FAQ
AmeriHealth® POS Coinsurance
What is the POS Coinsurance plan?
As an AmeriHealth POS Coinsurance member, do I need to select a primary care physician (PCP)?
What is the difference between network and non-network care?
Am I responsible for the difference between the amount billed by a provider and the allowered amount when I use a non-network provider?
When I use my non-network benefits, who is responsible to preapprove my benefits?
May I seek services directly from a network physician?
What is the POS Coinsurance plan?
The POS Coinsurance plan is a managed care program that combines the best features of a health maintenance organization (HMO) plan with the freedom to choose a particular doctor or hospital. Just like an HMO, POS Coinsurance members choose a PCP who provides and coordinates care. When the member’s PCP coordinates care, members receive the highest level of coverage with lower out-of-pocket costs. However, POS Coinsurance members also have the ability to seek care directly from any network or non-network provider without a referral. When members choose to use their non-network benefit, they are responsible for additional out-of-pocket costs, such as deductible and coinsurance.
As an AmeriHealth POS Coinsurance member, do I need to select a primary care physician (PCP)?
Yes, your PCP will provide and coordinate all of your care. To find a participating provider, use the online provider search.
What is the difference between network and non-network care?
Network care refers to those services that are provided by or coordinated through your PCP. When your care is referred, you will receive the highest level of benefits and lower copayments.
Non-network references services received directly from a network or non-network physician without a referral. You may be subject to increased out-of-pocket costs, as higher deductibles and coinsurance apply, and you may need to submit your claims for reimbursement.
Am I responsible for the difference between the amount billed by a provider and the allowed amount when I use a non-network provider?
In addition to your deductible and coinsurance, you will be responsible for the difference between the physician’s billed amount and the reasonable and customary amount when you seek care directly from a non-network physician. If you seek care directly from a network physician, you will only be responsible for the deductible and coinsurance for all covered services.
When I use my non-network benefits, who is responsible to preapprove my benefits?
If you choose to seek care directly from a provider, you are responsible for contacting our Care Management and Coordination Department at 1-800-227-3114 to obtain the necessary preapproval.
May I seek services directly from a network physician?
You have the option of seeking care directly from a network physician. By doing this, you may be responsible for an annual deductible and coinsurance applied for all covered services.
If you have additional questions, please go to the Contact Us page to find out where you can direct your questions.
