If you have an open all-access network and not a PPO plan, our claims department reimburses medical providers based on a percentage above Medicare Reference Based Pricing amounts. When bills are received, they are repriced according to the Medicare fee schedule. Payment is made to the provider based on this amount. The reimbursement system is set up to guarantee that you will not be responsible for any additional amount once the medical bill is repriced (subject to the terms outlined in the certificate of insurance).
Updated on October 13, 2020
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