Hospital-Based Physicians
An Important Reminder for Our Valued Members
We want you to understand your health benefits thoroughly,
so you can make informed choices when it comes to your insurance coverage.
Often, when members access service at a network hospital, they receive care
from a variety of physicians and providers of various specialties. Examples of
hospital-based providers include anesthesiologists, emergency room physicians,
radiologists plus a few other specialties listed in the following chart. In
these cases, members may presume that all of these specialists are network
providers. In some instances, this may not be true.
It is important for members to be aware of how their
coverage works with services obtained at a network hospital. Medical Mutual
contracts with hospital-based physician groups at nearly all network hospitals.
However, in a few rare cases, there are hospital-based providers who do not participate in any
type of contract with Medical Mutual. These types of hospital-based providers, for benefit purposes, are non-participating providers.
Please Note: Non-participating providers normally elect to balance bill patients for charges
above the Traditional Amount. This may result in additional cost sharing for
members. For this reason, we want you to be informed about these situations. To
ensure maximum benefits, avoid higher deductibles and higher out of pocket
maximum, you can verify the status of your provider. First, if you obtain
services at any of the hospitals on this list, please check to see whether the
provider utilized participates or contracts with us. Or, please call the
Customer Service number on your ID card for assistance.
Even if the hospital has a network or participating contract with us, these non-participating providers may balance bill our members for charges above the
Traditional Amount.
This situation applies to all Medical Mutual benefit plans
including our Traditional plan (which allows members to see any provider). A
list of hospitals that have non-participating hospital-based providers
as of July, 2007 follows.
THIS LIST IS NOT INCLUSIVE OF ALL PROVIDERS OR SERVICES, BUT INCLUDES THOSE MOST-COMMONLY UTILIZED.
Non-Participating Hospital Based Providers
* A practice at this hospital is non-participating/does not contract with Medical Mutual. However, other physicians of the same specialty that also serve this hospital may be contracting with Medical Mutual.