Ascension_Personalized_Care_ACA_health_plan_Agents_FAQs

Agent FAQs

Find answers to the most commonly asked questions by members and insurance agents.
  • Is anesthesia provided by an anesthesiologist who doesn’t participate in Ascension Personalized Care covered if the procedure is provided at an Ascension Personalized Care-approved facility?
    If you have a procedure at a facility that is part of the Ascension Personalized Care network and anesthesia is provided by an anesthesiologist that doesn’t participate in the plan you can be confident that it is covered under the Risk Adjustment Payment System (RAPS). These services will be paid at the in-network benefit level.
  • Are emergency room (ER) services provided by an ER doctor who doesn’t participate in Ascension Personalized Care covered if the procedure is provided at an Ascension Personalized Care-approved facility?
    All emergency room services are paid at the in-network benefit level.
  • Are ambulance services provided by an ambulance company who doesn’t participate in Ascension Personalized Care covered if the procedure is provided at an Ascension Personalized Care-approved facility?
    All ER/Ambulance services are paid at the in-network benefit level. 
  • Do we have full MRI capability & does this require pre-authorization? 
    All high-cost radiology services require prior authorization. MRI's performed as the result of an ER visit are covered and paid at the in-network benefit level due to the ER provisions. If the technician performing or doctor reading the MRI is out-of-network at an Ascension Personalized Care approved facility, these clinicians will be treated as in-network under the RAPS configuration.  
  • Do we have pain management services in the network?

    Ascension Personalized Care plans have provisions for PCP and specialist care along with the following services:

    •       • Generic drugs
    •       • Preferred brand drugs
    •       • Non-preferred brand drugs
    •       • Specialty drugs
    •       • Outpatient rehabilitation services - 90 days per benefit period
    •       • Durable medical equipment (DME)


    Please note:
    Pain management is not specifically listed, though there are pharmacy and specialty pharmacy benefits (along with DME) which typically provide coverage for pain management services. These are subject to prior authorization.

  • The No Deductible Silver plan shows no deductible but the service lines show 40% coinsurance after deductible. Can you explain?
    The deductible is $0. All services in this plan are automatically viewed as after the deductible.
  • The Low Premium Silver 73 shows 50% coinsurance for some services instead of 40% coinsurance. The plan is supposed to be 60/40%. Can you explain?
    All services in this plan are 40% coinsurance. The only exception is for non-preferred brand drugs and specialty drugs, which are 50% coinsurance.
  • The Low Premium Silver 87 shows 50% coinsurance for some services instead of 40% coinsurance. Can you explain?
    All services in this plan are 40% coinsurance. The only exception is for non-preferred brand drugs and specialty drugs, which are 50% coinsurance.
  • The Low Premium Silver 94 plan shows 20% coinsurance. For non-preferred brand drugs it shows 50% coinsurance after deductible. Should this be 20% coinsurance instead of 50%?
    All services in this plan are 20% coinsurance. The only exception is for non-preferred brand drugs and specialty drugs, which are 50% coinsurance.
  • Why does orthodontia-child for Kansas show as covered on the services differ tab but not on the SBC? 
    Please disregard the services differ tab. Ascension Personalized Care is not covering Orthodontia-Child in Kansas. 
  • Will Ascension Personalized Care set up an HSA account for the members who select the HSA plan? 
    Ascension Personalized Care will not set up an HSA for our members. Members that sign up for the HSA eligible plan will need to utilize an HSA they set up themselves.