April 20, 2018

Learn More About Our HMO Emergency Benefit Management Process

Some of our members are using the emergency room (ER) for things like head lice or sprained ankles, for convenience rather than for serious or life-threatening issues. Doing so not only drives up costs for our members, but uses limited ER resources for conditions that are not serious or life threatening. We want to make health care affordable for our members, and to do so, we have to be good stewards of their money.

What You Need to Know:

Member Communication Details
The letters being sent on May 1 are going to members who have had an out-of-network ER claim. It will explain the claims review process and their care options.

We want to make sure members receive the right care, at the right place and at the right time for the best health outcomes. We’ve spent the last few years educating members about where to go for the right level of care, and we will continue to do that through SmartER CareSM Education Campaign.

For additional resources, go to:

If you have any additional questions, reach out to your account executive or agent.