AmeriPlan® Health Frequently Asked Questions
The more you knowabout AmeriPlan Health™, the better... it is affordable Consumer Driven
Health Care (CDHC)!
Who is AmeriPlan®
AmeriPlan® is a Nationwide Provider Access Organization. We arrange for
our members to have access to physicians, ancillary services, hospital
advocacy, dental, vision, prescription drug and chiropractic providers
who have agreed to offer their services at negotiated discounts off
their usual and customary fees.
Does an AmeriPlan® Independent Business
Owner (IBO) have to be a member of AmeriPlan Health™ Medical Program
(CDHC) in order to sell it
No.
How do I locate an AmeriPlan Health™ provider
There are three ways to locate a provider. Instructions are included in
the Member Information Guide that you will receive with your
identification cards.
They are:
A directory of providers near your home is included in your Member Information Guide.
A provider locator is available at: www.ameriplanusa.com or www.ameriplanhealth.com
Call AmeriPlan Health™ customer service at the listed number in your guide.
Are ongoing dental/medical problems (conditions) accepted
Since AmeriPlan® is not insurance or a health organization, all ongoing
dental/medical problems (conditions) are accepted except orthodontic
treatment in progress.
Is there a deductible to be met from any of the health benefits
There are no deductibles, no claim forms to fill out, and no limits on
visits to AmeriPlan® network providers.
Will AmeriPlan Health™ Medical Program (CDHC) have all specialists and ancillary services
We will make every effort to contract with as many specialists and ancillary providers as possible.
Are doctors reimbursed by AmeriPlan® for their services
No. As with all of our health benefits, the provider receives the full
discounted fee from the member at the time services are rendered.
Does this Medical Program (CDHC) coordinate with regular insurance plans
Yes it can, but it is always at the Doctor's discretion to accept both.
As with our Dental Program (DVPC) benefits, your insurance should
always be the primary payment form.
Can anyone enroll in the Medical Program (CDHC)
Yes. Anyone can enroll in AmeriPlan Health™ .
Can members downgrade from AmeriPlan Health™ to the Dental Program (DVPC)
Yes.
If the doctor's office has lab facilities can these be utilized rather than having to go to another lab
Yes. The lab services will be billed at a 40% discount.
Do members receive a fee schedule
No. Fees will vary by zip code.
Do members receive a separate card for the Medical Program (CDHC)
Yes. Approved Individual members receive two (2) cards; one AmeriPlan
Health™ (CDHC) ID Card and one Dental Program (DVPC) card.
Approved household members receive four
(4) cards; two AmeriPlan Health™ (CDHC) ID Cards and two Dental Program
(DVPC) cards.
Are there benefits for emergency services
Yes. Emergency services may or may not be contracted with the Medical Program (CDHC).
Depending on the extent of the charges, these services may be eligible for the Patient Advocacy Benefit.
Can the $30.00 registration fee be waived for groups
Yes. Only with groups of 5 or more. REMINDER: Commissions will be paid as-earned.
If
a member lives in a state that has been introduced to the Medical
Program (CDHC) and enrolls, and then moves to another state that does
not have the Medical Program (CDHC) can the member still use the
medical benefits
No, but in most states they could still be able to use the benefits in the Dental Program (DVPC).
Will the provider's staff be adequately trained on the medical plan
Yes.
What is the difference between a limited patient visit, intermediate visit and an extended visit
A limited patient visit is one where the member is seen for a problem
focused visit with minor problems (Physician time 10 mins.), i.e.,
recheck for a cold. An intermediate patient visit is more involved with
low to moderate severity, and will require a longer visit with the
provider, i.e., sore throat. An extended patient visit is where the
member is having a physical examination or consultation for a chronic
illness or consideration for surgery, etc. (Moderate to high severity)
How is Ameriplan® recruiting providers for the medical plan
Through personal referrals, phone and direct marketing.
Will Ameriplan® notify current members of the new medical plan
No. Initial enrolling brokers will need to contact their existing members.
Will maternity be covered
All medical needs are covered as long as we have contracted providers offering this service.
Will the member's privacy be protected
AmeriPlan® is compliant with all HIPPA regulations.
Is it possible to get a service cost prior to treatment to avoid unexpected expenses
No, unless you have been given a treatment plan from your physician
with the medical codes for the treatment procedures.
Will current members of DVPC be automatically upgraded to include medical
No. Existing members will need to submit a new application for AmeriPlan Health™.
Why are the providers being paid 120% or 110% instead just 100% of Medicare fees
Medicare fees are a guideline and fees vary from this amount. This
schedule provides the member with a fair price and the provider with a
fair margin and reasonable incentive.
Does medical include hearing tests and hearing aids
Yes. Hearing Services will be covered under our Ancillary Services providers.
How is the discounted fee calculated
Primary Care Physicians (General Practitioners) and Ancillary Services
receive the 120% of their Medicare regional fees (example Medicare cost
is $100, we pay $120) and Physician Specialists will receive the 130%
of their Medicare regional fees.
Can I purchase the Medical Program (CDHC) without the Dental Program (DVPC) included
Yes, the Medical Program (CDHC) is available without the Dental Program (DVPC).
Is the $30.00 registration fee charged to current DVPC members
Yes. Everyone applying for AmeriPlan Health™ must pay the one-time $30.00 registration fee.
Do members get a discount if they sign up on an annual renewal
Yes, there is a 20% discount on all annual renewals.
Is there a waiting period for new members
No. Members can use the program as soon as they receive their membership cards.
If an applicant cannot be reached for verification, can the applicant call AmeriPlan®
Yes. If the applicant can not be contacted, the enrolling Broker will
be instructed to have the member call the appropriate Customer Service
800 number.
Will a current DVPC member's identification number change when they are accepted into AmeriPlan Health™
Yes.
For an annual DVPC member who upgrades to the health plan, what happens to the balance of their DVPC payment
They will receive a refund check of the unused balance.
Will any medical treatment be reported to the M.I.B. as with standard insurance
No. This is not insurance ... there are no claims ... there is no reporting.
Can we refer physicians from other states before you open in that state
Yes.
Is the Medical Program (CDHC) contract on an annual basis and cancelable at any time, like the Dental Program (DVPC)
Yes.
Can a current DVPC member use DVPC benefits while their application for AmeriPlan Health™ is being processed
Yes.
How does the Hospital Advocacy Program work
The Hospital Advocacy Program negotiates with the hospital based on the member's ability to pay.
How long will it take for the Advocate to contact the member
Once the completed forms are received by the Patient Advocacy Program,
it will take up to 2 days for the member to be contacted.
Does the member have a choice of which hospital will be used
Yes. The Patient Advocate will negotiate with any hospital of the members choice.
How much discount do members get on dental fees
Members can save 20% - 65% on all restorative and cosmetic work
(fillings, crowns, braces, etc.) and up to 80% on preventative work
(teeth cleaning, x-rays, etc.) performed by a general dentist.
Specialist fees are discounted 15 - 25%.
How much is the Dental Program (DVPC) membership fee
An entire household membership is $19.95 per month! Family membership
covers all residents in the household including parents, children,
relatives, significant others, and all permanent residents of the
household!
How much more do the Pharmacy, Vision, and Chiropractic Benefits cost
The Prescription Drug, Vision, and Chiropractic Benefits are absolutely
FREE with the Dental Program (DVPC) Membership!
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