Do I need to call Narus Concierge to discuss my mammogram?

You may call Narus Concierge if you have questions about scheduling your mammogram. Your plan covers mammograms as follows: Age-appropriate preventive mammograms are covered at 100% with no cost share by the member. The plan (your employer) pays for them. Diagnostic mammograms are subject to the member’s deductible or coinsurance. In either case, it is a good idea to call Narus Health to help locate an imaging center that is in-network or that does not issue a balance bill.

What services are covered as “Preventive Care” and covered 100% of the allowable amount by the plan?

The preventive care benefits covered under the plan include: A. Services with an A or B rating recommended by the United States Preventive Services Task Force (USPSTF). B. Immunizations for routine use in children, adolescents and adults who have a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. C. With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). D. With respect to women, evidence-informed preventive care and screening provided for in comprehensive guidelines supported by HRSA (not otherwise addressed by the recommendations of USPSTF). E. All Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity. F. Routine physical exam and associated diagnostic tests and immunization. G. Prostate specific antigen tests. H. Mammograms are limited to one baseline mammogram beginning at age 35 and then annually for ages 40–74. I. Shingles vaccination beginning at age 50. For a complete listing on the services covered as “Preventive Care” by the plan, please refer to the Summary Plan Description (SPD).

It seems that you stated that if I go to my physician and pay my copay, then the provider will send everything to Lucent Health and then I will receive my explanation of benefits (EOB). Is that right? Will I find out my EOB after the service has already been provided?

Yes, as it is with every health insurance plan. The provider may give you an itemized statement the day you see them, or they may mail you an itemized statement. The claim must be submitted and processed to generate an EOB.

None of my doctors are in the network. So you are saying they will all join if we call Narus Health?

No. Doctors have various reasons for not joining networks. If you want to nominate a doctor to the network, you will use the link on the PHCS website. You may go to doctors who do not participate in the PHCS network. If you have questions or issues, or if you receive a balance bill, you would then call Narus.

How do I know what amount I’m supposed to pay to my providers and the facilities?

Contact Narus Health at the number on your ID card. Narus Health will assist you in reviewing any bills you receive from your providers and in understanding your Lucent Health Explanation of Benefits.

What should I do if I receive a balance bill?

Contact Narus Health at the number on your ID card. Narus Health will work with the plan to resolve the balance bill. A. Facility - If the balance bill is from a facility, Narus Health will work with the Patient Advocacy Center (PAC) to educate the provider on the plan payment and negotiate, if necessary, to settle the balance bill. You may be required to sign documents allowing the PAC to represent you while it resolves the bill. The PAC will keep you informed on the status until an agreement is reached. Please note, the PAC process will take an average of 60 days to complete. B. Physician and Ancillary - If the balance bill is from a physician or ancillary provider, Narus Health will educate the provider on the plan payment and work to settle the bill. Narus Health will keep you informed on the status during this process. Please remember that you will be responsible for any amount represented as “patient responsibility” on the Lucent Health EOB. Make sure to pay your patient responsibility to the provider or contact the provider to set up a payment plan.

What is a balance bill?

If you receive a bill from a service provider that represents an amount owed by you that is greater than the amount represented on your Lucent Health Explanation of Benefits (EOB) as your “patient responsibility” for the same services, then you have received a balance bill.

What should I do if my physician has pre-certified my procedure but the facility where the procedure is scheduled says it will not accept my insurance and I will have to pay upfront if I do not want to cancel the procedure?

Contact Narus Health at the number on your ID card. Narus Health will collect your name, member ID number, facility name and contact information, physician’s name and contact information, type of procedure, and date of procedure. Narus Health will coordinate with the plan on your behalf and let it know that the facility is not accepting the insurance. The plan will contact the facility and, if needed, begin pre-service negotiations. Narus Health will keep you informed on the status of the procedure.

What do I do if my provider will not call or has not called the utilization review company to precertify a procedure?

Contact Narus Health at the number on your ID card. Narus Health will collect your name, member ID number, physician’s name and contact information, type of procedure requested, and expected date of procedure. Your provider will be notified when the pre-certification is complete and authorization has been granted.

What are my options for appeal if pre-certification denies my care at my chosen provider?

You may appeal a denial. However, since your plan is not limited to a network of providers, denials would not be due to a provider being “out of network.” A denial would be based on a procedure not being covered by the plan benefits, not being medically necessary, etc.

FAQs Archive - Page 3 of 4

Do I need to call Narus Concierge to discuss my mammogram?
You may call Narus Concierge if you have questions about scheduling your mammogram. Your plan covers mammograms as follows: Age-appropriate preventive […]

Continue reading
What services are covered as “Preventive Care” and covered 100% of the allowable amount by the plan?
The preventive care benefits covered under the plan include: A. Services with an A or B rating recommended by the United […]

Continue reading
It seems that you stated that if I go to my physician and pay my copay, then the provider will send everything to Lucent Health and then I will receive my explanation of benefits (EOB). Is that right? Will I find out my EOB after the service has already been provided?
Yes, as it is with every health insurance plan. The provider may give you an itemized statement the day you see […]

Continue reading
None of my doctors are in the network. So you are saying they will all join if we call Narus Health?
No. Doctors have various reasons for not joining networks. If you want to nominate a doctor to the network, you will […]

Continue reading
How do I know what amount I’m supposed to pay to my providers and the facilities?
Contact Narus Health at the number on your ID card. Narus Health will assist you in reviewing any bills you receive from your […]

Continue reading
What should I do if I receive a balance bill?
Contact Narus Health at the number on your ID card. Narus Health will work with the plan to resolve the balance […]

Continue reading
What is a balance bill?
If you receive a bill from a service provider that represents an amount owed by you that is greater than the amount represented […]

Continue reading
What should I do if my physician has pre-certified my procedure but the facility where the procedure is scheduled says it will not accept my insurance and I will have to pay upfront if I do not want to cancel the procedure?
Contact Narus Health at the number on your ID card. Narus Health will collect your name, member ID number, facility name […]

Continue reading
What do I do if my provider will not call or has not called the utilization review company to precertify a procedure?
Contact Narus Health at the number on your ID card. Narus Health will collect your name, member ID number, physician’s name […]

Continue reading
What are my options for appeal if pre-certification denies my care at my chosen provider?
You may appeal a denial. However, since your plan is not limited to a network of providers, denials would not be […]

Continue reading

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