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Network Health Plan offers price transparency

Move will give patients estimated costs prior to procedures

08 / 26 / 2008

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MENASHA, Wis.- With rising food and fuel costs, consumers are becoming more and more price conscious and are seeking out information about pricing before they buy. In health care, finding the price for a procedure isn’t always possible, but Network Health Plan has taken steps to meet consumers’ needs.    

Network Health Plan has joined the Wisconsin Association of Health Plans transparency initiative. The initiative calls for all health plans to provide commercially insured members, on request, the estimated out-of-pocket cost for a specific service from a specific provider.

“Our goal is to help individuals become better equipped to make sound health care decisions,” says Sheila Jenkins, president of Network Health Plan. “Joining the association’s initiative supports our members’ need to know.”

As part of the initiative, members call our Customer Service department at 920-720-1300 or 1-800-826-0940 Monday, Wednesday, Thursday and Friday 8am – 5 p.m. and on Tuesday 8 am – 4:30 pm and provide the following information:

• the name of the provider,
• the facility where the service will be provided,
• the date of service,
• the provider’s estimate of charges for the service,
• the diagnosis code,
• the CPT code, Diagnosis code or Current Dental Terminology code to be billed by the provider.

A customer service representative will process the request and call the consumer with the estimated out-of-pocket cost.

The association’s initiative is a voluntary commitment to go beyond current regulatory requirements and to give consumers the cost information most relevant to them. Network Health Plan will begin providing estimated costs on Sept. 1, 2008.

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For the Editor:
Affinity Health System, a Catholic mission-oriented regional health care network, is a partnership of Ministry Health Care and Wheaton Franciscan Healthcare. Affinity Health System is the Fox Valley’s third largest employer, according to the Fox Cities Chamber of Commerce & Industry, and is ranked 24 among the top 100 integrated health care networks nationwide (Verispan 2008). Both St. Elizabeth Hospital in Appleton and Mercy Medical Center in Oshkosh rank among the top 1 percent among hospitals nationwide in terms of quality and efficiency, as determined by the 2007 Premier | CareScience Select practice National Quality Award. Network Health Plan has achieved Excellent accreditation status from the National Committee for Quality Assurance (NCQA), the highest possible level. It is ranked 37th among the 250 rated health plans in the nation in terms of customer satisfaction and clinical performance, according to the U.S. News and World Report/NCQA Best Health Plans in America listing. Members of Affinity include Mercy Medical Center and Mercy Health Foundation, Oshkosh; St. Elizabeth Hospital and the St. Elizabeth Hospital Community Foundation, Appleton; Affinity Medical Group, a regional network of 23 family practice and specialty clinics in 13 communities; Calumet Medical Center, Chilton; Network Health Plan, Menasha; and Affinity Occupational Health.