Low or no-cost services and procedures available at select HealthChoice network facilities.
- What it is
- How it works
- Procedures and Facilities
What it is
HealthChoice Select is a program that offers specified services for free! The program offers certain services free to HealthChoice participants because some of our network facilities have agreed to accept one consolidated bundled payment for certain procedures at a reduced rate, and HealthChoice is passing all savings on to our members.
Select is available to any enrolled person on the HealthChoice High, High-Alternative, Basic, Basic-Alternative or High Deductible Health Plan (HDHP).
- No need to opt-in or sign up to qualify.
- Not available for HealthChoice Medicare Supplement plan members.
- HealthChoice must be member’s primary coverage.
- Not available for services originated in an Emergency Department.
How it works
Network HealthChoice facilities have the option to sign up for the Select program for some or all of the services offered under the program. There are multiple Select service categories available for either Outpatient, Inpatient or both service types. Facilities may opt-in for any category under either service type and all procedures within that category performed at that facility are covered under HealthChoice Select.
For HealthChoice High & Basic Members
If you have a qualifying Select Procedure done at a participating Select facility, it’s free!
- Any copay that may normally be applied is waived.
- No matter where you are in meeting your deductible, it’s waived.
- Any coinsurance that would normally be applied, it’s waived.
- And, if you have a qualifying Colonoscopy or Sigmoidoscopy done at a participating Select facility, HealthChoice pays you $100.
For HealthChoice HDHP Members
Federal regulations do require that participants meet their annual deductible before a health plan can pay towards any services other than preventive; however, there are still saving opportunities available:
- By having a qualifying Select service done at a participating Select facility, you get the service done at a lower price with only one easy-to-manage bill.
- You could fulfill your deductible as part of the Select service, and the rest of that Select procedure would be free. So you would pay your share up until your deductible is met, and all additional costs are waived.
- After your deductible is met, any qualifying Select service done at a participating Select Facility is completely free to you. Any copay or coinsurance that may normally be applied is waived.
- Once your annual deductible is met, if you have a Select qualifying Colonoscopy or Sigmoidoscopy done at a participating Select facility, HealthChoice pays you $100.
- If you have a qualifying preventive Colonoscopy or Sigmoidoscopy done at a participating select facility, HealthChoice will pay you $100 even if your deductible hasn’t been met.
|KNEE REPLACEMENT||NETWORK PROVIDER||SELECT PROVIDER|
|Member Cost Share|
|Total Member Cost||$6,000||$1,750|
* Enrolled in the Individual HDHP and has not met any deductible
** Up to individual annual Maximum Out-of-Pocket: $6,000
In order to confirm that the specific procedure you are having is Select, we need to have the procedure code(s) that the doctor/facility will bill on your claim. Your provider should be able to provide you with a 5 digit CPT code if you are having an Outpatient procedure (services that can be done in a medical center without an overnight stay) or a 3 digit DRG code if you are having an Inpatient procedure (services that require an “overnight” stay). To speak to a dedicated Select team member, please call toll free 800-323-4314 and follow the prompts.
If a Select Facility only provides certain services within a category, they can still sign up and participate. A Select Facility is not required to perform every listed procedure within a category to participate.
For example, a facility may not have the ability, personnel or equipment to perform a procedure within their participating bundle category. However, if at any time they begin to offer the service within that bundle category at their facility, it will always qualify and reimburse as Select.
The services that are offered under Select are procedures that HealthChoice is willing to offer if a provider would like to participate. If at any time a network facility would like to participate in one of the service categories offered, procedures within that category would then be available as part of the Select program if performed at that participating facility.
Unfortunately there are instances when an anesthesiology group files a claim for a Select qualifying procedure in advance of the hospital facility filing a claim. Because the hospital facility’s claim includes the information needed to determine Select eligibility, claims filed in advance of that claim may process under standard HealthChoice guidelines initially. Once the qualifying claim is received, all other ancillary claims will be reprocessed in accordance with Select benefits.
To receive the $100 incentive payment from HealthChoice you must have a qualifying Select colonoscopy or sigmoidoscopy done at a Select facility participating for those services. Once we receive your claim indicating you received a qualifying service from a participating Select provider, HealthChoice will process your incentive payment.
For HDHP members, if you have not yet met your annual deductible you can only qualify for the incentive payment if the Select colonoscopy or sigmoidoscopy is also a qualifying preventive service for you. If your claim indicates that your Select service also qualifies as a preventive service and was done at a participating Select facility, then HealthChoice will process your incentive payment. Once you have met your annual deductible, you can receive the incentive payment even if it wouldn’t otherwise qualify as preventive.
HealthChoice members are only eligible to receive the $100 incentive once per calendar year. Unless you have opted in for electronic funds transfers through HealthChoice Connect, you will receive a check by mail.
To opt in for EFT transfers login to www.healthchoiceconnect.com, go to the Claims and Benefits page, then at the top of the page select the Member Services dropdown and click on Eligibility Changes and Electronic Transactions Setup and follow the steps. Please note that dependents over the age of 18 must create their own HealthChoice Connect account to update their information.
Find Qualified Facilities and Procedures
To determine what procedures qualify under the HealthChoice Select program and which network facilities are participating for those procedures, use HealthChoice Select section of our Provider Search tool.
You can search there by service category, by more specific type of service, or by the actual service/procedure code you can get from your doctor.