark

Call Aither

This requires a pre-approval and you will need to plan on up to 14 days to get it approved – though the approval time typically is much shorter. In an urgent situation this will be done within 48 hours.

In order for it to be approved:

Needs to be conducted in a free-standing facility. Imaging conducted within a hospital is not covered (unless you were admitted during an ER visit).

YOUR PROVIDER IS RECOMMENDING SURGERY

At your providers office:

Ask if they operate at a surgical center (instead of a hospital)

  • Hospitals charge significantly more for surgeons to use their facilities, and this gets billed directly to you – not your provider.
  • Most surgeries can be preformed at a surgical center
    • A lot of providers are associated with multiple facilities and unless you ask, you might be scheduled at a hospital simply because your provider is doing all of his surgeries there that day. Versus if you scheduled a different day, you might be scheduled at a surgery center.

Ask for Cash Pricing and the procedure codes

  • Surgeries paid in cash are generally a fraction of the cost they charge when billing insurance
  • Allow us to compare price for the procedure codes to the cash price they are offering
    • Call/ email Heather Heitzman and she can compare these amounts. If the amount is significantly less than the typical billed/allowed amount, Spooner can pay for the procedure over the phone and save you hundreds if not thousands!

After you leave your providers office:

Call Aither

  • Your surgery will require a pre-approval and pre-certificate
    • Pre-approval – makes sure your surgery is not happening at a banner facility and that the location is appropriate for the type of surgery you are having.
    • Pre-certification – makes sure your surgery is medically necessary. Once notified, Aither will call your provider to start the pre-cert process.

YOUR PROVIDER SAYS THEY AREN’T CONTRACTED WITH AITHER

  1. Tell your provider Aither has no network and will pay any provider.
  2. If they still won’t schedule you:
    1. Call Aither
      • Let Aither know your providers office would not let you schedule, and you need Aither to call them and see if they will accept our plan.
      • If they still will not see you, Aither can help you find another provider
    2. Ask for cash pay/ self-pay rates and billing codes
      • You can pay for the visit up front and submit for reimbursement, you will need the billing codes to include in your reimbursement requests

NOT SURE WHO TO CALL?

Questions related to your personal health? Call Ark – 623.226.8825
Questions regarding medical plan coverage and accessing services? Call Aither – 855.282.8337
Questions related to your musculoskeletal health? Call Torrey Foster

1 https://www.abi.org/feed-item/health-care-costs-number-one-cause-of-bankruptcy-for-american-families