How Your Medical Plan Works
Know where to go when you need medical care.
There are three important things to know about your plan:
- You can see doctors and providers who are in your Preferred Provider Organization (PPO) network (or accept RBP if they’re not in the PPO or if your plan does not utilize a PPO network).
- You can visit hospitals or facilities that accept Reference-Based Pricing (RBP).
- You should talk to your doctor about precertifying your services if you will receive them in a facility or hospital, or if your doctor does not participate in your network.
Learn about how your plan works
If your plan includes access to Pathways Concierge:
Watch this helpful video to learn more about how it works with Reference-Based Pricing:
What are the differences between Physician, Ancillary and Facility care?
- Your Physician network represents the different doctors that are contracted to provide services at certain rates and agree not to bill patients above and beyond the contractual amounts. Sometimes this is referred to as your “PPO network.”
- An Ancillary network, sometimes combined with a Physician network, are providers that support the work of primary care physicians and specialists. Examples include laboratories, imaging centers, and chiropractors.
- A “facility” is a hospital or free-standing healthcare center where services rendered by physicians or ancillary providers are held.
How to find doctors and facilities that are covered on your plan.
To search for a physician or ancillary provider, go back to the internet browser tab you have open for My Plan. If you have an applicable PPO Network, a link to it will appear under My Provider Network(s). Click on the link and search using the criteria that matters to you.
If you do not see a PPO network link, check out our Find an RBP-Friendly Provider instructions to use the HST Connect mobile app to search for RBP-friendly providers.
Precertifying RBP services
Before you schedule a procedure or service at a hospital or facility, have your provider call the provider services number on the back of your member ID card to precertify your services, then check to see if it is an RBP-friendly provider.
The Patient Advocacy Center (PAC)
Your Plan also provides you with a Patient Advocacy Center (PAC) that will help you resolve any billing issues you might have with facilities. For more information, or assistance with navigating your plan, contact the member services phone number listed on the back of your member ID card.
Learn more about the HST Connect app.
Get more information about costs for certain services at the facilities in your area by using the HST Connect app. Watch this quick video to learn more*:
*RBP is sometimes referred to as a "Value-Based Payments" plan or "VBP" in materials produced by our partner, HST Connect.