2014 Annual Member Group Meeting - Advantage … AHP Member...2014 Annual Member Group Meeting 9/13/2014 1 Chairman Roi Nelson Trustee Guy Sims Trustee Jeff Nunn Trustee Lynn Kinder

2014 Annual Member Group Meeting

9/13/2014

1

Chairman Roi NelsonTrustee Guy SimsTrustee Jeff Nunn

Trustee Lynn Kinder

Trustee AB BayouthTrustee Kirk Pittman

Trustee Robert JenningsAdvisor Trustee Paul Freeman

MODERATED BY:Maria Robles Meyers, Esq

Jay Kempton

2014 MEMBER GROUP MEETINGFOR MEMBERS OF ADVANTAGE HEALTH PLANS TRUST

AGENDA

1) Introductions

2) What free market healthcare means for your community and your Plan Mark Galliart, CEO, McBride Orthopedic Hospital

3) ACA Update by Maria Robles Meyers

4) Concerning trends & our strategies

5) Mandatory ACA benefit design changes in 2015

YOUR TRUSTEES

Chairman Roi Nelson

First National BankMcAlester, OK

Trustee Jeff Nunn

Citizen’s BankClaude, TX

Trustee Lynn Kinder

Payne County BankPerkins, OK

Trustee Robert Jennings

The People’s National BankChecotah, OK

Trustee Kirk Pittman

First National BankSeiling, OK

AB Bayouth

Exchange BankSkiatook, OK

Advisory TrusteePaul Freeman

Anchor D BankTexhoma, OK

Trustee Guy Sims

Shamrock BankCoalgate, OK

9/13/2014

2

Maria Robles MeyersTrust Counsel

Health Law Advisors, PLLCOklahoma City, OK

Jay KemptonAdministrator

The Kempton CompanyOklahoma City, OK

Mark GalliartCEO

McBride Orthopedic HospitalOklahoma City, OK

SPEAKERS

What does the Free Market mean for your Plan?

Mark GalliartCEO, McBride

Orthopedic HospitalOklahoma City, OK

9/13/2014

3

APP Utilization 797 Procedures Performed at an APP

APP Savings $5,327,886.66 in savings as of September 1, 2014

LOOK WHAT YOU HAVE ACCOMPLISHED!

WE HAVE NEW ADVANTAGE PREMIER PROVIDERSTM!

1. Breast Imaging Of Oklahoma Oklahoma City, OK Women’s Health2. Cancer Specialists Of Oklahoma Multiple Locations Oncology3. Christus Santa Rosa San Antonio, TX/Multiple General/Orthopedics4. Comprehensive Diagnostic Imaging Oklahoma City, OK Advanced Imaging5. Envision Imaging Tulsa, OK Advanced Imaging6. McBride Orthopedic Hospital* Oklahoma City, OK Orthopedics7. Norman Endoscopy Center Norman, OK Colonoscopy/Endoscopy8. Oklahoma Heart Hospital* Oklahoma City, OK Cardiac9. Oklahoma Kidney Stone Center Oklahoma City, OK Kidney Stone Treatment10. Oklahoma Surgical Hospital* Tulsa, OK General/Orthopedic/Bariatric11. Optim Oncology Midwest City, OK Oncology12. Pine Creek Medical Center Dallas, TX General/Orthopedics/Bariatric13. River Pointe Surgical Center Sugar Land, TX Orthopedic/General Surgery14. South Austin Surgery Center Austin, TX Orthopedic/General Surgery15. Southwest Eye Surgery Center Oklahoma City, OK Ophthalmologic Surgery16. Surgery Center Of Oklahoma Oklahoma City, OK Orthopedic/General Surgery17. Synergy Spine and Surgery Center Seneca, SC Orthopedic/General Surgery

*Facilities named by Consumer Reports as Top in US

• Same Sex Marriage (not ACA, but Federal intervention possible)» 10th Circuit Court Decision – Oklahoma» Supreme Court Expected to take case this fall» DOL has extended same sex marriage to recognize FMLA; IRS has extended

to retirement plans

• Maximum Out Of Pocket Amounts» Forcing major changes in plan designs Jan 1, 2015- More on this later» 2014 - $6,350 Single; $12,500 Family» 2015 - $6,600 Single; $13,200 Family

ACA UPDATE

9/13/2014

4

• Taxes Due Now» Transitional Reinsurance Tax - AHP does this for the banks

• First payment due this year - $63 per member• $318,000

» PCORI Fee - AHP does this for the banks• $2 per member• 2014 - $5,300• 2015 - $12,000

• Summary of Benefits and Coverage» New Hires and Open Enrollment» You WILL get new ones for 2015!» Available on website, under individual login

ACA UPDATE

PAY OR PLAY TAXES

What is it?– Sledge Hammer: $2,000 for ALL FT employees (less the first 80)

» If one employee gets a subsidy on the Exchange and » Employer does not offer Minimum Essential Coverage

– Must offer Minimum Essential Coverage to 70% of full-time employees– Non deductible tax– All AHP plans offer MEC

ACA UPDATE

PAY OR PLAY TAXESWhat is it?

– Tack Hammer: $3,000 for EACH FT employee who gets a subsidy on exchange» If one employee gets a subsidy on the Exchange and » If Minimum Essential Coverage is offered, but not “affordable” or does not meet

“minimum value”

– All AHP Plans exceed Minimum Value– Banks will need to determine if its affordable

» 9.5% taxable compensation safe harbor on employee only coverage

ACA UPDATE

9/13/2014

5

PAY OR PLAY TAXESWho’s liable?

– Employers with 100 full time/full time equivalents subject to tax in 2015» Not assessed until 2016

– Employers with 50-99 full time/full time equivalents tax delayed until 2016» Not assessed until 2017

– Employer includes all companies under common control– May be delayed further

ACA UPDATE

PAY OR PLAY TAXES

How will government know who to assess?– Reporting REQUIRED for 2015 all employers

» Employee Reporting -• AHP may be able to provide certificate to prove not subject to individual mandate• Waiting on IRS guidance• Due January 2016

» Employer Reporting – Check with your payroll vendor• Used by IRS, HHS to assess Pay or Play penalties

ACA UPDATE

LETS TAKE A BREAK

WHEN WE RETURN

2015 PLAN DESIGN CHANGES

9/13/2014

6

CONCERNING TRENDS

– Compounded Drugs» Over $750 will be reviewed to see if

pharmacy’s charges are reasonable

– Specialty Medications» ie Sovaldi for Hep C

• $84,000 - $168,000 for a course of treatment

» 11 of top 15 highest cost drugs on AHP are specialty medications = $1,380,882 in 12 months

» Now, if specialty drug costs more than $5,000 it will be subject to tight clinical review

1/3 of AHP total claims are now RX

July 2014

3 participants

33% of total drug claims for all of AHP

CONCERNING TRENDS

[Gilead’s] arguments fall flat with health officials Most hepatitis C patients are low-income minorities who probably receive Medicaid, and state and federally funded Medicaid programs are financially strained – San Francisco Chronicle

Pharmacists complain it's become an epidemic: generic meds suddenly going for a premium you'd expect to pay for brand names - Channel 8 News Dallas

2015 PLAN CHANGES

9/13/2014

7

Plan Design Changes due to ACA– 2014

» Federal out of pocket limits $6,250/$12,500» Includes deductibles, coinsurance, and co-pays» Instead of changing plan designs in the middle of the year, if a participants goes over the

federal limits - refund check– 2015

» Federal out of pocket limits $6,600/$13,200» Includes deductibles, coinsurance, co-pays, AND RX» All plan designs must be modified» Some plan designs are going away» Minimum Value Plan – Safe Harbor for employers over 50 full time employees

• Plan design changes/deletions/additions due to the market

2015 PLAN CHANGES

2015 PLAN CHANGES

Select Plans

– Select 300, 500, 750» Total aggregate out-of-pocket including deductible, co-insurance, and co-pays not to

exceed $6,600 individual and $13,200 family » Participant may reach the Plan out-of-pocket limitation prior to reaching the Federal out-

of-pocket limitations

– Select 1500» Total aggregate out-of-pocket including deductible, co-insurance, and co-pays not to


of-pocket limitations» Family out-of-pocket and deductible amounts – 2 times individual instead of 3

– Select 1000 – No Longer Available» When out-of-pocket limits are lowered, premium difference disappears

2015 PLAN CHANGES

9/13/2014

8

2015 PLAN CHANGES

Value Plans

– Value 750, 1500, 2000» Total aggregate out-of-pocket including deductible, co-insurance, and co-pays not to


of-pocket limitations» Family out-of-pocket and deductible amounts – 2 times individual instead of 3

– Value 1000 – No Longer Available» When out-of-pocket limits are lowered, premium difference disappears

2015 PLAN CHANGES

2015 PLAN CHANGES

HDHP & Consumer Plans

9/13/2014

9

– HDHP 1500– No Longer Available» Very low participation» When out-of-pocket limits are lowered, premium difference disappears

– HDHP 2500» Total aggregate out-of-pocket including deductible, co-insurance, and co-pays not to


of-pocket limitations» Family out-of-pocket and deductible amounts – 2 times individual instead of 3» Embedded deductible

– Consumer 3000/5000 & Consumer 5000 Plus– No Longer Available» No participation» When out-of-pocket limits are lowered, premium difference disappears

2015 PLAN CHANGES

2015 PLAN CHANGES

New Plans

– NEW PLAN - Consumer 3000 Plus Consumer 3500 Plus» Total aggregate out-of-pocket including deductible, co-insurance, and co-pays not to


of-pocket limitations» Family out-of-pocket and deductible amounts – 2 times individual instead of 3» Increase deductible $500

– NEW PLAN – Minimum Value Plan 6600» Minimum safe harbor for Pay or Play » $6,600/$13,200 deductible, no additional co-insurance» Premier Providers, LabCard and OneCall ARE available prior to deductible» NOT HSA qualified; use with HRA

2015 NEW PLANS

9/13/2014

10

SUMMARY OF 2015 PLAN DESIGNS

» Value 750» Value 1500» Value 2000

» Select 300» Select 500» Select 750» Select 1500

»HDHP 2500» Consumer 3500 Plus»Minimum Value Plan

Traditional Plans that are Value Priced

Traditional Plans Consumer Driven Options

DO YOU HAVE ANY QUESTIONS ?

Plan NameIndividual

Deductible

Individual

Out of Pocket

Maximum

Family

Deductible

Family

Out of Pocket

Maximum

Coinsurance

Percentage

% of Minimum

Value

Select 300 $300.00 $2,500.00 3 indvidual 3 indvidual 80% 89.90%



Select 1000

Select 1500 $1,500.00 $3,000.00 2 indvidual 2 indvidual 80% 84.60%

Value 750 $750.00 $5,000.00 2 indvidual 2 indvidual 70% 83.90%

Value 1000

Value 1500 $1,500.00 $5,000.00 2 indvidual 2 indvidual 70% 81.30%

Value 2000 $2,000.00 $5,000.00 2 indvidual 2 indvidual 70% 80.10%

HDHP 1500 w/ Rx

HDHP 2500 w/ Rx $2,500.00 $5,000.00 $5,000.00 $7,900.00 80% 71.00%

HDHP 1500 w/out Rx

HDHP 2500 w/out Rx

Consumer 3000

Consumer 5000

Consumer 3000 Plus

Consumer 5000 Plus

Consumer 3500 Plus* $3,500.00 $6,600.00 $7,000.00 $13,200.00 80% 80.70%

Minimum Value Plan* $6,600.00 $0.00 $13,200.00 $0.00 100% 61.90%

Advantage Health Plans

Eliminated

Eliminated

Eliminated

Eliminated

Eliminated

2015 Available Plan Options

Eliminated

Eliminated

Eliminated

Eliminated

megan

AHP

2015 AHP Plan Designs

All information provided is for in-network

benefits onlySelect 300 Select 500 Select 750 Select 1500

Individual Deductible $300 $500 $750 $1,500

Family Deductible3 individual deductibles must be

satisfied per family.

3 individual deductibles must be






$2,500 $3,000 $3,000 $3,000

*Does not include deductible *Does not include deductible *Does not include deductible *Does not include deductible

Family out-of-pocket Maximum3 family members; does not aggregate;

Excludes deductibles and co-pays.

3 family members; does not aggregate;






Total aggregate out-of-pocket including

deductible, coninsurance, and co-pays

not to exceed $6,600 individual and

$13,200 family.

Does not include non-covered and

excluded out-of-pocket amounts.




$13,200 family.






$13,200 family.






$13,200 family.



You may reach the Plan out-of-

pocket limitation prior to reaching

the Federal out-of-pocket

limitations.




limitations.




limitations.




limitations.

Physician's Office Visit $15 $15 $25 $25

ER co-pay - May be subject to ER co-pay if not

accident, admitted or life-threatening$100 $100 $100 $100

Surgical Procedures$300 per occurrence, then deductible

and coinsurance.

$300 per occurrence, then deductible

and coinsurance.


and coinsurance.


and coinsurance.

No co-pay/100% benefit if a Advantage

Premier Provider is used. Please

contact us for information.










Coinsurance Percentage - unless another

percentage is stated80% 80% 80% 80%

Pre-Certification Requirement

Pre-certification of all in-patient

confinements, out-patient surgeries,

and sleep studies is required. This is

the patient's responsibility.













Lab Benefit 80% when a network provider is used;

100% when LabCard provider is used

80% when a network provider is used;






100% Benefits Available: Please contact us or go to the website for

details on all 100% benefits.







Advantage Premier Providers ; 100% benefit

when APP is used.

LabCard; 100% lab when LabCard provider is

used

OneCall Medical; 100% for CAT/PET/MRI

when OneCall provider is used

OTC medications: 100% for certain OTC

medications


when APP is used.


used




medications


when APP is used.


used




medications


when APP is used.


used




medications

Pharmacy Benefits BASIC PHARMACY BENEFIT BASIC PHARMACY BENEFIT BASIC PHARMACY BENEFIT BASIC PHARMACY BENEFIT

Generic - $10

Name Brand $45

Generic - $10

Name Brand $45

Generic - $10

Name Brand $45

Generic - $10

Name Brand $45

If you select a brand name drug when a generic drug

is available, you pay the co-pay PLUS the difference

in cost between the generic and the brand name

drug.




drug.




drug.




drug.

Therapeutic List - Specific Name Brand RX

There are specific Name Brand prescriptions that

have a therapeutic alternative. If you choose one of

these drugs, the co-pay will be 50% of the drug

cost. The list of these drugs is available on our

website.





website.





website.





website.

Over the Counter Benefit

You can receive a 102 day supply of an OTC drug

for $0 when your physician prescribes an OTC drug

in lieu of a prescription drug. Refer to the OTC Drug

List at www.advantagehealthplans.com













A 3-month supply of covered drugs that appear on

the Maintenance Drug list is available at your local

pharmacy.



pharmacy.



pharmacy.



pharmacy.

Generic - One co-pay

Name Brand - Two co-pays







Individual out-of-pocket Maximum

Special Benefits

Federal ACA Out of Pocket Maximums

Maintenance Drugs

*This comparison is for review purposes only and is not a guarantee of benefits. Please refer to your Summary Plan Description.

megan

AHP



benefits only

Individual Deductible

Family Deductible

Family out-of-pocket Maximum

Physician's Office Visit


accident, admitted or life-threatening

Surgical Procedures


percentage is stated


Lab Benefit

Pharmacy Benefits




Special Benefits


Maintenance Drugs

Value 750 Value 1500 Value 2000

$750 $1,500 $2,000







$5,000 $5,000 $5,000

*Does not include deductible *Does not include deductible *Does not include deductible










$13,200 family.






$13,200 family.






$13,200 family.






limitations.




limitations.




limitations.

$35 $35 $35

$200 $200 $200


and coinsurance.


and coinsurance.


and coinsurance.










70% 70% 70%


























when APP is used.


used




medications


when APP is used.


used




medications


when APP is used.


used




medications

BASIC PHARMACY BENEFIT BASIC PHARMACY BENEFIT BASIC PHARMACY BENEFIT

Generic - $15

Name Brand $55

Generic - $15

Name Brand $55

Generic - $15 Name

Brand $55




drug.

If you select a brand name drug when a generic

drug is available, you pay the co-pay PLUS the

difference in cost between the generic and the brand

name drug.




drug.





website.





website.





website.














the Maintenance Drug list is only available through

mail order.



mail order.



mail order.

Generic - Two co-pays







megan

AHP



benefits only

Individual Deductible

Family Deductible

Family out-of-pocket Maximum

Physician's Office Visit


accident, admitted or life-threatening

Surgical Procedures


percentage is stated


Lab Benefit

Pharmacy Benefits




Special Benefits


Maintenance Drugs

HDHP 2500 Consumer Plan 3500 Plus Minimum Value Plan

$2,500 $3,500 $6,600

$5,000 aggregate; The entire Family

Deductible must be met$7,000 aggregate $13,200

$5,000 $6,600 $6,600

*Does include deductible *Does include deductible *Does include deductible

INCLUDES deductibles and co-pays.

Equal to 2 family members. $13,200 aggregate $13,200 aggregate




$13,200 family.






$13,200 family.






$13,200 family.






limitations.




limitations.




limitations.

Subject to deductible, then 80% $25 Deductible & Consinsurance

Subject to deductible, then 80% $100 Deductible & Consinsurance


and coinsurance. Deductible & Consinsurance




80% 80% 0%













Subject to deductible, then 80%. 100%

if LabCard provider is used.

100% if LabCard provider is used. 80%

after deductible if in-network provider is

used

100% if LabCard provider is used. 80%

after deductible if in-network provider is

used

100% Benefits Available after

Deductible: Please contact us or go to the website for







when APP is used.


used




medications


when APP is used.


used




medications


when APP is used.


used




medications

Subject to deductible. BASIC PHARMACY BENEFIT BASIC PHARMACY BENEFIT

There is NO benefit until deductible is

met

Generic - $10 Name

Brand $45

Generic - Plan pays 90%

Brand Name - Plan pays 10%




drug.





website.





website.

Deductible & Consinsurance

AFTER your deductible is met, you can receive a

102 day supply of an OTC drug for $0 when your

physician prescribes an OTC drug in lieu of a

prescription drug. Refer to the OTC Drug List at

www.advantagehealthplans.com











mail order.



pharmacy.





Brand Two co-pays

Subject to deductible, then 80%. 100%

after deductible if an Advantage

Premier Provider is used.



megan

AHP

Breast Imaging Of Oklahoma Oklahoma City, OK Women’s Health

Cancer Specialists Of Oklahoma Multiple Locations Oncology

Christus Santa Rosa San Antonio, TX/Multiple General/Orthopedics

Comprehensive Diagnostic Imaging Oklahoma City, OK Advanced Imaging

Envision Imaging Tulsa, OK Advanced Imaging

McBride Orthopedic Hospital* Oklahoma City, OK Orthopedics

Norman Endoscopy Center Norman, OK Colonoscopy/Endoscopy

Oklahoma Heart Hospital* Oklahoma City, OK Cardiac

Oklahoma Kidney Stone Center Oklahoma City, OK Kidney Stone Treatment

Oklahoma Surgical Hospital* Tulsa, OK General/Orthopedic/Bariatric

Optim Oncology Midwest City, OK Oncology

Pine Creek Medical Center Dallas, TX General/Orthopedics/Bariatric

River Pointe Surgical Center Sugar Land, TX Orthopedic/General Surgery

South Austin Surgery Center Austin, TX Orthopedic/General Surgery

Southwest Eye Surgery Center Oklahoma City, OK Ophthalmologic Surgery

Surgery Center Of Oklahoma Oklahoma City, OK Orthopedic/General Surgery

Synergy Spine and Surgery Center Seneca, SC Orthopedic/General Surgery

*Facilities named by Consumer Reports as Top in U.S.

Envision Imaging Dallas, TX/Lafayette, LA

Shannon Health San Angelo, TX

Ortho4States Galena, KS/Grove, OK

ESEC Oklahoma City, OK

Memorial Surgery Center Tulsa, OK

Description Premier ProviderDistance

Traveled

Premier

Price

Historical Svc

Allowable

Possible Savings

Per Service

Arthroscopically aided anterior cruciate ligament repair Surgery Center of Oklahoma 1250.88 $6,990.00 $18,897.52 $11,907.52

Extracapsular cataract removal with insertion of intraocular lens prosthesis Southwest Eye Surgery Center 492.35 $3,600.00 $7,607.38 $4,007.38

Extracapsular cataract removal with insertion of intraocular lens prosthesis Oklahoma Surgical Hospital 430.01 $3,500.00 $7,607.38 $4,107.38

Tendon sheath incision (eg, for trigger finger) Surgery Center of Oklahoma 399.69 $2,750.00 $5,540.26 $2,790.26

Laparoscopy, abdomen, peritoneum, and omentum Surgery Center of Oklahoma 399.17 $4,300.00 $17,418.32 $13,118.32

DXA, bone density study Comprehensive Diag Imaging 396.34 $83.50 $478.86 $395.36

Screening mammography, bilateral, all views Comprehensive Diag Imaging 396.34 $221.50 $564.11 $342.61

Laparoscopy, vaginal hysterectomy w/ removal of tubes and/or ovaries Surgery Center of Oklahoma 389.92 $8,000.00 $43,445.85 $35,445.85

Septoplasty or submucous resection, w/ or w/o cartilage scoring Surgery Center of Oklahoma 385.70 $3,550.00 $17,728.84 $14,178.84

Parathyroidectomy or exploration of parathyroid(s) Surgery Center of Oklahoma 383.61 $6,160.00 $16,174.39 $10,014.39

CT, maxillofacial area; without contrast Comprehensive Diag Imaging 382.55 $368.50 $1,209.68 $841.18

Removal of implant; deep Surgery Center of Oklahoma 382.51 $2,530.00 $3,137.41 $607.41

Nasal/sinus endoscopy, surgical, with maxillary antrostomy Surgery Center of Oklahoma 382.51 $5,885.00 $15,001.18 $9,116.18

Extracapsular cataract removal with insertion of intraocular lens prosthesis Triad Eye Medical Clinic 381.35 $3,500.00 $7,607.38 $4,107.38

Extracapsular cataract removal with insertion of intraocular lens prosthesis Triad Eye Medical Clinic 381.35 $3,500.00 $7,607.38 $4,107.38

Colonoscopy, flexible, proximal to splenic flexure; with biopsy Norman Endoscopy Center 373.12 $2,163.00 $4,643.67 $2,480.67



Osteotomy, w/or w/o lengthening or shortening, first metatarsal Surgery Center of Oklahoma 363.99 $4,125.00 $8,754.21 $4,629.21



Total thyroid lobectomy, unilateral Surgery Center of Oklahoma 352.65 $6,160.00 $24,691.89 $18,531.89



Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) McBride Orthopedic Hospital 335.90 $115.80 $9,542.62 $9,426.82

Injection(s), diag or therapeutic agent, paravertebral facet, level 1 McBride Orthopedic Hospital 335.90 $855.00 $2,763.82 $1,908.82


Injection(s), diag or therapeutic agent, paravertebral facet, level 2 McBride Orthopedic Hospital 335.90 $240.00 $1,094.33 $854.33

Injection(s), diag or therapeutic agent, paravertebral facet, level 3 McBride Orthopedic Hospital 335.90 $240.00 $738.20 $498.20

Paravertebral facet joint nerve, (fluroscopy or CT); lumbar/sacral, single McBride Orthopedic Hospital 335.90 $1,465.00 $9,923.96 $8,458.96

Paravertebral facet joint nerve, (fluroscopy or CT); lumbar/sacral, addt McBride Orthopedic Hospital 335.90 $760.00 $1,782.50 $1,022.50

Paravertebral facet joint nerve, (fluroscopy or CT); lumbar/sacral, addt McBride Orthopedic Hospital 335.90 $760.00 $1,782.50 $1,022.50

MRI, spinal canal and contents, without and with contrast; lumbar McBride Orthopedic Hospital 335.90 $750.00 $1,666.70 $916.70

MRI, any joint of upper extremity; without contrast McBride Orthopedic Hospital 335.90 $650.00 $1,154.87 $504.87

Needle electromyography; 1 ext w/ or w/o related paraspinal areas McBride Orthopedic Hospital 335.90 $121.50 $690.00 $568.50

Nerve conduction, amp & lat/velo study, ea nerve; motor, w/o F-wave McBride Orthopedic Hospital 335.90 $80.00 $305.88 $225.88

Nerve conduction, amp & lat/velo study, ea nerve; motor, w/F-wave McBride Orthopedic Hospital 335.90 $94.00 $344.28 $250.28

Nerve conduction, amp & lat/velo study, ea nerve; sensory McBride Orthopedic Hospital 335.90 $141.00 $393.36 $252.36

H-reflex, amp & lat study; record gastrocnemius/soleus muscle McBride Orthopedic Hospital 335.90 $124.00 $715.04 $591.04

Injection(s), of diagnostic or therapeutic substance(s), epidural; cervical Surgery Center of Oklahoma 335.53 $1,100.00 $2,317.28 $1,217.28

Injection(s), of diagnostic or therapeutic substance(s), epidural; cervical Surgery Center of Oklahoma 335.53 $1,100.00 $2,317.28 $1,217.28

Screening mammography, bilateral, all views Breast Imaging of Oklahoma 330.25 $171.50 $564.11 $392.61

Biopsy of breast; percutaneous, needle core, using imaging guidance Breast Imaging of Oklahoma 314.67 $783.02 $4,071.64 $3,288.62

Ultrasound, breast(s) (unilateral or bilateral) Breast Imaging of Oklahoma 314.67 $104.64 $344.11 $239.47

MRI, breast, bilateral; with or without contrast Breast Imaging of Oklahoma 314.67 $1,012.88 $2,365.60 $1,352.72

DXA, bone density study Breast Imaging of Oklahoma 314.67 $66.00 $478.86 $412.86

Diagnostic mammography, bilateral Breast Imaging of Oklahoma 314.67 $205.78 $980.48 $774.70

Mastectomy, partial; with axillary lymphadenectomy Surgery Center of Oklahoma 312.17 $5,005.00 $26,025.63 $21,020.63




Laryngoscopy, direct, operative, w/excision of tumor Surgery Center of Oklahoma 312.17 $2,970.00 $11,280.29 $8,310.29

Excision of parotid tumor or parotid gland; lateral lobe Surgery Center of Oklahoma 312.17 $7,000.00 $30,760.72 $23,760.72

Neuroplasty and/or transposition; median nerve at carpal tunnel Surgery Center of Oklahoma 312.17 $2,750.00 $6,017.75 $3,267.75


Collection of venous blood by venipuncture; 5 tx Cancer Specialists of Oklahoma 311.99 $18.00 $85.00 $67.00


Injection proc; radioactive tracer for identification of sentinel node Deaconess Hospital 311.99 $265.00 $581.28 $316.28

CT guidance for placement of radiation therapy fields Cancer Specialists of Oklahoma 311.99 $84.88 $161.25 $76.37

Therapeutic radiology treatment planning; complex Cancer Specialists of Oklahoma 311.99 $180.37 $674.10 $493.73

Therapeutic radiology simulation-aided field setting; simple Cancer Specialists of Oklahoma 311.99 $189.84 $418.29 $228.45

Therapeutic radiology simulation-aided field setting; complex Cancer Specialists of Oklahoma 311.99 $554.66 $1,200.20 $645.54

Therapeutic radiology simulation-aided field setting; 3-dimensional Cancer Specialists of Oklahoma 311.99 $482.89 $1,740.00 $1,257.11

Basic radiation dosimetry calculation, central axis depth dose calc (3 tx) Cancer Specialists of Oklahoma 311.99 $215.82 $661.65 $445.83

Special teletherapy port plan, particles, hemibody, total body Cancer Specialists of Oklahoma 311.99 $98.65 $298.35 $199.70

Treatment devices, design and construction; complex; 4 tx Cancer Specialists of Oklahoma 311.99 $644.44 $2,933.08 $2,288.64

Cont. med physics consult, including assessment of tx parameters; 6 tx Cancer Specialists of Oklahoma 311.99 $270.24 $1,322.76 $1,052.52

Radiation treatment delivery, 3 or more separate treatment areas; 26 tx Cancer Specialists of Oklahoma 311.99 $6,177.60 $10,628.80 $4,451.20


Therapeutic radiology port film(s); 4 tx Cancer Specialists of Oklahoma 311.99 $58.52 $642.40 $583.88

Radiation treatment management, five treatments; 7 units Cancer Specialists of Oklahoma 311.99 $1,411.20 $1,754.06 $342.86

Special treatment procedure Cancer Specialists of Oklahoma 311.99 $167.26 $500.00 $332.74

PET Image w/CT; skull base to mid-thigh Cancer Specialists of Oklahoma 311.99 $1,201.62 $4,787.20 $3,585.58

Comprehensive metabolic panel; 4 tx Cancer Specialists of Oklahoma 311.99 $69.76 $165.24 $95.48

Advantage Health Plans (Oklahoma and Texas)

03/01/2012 - 08/31/14

Estimated Savings: $5,327,886.66

Premier Provider Savings by Procedure


Traveled

Premier

Price

Historical Svc

Allowable

Possible Savings

Per Service


03/01/2012 - 08/31/14




Blood count; complete (CBC), automated; 4 tx Cancer Specialists of Oklahoma 311.99 $51.32 $83.00 $31.68



Major joint replacement or reattachment of lower extremity w/o CC McBride Orthopedic Hospital 309.15 $19,400.00 $93,905.99 $74,505.99

Polysomnography; age 6 years or older, sleep staging w/4+ add'l parameters Oklahoma Surgical Hospital 307.47 $1,600.00 $4,333.73 $2,733.73


Excision, interdigital (Morton) neuroma, single, each Surgery Center of Oklahoma 305.47 $2,750.00 $6,189.95 $3,439.95

Repair initial inguinal hernia, age 5 years or older; reducible Surgery Center of Oklahoma 305.47 $3,060.00 $8,722.58 $5,662.58

Repair umbilical hernia, age 5 years or older; reducible Surgery Center of Oklahoma 305.47 $3,190.00 $14,974.83 $11,784.83


Arthroscopy, hip, surgical; w/labral repair McBride Orthopedic Hospital 304.83 $5,700.00 $15,359.38 $9,659.38


Ultrasound, abdominal; complete Comprehensive Diag Imaging 282.16 $253.20 $886.22 $633.02

Adenoidectomy Surgery Center of Oklahoma 280.03 $3,300.00 $14,991.19 $11,691.19


Injection(s), of diagnostic or therapeutic substance(s), epidural; lumbar Pine Creek Medical Center 279.95 $1,000.00 $1,675.46 $675.46


Combined anterior/posterior spinal fusion w/o CC/MCC Pine Creek Medical Center 279.67 $65,000.00 $97,353.55 $32,353.55



Arthroscopy, shoulder, surgical; distal claviculectomy Surgery Center of Oklahoma 276.68 $6,160.00 $26,656.52 $20,496.52


Injection(s), of diagnostic or therapeutic substance(s), epidural; lumbar Surgery Center of Oklahoma 276.68 $900.00 $1,675.46 $775.46



Arthroscopy, knee, surgical; with meniscectomy McBride Orthopedic Hospital 275.14 $4,510.00 $13,742.15 $9,232.15


Osteotomy, w/or w/o lengthening or shortening, first metatarsal Surgery Center of Oklahoma 269.67 $4,125.00 $8,754.21 $4,629.21

Laparoscopy, surgical; cholecystectomy with cholangiography Surgery Center of Oklahoma 261.96 $5,865.00 $15,975.12 $10,110.12

Hysteroscopy, diagnostic Surgery Center of Oklahoma 259.72 $1,800.00 $8,496.48 $6,696.48




Arthroscopy, shoulder, surgical; debridement, extensive Surgery Center of Oklahoma 253.94 $6,160.00 $9,865.16 $3,705.16






Neuroplasty and/or transposition; median nerve at carpal tunnel McBride Orthopedic Hospital 244.76 $2,720.00 $6,017.75 $3,297.75

Nerve conduction studies - 5-6 studies McBride Orthopedic Hospital 244.76 $195.00 $600.00 $405.00



Laparoscopy, vaginal hysterectomy w/ removal of tubes and/or ovaries Pine Creek Medical Center 243.44 $11,500.00 $43,445.85 $31,945.85



Correction, hammertoe Surgery Center of Oklahoma 233.77 $2,475.00 $11,725.11 $9,250.11




Laminotomy (hemilaminectomy), with decompression of nerve root(s) McBride Orthopedic Hospital 233.45 $6,000.00 $15,806.75 $9,806.75

MRI, spinal canal and contents, lumbar; without contrast McBride Orthopedic Hospital 233.45 $675.00 $3,067.50 $2,392.50

MRI, any joint of lower extremity; without contrast McBride Orthopedic Hospital 223.64 $700.00 $1,330.00 $630.00




Diagnostic mammography, unilateral Breast Imaging of Oklahoma 213.92 $164.24 $1,199.51 $1,035.27

Reduction mammaplasty Surgery Center of Oklahoma 211.42 $9,500.00 $24,851.46 $15,351.46

Breast reconstruction, immediate or delayed, with tissue expander Surgery Center of Oklahoma 211.42 $5,555.00 $19,724.65 $14,169.65

Hysteroscopy, surgical; with endometrial ablation Surgery Center of Oklahoma 211.42 $3,800.00 $24,316.44 $20,516.44


MRI, lower extremity other than joint; with contrast McBride Orthopedic Hospital 210.99 $800.00 $963.90 $163.90





Laparoscopy, surgical; cholecystectomy South Austin Surgery Center 208.48 $5,715.00 $10,426.19 $4,711.19


Colposcopy of the cervix including upper/adjacent vagina Pine Creek Medical Center 203.98 $3,540.00 $7,174.30 $3,634.30

Laparoscopy, hysterectomy w/removal of tubes and/or ovaries Pine Creek Medical Center 203.98 $11,500.00 $51,609.90 $40,109.90


Fasciectomy, partial palmar with release of single digit Surgery Center of Oklahoma 202.72 $2,950.00 $11,808.12 $8,858.12

O.R. Procedures for Obesity w/o CC/MCC Pine Creek Medical Center 202.70 $10,900.00 $35,719.55 $24,819.55


Traveled

Premier

Price

Historical Svc

Allowable

Possible Savings

Per Service


03/01/2012 - 08/31/14





Injection(s), of diagnostic or therapeutic substance(s), epidural; cervical Pine Creek Medical Center 201.22 $1,100.00 $2,317.28 $1,217.28

Colonoscopy, flexible, proximal to splenic flexure Norman Endoscopy Center 199.21 $1,200.00 $4,670.07 $3,470.07

Ultrasound, breast(s) (unilateral or bilateral) Comprehensive Diag Imaging 198.68 $174.60 $344.11 $169.51


Diagnostic mammography, bilateral Comprehensive Diag Imaging 198.68 $264.00 $980.48 $716.48

Total thyroid lobectomy, unilateral; with or without isthmusectomy Surgery Center of Oklahoma 197.77 $6,160.00 $24,691.89 $18,531.89

Total thyroid lobectomy, unilateral; w/ contralateral subtotal lobectomy Surgery Center of Oklahoma 197.77 $6,160.00 $10,228.97 $4,068.97

Arthroscopy, knee, surgical; debridement/shaving of cartilage Surgery Center of Oklahoma 194.06 $3,740.00 $11,381.79 $7,641.79


Cervical spinal fusion w/o CC Pine Creek Medical Center 191.93 $23,000.00 $34,874.09 $11,874.09



Laparoscopy, surgical, with vaginal hysterectomy Pine Creek Medical Center 189.44 $9,000.00 $19,234.80 $10,234.80


Dilation and curettage, diagnostic and/or therapeutic Surgery Center of Oklahoma 186.14 $1,600.00 $4,547.96 $2,947.96





Manipulation of knee joint under general anesthesia Surgery Center of Oklahoma 179.84 $2,000.00 $4,184.05 $2,184.05




Back & neck proc except spinal fusion w/o CC/MCC McBride Orthopedic Hospital 174.54 $9,500.00 $22,006.08 $12,506.08

Neuroplasty and/or transposition; median nerve at carpal tunnel McBride Orthopedic Hospital 174.54 $2,720.00 $6,017.75 $3,297.75

CT, lumbar spine; without contrast McBride Orthopedic Hospital 174.54 $250.00 $1,826.58 $1,576.58

Laparoscopy, surgical, supracervical hysterectomy Pine Creek Medical Center 172.86 $11,500.00 $29,140.24 $17,640.24







Upper gastrointestinal endoscopy; w/biopsy, single Pine Creek Medical Center 169.87 $1,750.00 $3,265.06 $1,515.06

Laparoscopy, surgical, gastric restrictive procedure Pine Creek Medical Center 169.87 $12,900.00 $35,719.55 $22,819.55



Insertion of tunneled centrally inserted central venous access device Surgery Center of Oklahoma 168.95 $3,190.00 $8,865.08 $5,675.08


Tympanoplasty with mastoidectomy Surgery Center of Oklahoma 168.27 $5,060.00 $7,389.00 $2,329.00





Injection(s), of diagnostic or therapeutic substance(s), epidural; lumbar McBride Orthopedic Hospital 165.61 $900.00 $1,675.46 $775.46


Nerve conduction studies - 5-6 studies McBride Orthopedic Hospital 165.61 $195.00 $600.00 $405.00

Cystourethroscopy, with insertion of indwelling ureteral stent Surgery Center of Oklahoma 164.58 $3,600.00 $14,485.51 $10,885.51

Excision of hydrocele; unilateral Surgery Center of Oklahoma 164.58 $3,600.00 $7,995.52 $4,395.52





Revision of hip or knee replacement w/ CC McBride Orthopedic Hospital 164.49 $29,300.00 $66,303.55 $37,003.55



Local excision & removal int fix devices of hip & femur w/CC/MCC McBride Orthopedic Hospital 164.49 $15,000.00 $17,030.24 $2,030.24

Postoperative/post-traumatic infections w/operating room proc w/CC McBride Orthopedic Hospital 164.49 $7,000.00 $28,102.11 $21,102.11

Arthrocentesis, aspiration and/or injection; major joint or bursa McBride Orthopedic Hospital 164.49 $370.00 $24,851.46 $24,481.46

Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial Surgery Center of Oklahoma 164.49 $5,885.00 $15,359.38 $9,474.38





Sling operation for stress incontinence Surgery Center of Oklahoma 162.61 $4,480.00 $19,133.77 $14,653.77


Duplex scan of extracranial arteries; complete bilateral study Lawton Imaging Center 161.18 $125.00 $846.68 $721.68



Upper gastrointestinal endoscopy; w/biopsy, single Norman Endoscopy Center 159.44 $1,563.00 $3,265.06 $1,702.06


Repair, tendon or muscle, upper arm or elbow, each tendon or muscle Surgery Center of Oklahoma 158.86 $4,950.00 $37,472.51 $32,522.51


Traveled

Premier

Price

Historical Svc

Allowable

Possible Savings

Per Service


03/01/2012 - 08/31/14




MRI, spinal canal and contents, cervical; without contrast McBride Orthopedic Hospital 158.86 $700.00 $2,216.75 $1,516.75


Tonsillectomy; age 12 or over Surgery Center of Oklahoma 158.68 $3,050.00 $4,475.35 $1,425.35

Injection(s), of diagnostic or therapeutic substance(s), epidural; cervical McBride Orthopedic Hospital 158.68 $900.00 $2,317.28 $1,417.28

Needle electromyography; 2 ext w/ or w/o related paraspinal areas McBride Orthopedic Hospital 158.68 $177.50 $1,200.38 $1,022.88

Nerve conduction, amp & lat/velo study, ea nerve; motor, w/o F-wave McBride Orthopedic Hospital 158.68 $80.00 $305.88 $225.88

Nerve conduction, amp & lat/velo study, ea nerve; motor, w/F-wave McBride Orthopedic Hospital 158.68 $94.00 $344.28 $250.28

Nerve conduction, amp & lat/velo study, ea nerve; sensory McBride Orthopedic Hospital 158.68 $141.00 $393.36 $252.36

Lithotripsy, extracorporeal shock wave Oklahoma Kidney Stone Center 158.09 $5,750.00 $21,959.57 $16,209.57



Excision of cyst, fibroadenoma, or other benign or malignant tumor Breast Imaging of Oklahoma 156.09 $2,365.00 $4,662.55 $2,297.55




Arthroscopy, shoulder, surgical; capsulorrhaphy McBride Orthopedic Hospital 155.52 $5,750.00 $17,808.93 $12,058.93




Ultrasonic guidance for needle placement Breast Imaging of Oklahoma 153.41 $585.72 $1,123.97 $538.25

Lower extremity & humerus proc except hip, foot, femur w/o CC McBride Orthopedic Hospital 152.26 $12,400.00 $36,673.30 $24,273.30

Excision of lesion of tendon sheath or joint capsule Surgery Center of Oklahoma 152.26 $2,750.00 $3,466.30 $716.30





Intravenous infusion, for therapy, prophylaxis, or diagnosis, addt; 10 tx Cancer Specialists of Oklahoma 151.30 $339.20 $1,500.00 $1,160.80

Intravenous infusion, for therapy, prophylaxis, or diag; concurrent; 8 tx Cancer Specialists of Oklahoma 151.30 $161.36 $422.24 $260.88

Therapeutic, prophylactic, or diagnostic injection; ea addt; 5 tx Cancer Specialists of Oklahoma 151.30 $118.00 $511.20 $393.20

Chemotherapy admin; intravenous, push technique, ea addt, 4 tx Cancer Specialists of Oklahoma 151.30 $261.32 $411.72 $150.40

Chemotherapy admin, intravenous infusion technique; up to 1 hr; 8 tx Cancer Specialists of Oklahoma 151.30 $1,188.16 $2,316.16 $1,128.00

Chemotherapy administration, intravenous infusion technique; 2 tx Cancer Specialists of Oklahoma 151.30 $120.16 $180.00 $59.84












Combined anterior/posterior spinal fusion w/CC McBride Orthopedic Hospital 146.79 $61,200.00 $153,987.24 $92,787.24


Injection(s), diag or therapeutic agent, paravertebral facet, level 2 McBride Orthopedic Hospital 146.79 $240.00 $1,094.33 $854.33

Injection(s), diag or therapeutic agent, paravertebral facet, level 3 McBride Orthopedic Hospital 146.79 $240.00 $738.20 $498.20




Synovectomy, tendon sheath, radical Surgery Center of Oklahoma 143.72 $2,950.00 $7,132.45 $4,182.45






Repair of ruptured musculotendinous cuff open; acute Surgery Center of Oklahoma 142.70 $6,160.00 $10,320.36 $4,160.36









Excision of lesion of tendon sheath or joint capsule Surgery Center of Oklahoma 140.36 $2,750.00 $3,466.30 $716.30




Arthroplasty, interposition, intercarpal or carpometacarpal joints Surgery Center of Oklahoma 139.56 $4,650.00 $5,737.19 $1,087.19

Arthroscopy, shoulder, surgical; w/rotator cuff repair McBride Orthopedic Hospital 139.56 $6,000.00 $22,729.82 $16,729.82




Traveled

Premier

Price

Historical Svc

Allowable

Possible Savings

Per Service


03/01/2012 - 08/31/14







Aftercare, musculoskeletal system & connective tissue w/CC McBride Orthopedic Hospital 136.16 $1,000.00 $9,466.81 $8,466.81

Injection(s), of diagnostic or therapeutic substance(s), epidural; cervical Surgery Center of Oklahoma 135.82 $1,400.00 $2,317.28 $917.28


Bilateral or mult major joint replacement lower extremity w/o CC McBride Orthopedic Hospital 135.73 $35,000.00 $70,414.75 $35,414.75

Manipulation of knee joint under general anesthesia McBride Orthopedic Hospital 135.73 $1,600.00 $4,184.05 $2,584.05



Spinal fusion except cervical w/o CC Pine Creek Medical Center 135.45 $32,000.00 $50,441.00 $18,441.00

Injection procedure for sacroiliac joint, anesthetic/steroid Pine Creek Medical Center 135.16 $1,200.00 $2,798.02 $1,598.02

Injection/Steroid, epidural lumbar or sacral, single level Pine Creek Medical Center 135.16 $1,100.00 $3,854.97 $2,754.97

Injection/Steroid, epidural lumbar or sacral, single level Pine Creek Medical Center 135.16 $300.00 $3,854.97 $3,554.97









Hysteroscopy, surgical; with sampling of endometrium and/or polypectomy Surgery Center of Oklahoma 126.17 $2,500.00 $10,627.45 $8,127.45







Tonsillectomy and adenoidectomy Surgery Center of Oklahoma 125.96 $3,695.00 $4,922.16 $1,227.16

Open treatment of patellar fracture, with partial or complete patellectomy McBride Orthopedic Hospital 125.85 $5,500.00 $13,356.53 $7,856.53



Arthroscopy, shoulder, surgical; decompression of subacromial space Surgery Center of Oklahoma 125.51 $6,160.00 $19,215.79 $13,055.79





Excision of ganglion, wrist (dorsal or volar); primary Surgery Center of Oklahoma 124.03 $2,750.00 $5,759.38 $3,009.38




Back & neck proc except spinal fusion w/o CC/MCC McBride Orthopedic Hospital 123.63 $9,500.00 $22,006.08 $12,506.08


Injection/Steroid, epidural lumbar or sacral, single level McBride Orthopedic Hospital 123.63 $900.00 $3,854.97 $2,954.97




Hallux rigidus correction with cheilectomy, debridement Surgery Center of Oklahoma 121.64 $3,650.00 $26,025.68 $22,375.68






Esophagogastroduodenoscopy, flexible, transoral; diagnostic Norman Endoscopy Center 119.21 $1,200.00 $2,800.53 $1,600.53


Combined anterior/posterior spinal fusion w/CC McBride Orthopedic Hospital 118.68 $61,200.00 $153,987.24 $92,787.24
















O.R. procedures for obesity w/MCC Oklahoma Surgical Hospital 117.96 $16,202.00 $38,610.11 $22,408.11


Traveled

Premier

Price

Historical Svc

Allowable

Possible Savings

Per Service


03/01/2012 - 08/31/14



CT, abdomen and pelvis; with contrast Oklahoma Surgical Hospital 117.96 $350.00 $2,178.64 $1,828.64



Repair of ectropion; extensive (eg, tarsal strip operations) Southwest Eye Surgery Center 116.73 $2,900.00 $9,853.11 $6,953.11


Arthroscopy, shoulder, surgical; w/rotator cuff repair McBride Orthopedic Hospital 113.09 $6,000.00 $22,729.82 $16,729.82



Arthroscopy, knee, surgical; debridement/shaving of cartilage McBride Orthopedic Hospital 108.89 $4,550.00 $11,381.79 $6,831.79

Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate Surgery Center of Oklahoma 106.51 $6,990.00 $29,197.42 $22,207.42


Laryngoscopy, indirect; with biopsy Surgery Center of Oklahoma 106.51 $2,970.00 $3,872.62 $902.62



Esophagogastroduodenoscopy, flexible, transoral; w/biopsy Pine Creek Medical Center 105.39 $1,750.00 $3,719.92 $1,969.92

Laparoscopy, surgical, gastric restrictive procedure Pine Creek Medical Center 105.39 $12,900.00 $35,719.55 $22,819.55






Intravenous infusion, hydration; each additional hour (1 tx) Cancer Specialists of Oklahoma 105.04 $16.09 $219.72 $203.63




Chemotherapy administration, intravenous infusion technique; 4 tx Cancer Specialists of Oklahoma 105.04 $261.52 $584.80 $323.28

CT, thorax; with contrast Comprehensive Diag Imaging 104.68 $257.70 $1,381.73 $1,124.03

CT, abdomen and pelvis; with contrast Comprehensive Diag Imaging 104.68 $349.76 $2,178.64 $1,828.88

Laparoscopy, surgical, with vaginal hysterectomy Pine Creek Medical Center 104.40 $10,000.00 $19,234.80 $9,234.80

Laparoscopy, surgical; with fulguration or excision of lesions of the ovary Pine Creek Medical Center 104.40 $5,200.00 $15,647.49 $10,447.49


Excision of extensor tendon, w/implantation of synthetic rod Surgery Center of Oklahoma 103.61 $2,400.00 $3,471.29 $1,071.29






Ultrasound, transvaginal Comprehensive Diag Imaging 102.33 $227.40 $584.69 $357.29

Ultrasound, pelvic; complete Comprehensive Diag Imaging 102.33 $225.00 $624.86 $399.86







Chemotherapy administration, intravenous infusion technique; 16 tx Cancer Specialists of Oklahoma 101.37 $961.28 $1,440.00 $478.72

Chemotherapy administration, intravenous infusion technique; 12 tx Cancer Specialists of Oklahoma 101.37 $1,767.84 $3,855.60 $2,087.76

Irrigation of implanted venous access device for drug delivery systems; 11 tx Cancer Specialists of Oklahoma 101.37 $284.02 $811.14 $527.12









Open treatment of distal tibiofibular joint disruption, incl internal fixation Surgery Center of Oklahoma 99.89 $4,950.00 $13,376.58 $8,426.58


Manipulation under anesthesia, shoulder joint Surgery Center of Oklahoma 99.70 $2,000.00 $6,424.95 $4,424.95

Excision of ganglion, wrist (dorsal or volar); primary McBride Orthopedic Hospital 99.70 $2,735.00 $5,759.38 $3,024.38










MRI, spinal canal and contents, without and with contrast; lumbar Pine Creek Medical Center 98.89 $496.00 $1,666.70 $1,170.70


Lower extremity & humerus proc except hip, foot, femur w/CC McBride Orthopedic Hospital 98.39 $16,600.00 $31,101.74 $14,501.74

Soft tissue procedures w/o CC McBride Orthopedic Hospital 98.39 $11,900.00 $17,866.46 $5,966.46



Traveled

Premier

Price

Historical Svc

Allowable

Possible Savings

Per Service


03/01/2012 - 08/31/14



Tonsillectomy and adenoidectomy; age 12 or over Surgery Center of Oklahoma 98.39 $3,695.00 $7,514.24 $3,819.24


Tympanostomy (requiring insertion of ventilating tube) Surgery Center of Oklahoma 98.39 $1,700.00 $5,913.89 $4,213.89

Laminotomy (hemilaminectomy), with decompression of nerve root(s) Pine Creek Medical Center 97.87 $11,500.00 $15,806.75 $4,306.75

Injection(s), diag or therapeutic agent, paravertebral facet, level 1 Pine Creek Medical Center 97.87 $1,300.00 $2,763.82 $1,463.82

Injection(s), diag or therapeutic agent, paravertebral facet, level 1 Pine Creek Medical Center 97.87 $1,300.00 $2,763.82 $1,463.82








Strabismus surgery, recession or resection procedure; one horizontal muscle Surgery Center of Oklahoma 97.47 $3,300.00 $5,735.69 $2,435.69



Ostectomy, partial excision, fifth metatarsal head Surgery Center of Oklahoma 96.53 $4,125.00 $13,427.11 $9,302.11

Insertion of tunneled centrally inserted central venous access device Surgery Center of Oklahoma 96.53 $3,190.00 $8,865.08 $5,675.08

Dilation and curettage, diagnostic and/or therapeutic Surgery Center of Oklahoma 96.50 $1,600.00 $4,547.96 $2,947.96



Removal of tunneled central venous access device Surgery Center of Oklahoma 96.13 $1,850.00 $4,712.90 $2,862.90









Total abdominal hysterectomy, w/ or w/o removal of tube(s)/ovary(s) Surgery Center of Oklahoma 92.15 $9,500.00 $15,368.59 $5,868.59

Laparoscopy, surgical, w/vaginal hysterectomy, uterus greater than 250 g Pine Creek Medical Center 92.00 $10,000.00 $18,858.90 $8,858.90

Arthroscopy, knee, surgical; synovectomy McBride Orthopedic Hospital 91.98 $4,510.00 $10,922.94 $6,412.94


Biopsy or excision of lymph node(s); open, deep cervical node(s) Surgery Center of Oklahoma 91.98 $4,300.00 $6,323.20 $2,023.20


Correction, hallux valgus (bunion), w/ or w/o sesamoidectomy Surgery Center of Oklahoma 91.94 $4,125.00 $24,747.56 $20,622.56




X-Ray, hip, arthrography McBride Orthopedic Hospital 91.94 $131.00 $672.11 $541.11






Stereotactic localization guidance for breast biopsy Breast Imaging of Oklahoma 89.98 $1,139.87 $1,532.67 $392.80






Major small & large bowel procedures w/o CC/MCC Oklahoma Surgical Hospital 88.76 $13,036.00 $32,962.27 $19,926.27




Spinal fusion except cervical w/o CC Oklahoma Surgical Hospital 87.82 $32,510.00 $50,441.00 $17,931.00






Arthrodesis, great toe; metatarsophalangeal joint Surgery Center of Oklahoma 87.20 $4,125.00 $6,778.82 $2,653.82











Diagnostic mammography, bilateral Comprehensive Diag Imaging 81.68 $264.00 $980.48 $716.48


Traveled

Premier

Price

Historical Svc

Allowable

Possible Savings

Per Service


03/01/2012 - 08/31/14



Injection(s), of diagnostic or therapeutic substance(s), epidural; lumbar Oklahoma Surgical Hospital 81.17 $990.00 $1,675.46 $685.46

Injection/Steroid, epidural lumbar or sacral, single level Oklahoma Surgical Hospital 81.17 $900.00 $3,854.97 $2,954.97






Oth Vasc PX w/o CC/MCC Oklahoma Heart Hospital 79.51 $16,987.48 $82,724.41 $65,736.93


Arthroscopy, knee, surgical; with meniscectomy Oklahoma Surgical Hospital 75.93 $3,900.00 $13,742.15 $9,842.15

Cervical spinal fusion w/o CC McBride Orthopedic Hospital 75.81 $19,600.00 $34,874.09 $15,274.09



Major joint replacement or reattachment of lower extremity w/o CC Oklahoma Surgical Hospital 74.30 $18,950.00 $93,905.99 $74,955.99

Spinal fusion except cervical w/o CC Oklahoma Surgical Hospital 72.89 $28,708.00 $50,441.00 $21,733.00
















Ultrasound, abdominal; limited Envision Imaging of Tulsa 53.48 $135.00 $450.36 $315.36




Arthroscopy, knee, surgical; synovectomy McBride Orthopedic Hospital 51.61 $4,510.00 $10,922.94 $6,412.94





Arthrocentesis, aspiration and/or injection; major joint or bursa Oklahoma Surgical Hospital 40.61 $977.00 $24,851.46 $23,874.46






Arthrocentesis, aspiration and/or injection; major joint or bursa McBride Orthopedic Hospital 39.00 $370.00 $24,851.46 $24,481.46







Arthroscopy, knee, surgical; with meniscectomy Surgery Center of Oklahoma 38.59 $3,740.00 $13,742.15 $10,002.15



Ultrasound, abdominal; complete Envision Imaging of Tulsa 37.48 $175.00 $698.75 $523.75

Injection procedure for sacroiliac joint, anesthetic/steroid Surgery Center of Oklahoma 37.47 $900.00 $2,798.02 $1,898.02




Back & neck proc except spinal fusion w/o CC/MCC Oklahoma Surgical Hospital 35.62 $6,851.00 $22,006.08 $15,155.08

Arthroscopy, knee, surgical; with meniscectomy South Austin Surgery Center 35.28 $3,590.00 $13,742.15 $10,152.15








MRI, spinal canal and contents, lumbar; without contrast Comprehensive Diag Imaging 29.85 $527.50 $3,067.50 $2,540.00


Duplex scan of extremity veins including responses to compression Comprehensive Diag Imaging 28.32 $274.00 $599.20 $325.20

Intravenous infusion, for therapy, prophylaxis, or diagnosis; 2 tx Cancer Specialists of Oklahoma 28.32 $154.22 $270.00 $115.78

CT, thorax; without and with contrast Lawton Imaging Center 28.06 $400.00 $1,938.48 $1,538.48


Traveled

Premier

Price

Historical Svc

Allowable

Possible Savings

Per Service


03/01/2012 - 08/31/14



CT, pelvis; without and with contrast Lawton Imaging Center 28.06 $400.00 $2,026.76 $1,626.76

CT, abdomen; without and with contrast Lawton Imaging Center 28.06 $400.00 $1,558.96 $1,158.96





Perc cardiovasc proc with drug-eluting stent w/o MCC Oklahoma Heart Hospital South 25.87 $22,294.36 $50,642.88 $28,348.52


MRI, orbit, face, and/or neck; without contrast Oklahoma Surgical Hospital 24.23 $670.00 $1,310.42 $640.42





CT, soft tissue neck; with contrast Oklahoma Surgical Hospital 23.44 $350.00 $1,356.24 $1,006.24





Removal of tunneled central venous access device Surgery Center of Oklahoma 21.72 $1,850.00 $4,712.90 $2,862.90




Arthrodesis, great toe; metatarsophalangeal joint Surgery Center of Oklahoma 21.45 $4,125.00 $6,778.82 $2,653.82





Open treatment of distal fibular fracture Austin Surgical Hospital 21.33 $8,704.14 $32,599.13 $23,894.99











Ultrasound, abdominal; limited Comprehensive Diag Imaging 20.52 $193.80 $450.36 $256.56




Ultrasound, soft tissues of head and neck Comprehensive Diag Imaging 19.75 $217.20 $517.23 $300.03

DXA, bone density study Comprehensive Diag Imaging 19.75 $83.50 $478.86 $395.36




Correction, hallux valgus (bunion), w/ or w/o sesamoidectomy Surgery Center of Oklahoma 19.24 $4,125.00 $24,747.56 $20,622.56




Synovectomy, tendon sheath, radical Surgery Center of Oklahoma 18.95 $2,950.00 $7,132.45 $4,182.45






CT, thorax; with contrast Envision Imaging of Tulsa 17.29 $325.00 $1,381.73 $1,056.73

CT, abdomen and pelvis; without and with contrast Envision Imaging of Tulsa 17.29 $475.00 $2,753.44 $2,278.44

CT guidance for placement of radiation therapy fields Cancer Specialists of Oklahoma 16.95 $84.88 $161.25 $76.37

Special teletherapy port plan, particles, hemibody, total body Cancer Specialists of Oklahoma 16.95 $98.65 $298.35 $199.70

Irrigation of implanted venous access device for drug delivery systems; 1 tx Cancer Specialists of Oklahoma 16.95 $25.82 $73.74 $47.92

MRI, brain (including brain stem); without and with contrast Comprehensive Diag Imaging 16.78 $967.00 $3,583.50 $2,616.50




CT, maxillofacial area; without contrast Comprehensive Diag Imaging 16.27 $369.00 $1,209.68 $840.68


CT, abdomen and pelvis; without and with contrast Comprehensive Diag Imaging 15.89 $667.50 $2,753.44 $2,085.94

Mastectomy; partial Deaconess Hospital 15.87 $5,897.50 $16,218.93 $10,321.43

Venipuncture, for diagnostic or therapeutic purposes; 20 tx Cancer Specialists of Oklahoma 15.87 $333.00 $564.00 $231.00


Therapeutic radiology treatment planning; complex Cancer Specialists of Oklahoma 15.87 $180.37 $674.10 $493.73

Therapeutic radiology simulation-aided field setting; simple Cancer Specialists of Oklahoma 15.87 $189.84 $418.29 $228.45


Traveled

Premier

Price

Historical Svc

Allowable

Possible Savings

Per Service


03/01/2012 - 08/31/14



Therapeutic radiology simulation-aided field setting; complex (2 tx) Cancer Specialists of Oklahoma 15.87 $1,109.32 $2,400.04 $1,290.72

3-dimensional radiotherapy plan, including dose-volume histograms Cancer Specialists of Oklahoma 15.87 $482.89 $1,740.00 $1,257.11

Basic radiation dosimetry calculation, central axis depth dose calc (3 tx) Cancer Specialists of Oklahoma 15.87 $215.82 $661.65 $445.83

Treatment devices, design and construction; complex; 4 tx Cancer Specialists of Oklahoma 15.87 $644.44 $2,933.08 $2,288.64

Cont. med physics consult, including assessment of tx parameters; 5 tx Cancer Specialists of Oklahoma 15.87 $225.20 $1,102.30 $877.10



Therapeutic radiology port film(s); 4 tx Cancer Specialists of Oklahoma 15.87 $58.52 $642.40 $583.88

Radiation treatment management, five treatments; 7 units Cancer Specialists of Oklahoma 15.87 $1,411.20 $1,754.06 $342.86

Special treatment procedure Cancer Specialists of Oklahoma 15.87 $167.25 $500.00 $332.75

PET Image w/CT; skull base to mid-thigh (2 tx) Cancer Specialists of Oklahoma 15.87 $2,403.24 $9,574.40 $7,171.16



Intravenous infusion, hydration; each additional hour (2 tx) Cancer Specialists of Oklahoma 15.87 $32.42 $219.72 $187.30

Intravenous infusion, for therapy, prophylaxis, or diagnosis Cancer Specialists of Oklahoma 15.87 $75.55 $135.00 $59.45

Intravenous infusion, for therapy, prophylaxis, or diagnosis, addt; 8 tx Cancer Specialists of Oklahoma 15.87 $271.36 $1,200.00 $928.64


Therapeutic, prophylactic, or diagnostic injection; 29 tx Cancer Specialists of Oklahoma 15.87 $925.77 $3,345.50 $2,419.73

Therapeutic, prophylactic, or diagnostic injection; ea addt; 2 tx Cancer Specialists of Oklahoma 15.87 $47.20 $204.48 $157.28





Repair of tunica vaginalis hydrocele (Bottle type) Oklahoma Surgical Hospital 15.10 $3,245.00 $6,536.33 $3,291.33

Biopsy or excision of lymph node(s) Surgery Center of Oklahoma 14.93 $2,255.00 $9,934.61 $7,679.61

Injection(s), of diagnostic or therapeutic substance(s), epidural; cervical Northwest Surgery Center 14.43 $1,525.00 $2,317.28 $792.28







Incision, extensor tendon sheath, wrist Surgery Center of Oklahoma 13.88 $2,915.00 $5,874.12 $2,959.12

Arthroplasty, interposition, intercarpal or carpometacarpal joints Surgery Center of Oklahoma 13.88 $4,650.00 $5,737.19 $1,087.19





Injection, anesthetic agent; brachial plexus, single Surgery Center of Oklahoma 13.88 $1,200.00 $6,201.20 $5,001.20





Arthroscopy, knee, surgical; with meniscectomy Oklahoma Surgical Hospital 13.14 $4,460.00 $13,742.15 $9,282.15






CT, abdomen and pelvis; without contrast Comprehensive Diag Imaging 11.88 $332.00 $2,003.37 $1,671.37

Ostectomy, partial excision, fifth metatarsal head Surgery Center of Oklahoma 11.84 $4,125.00 $13,427.11 $9,302.11








Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic Surgery Center of Oklahoma 11.42 $2,150.00 $10,616.56 $8,466.56






Placement of breast localization device(s) percutaneous; first lesion Breast Imaging of Oklahoma 9.95 $411.29 $4,641.12 $4,229.83


Incision, extensor tendon sheath, wrist Surgery Center of Oklahoma 9.80 $2,915.00 $5,874.12 $2,959.12


Biopsy or excision of lymph node(s) Surgery Center of Oklahoma 9.59 $2,255.00 $9,934.61 $7,679.61


Laparoscopy, surgical; cholecystectomy Surgery Center of Oklahoma 9.59 $5,865.00 $10,426.19 $4,561.19



Arthroscopy, shoulder, surgical; capsulorrhaphy South Austin Surgery Center 8.86 $6,000.00 $17,808.93 $11,808.93


Traveled

Premier

Price

Historical Svc

Allowable

Possible Savings

Per Service


03/01/2012 - 08/31/14



















Ultrasound, abdominal; limited Comprehensive Diag Imaging 7.07 $193.80 $450.36 $256.56



Therapeutic procedure, 1 or more areas, each 15 minutes; 12 tx Penney Rehab & Wellness Center 5.63 $900.00 $1,318.56 $418.56

Major joint replacement or reattachment of lower extremity w/o CC Northwest Surgical Hospital 5.52 $19,400.00 $93,905.99 $74,505.99


PET Image w/CT; skull base to mid-thigh (4 tx) Cancer Specialists of Oklahoma 5.26 $4,806.48 $19,148.80 $14,342.32



Arthroscopy, shoulder, surgical; biceps tenodesis Orthopaedic Surgery Center 4.93 $11,644.43 $25,324.16 $13,679.73


Laminotomy (hemilaminectomy), with decompression of nerve root(s) Oklahoma Surgical Hospital 4.59 $6,851.00 $15,806.75 $8,955.75

Conization of cervix, w/ or w/o fulguration/d & c/repair Surgery Center of Oklahoma 4.11 $2,500.00 $6,768.66 $4,268.66


Arthroscopy, knee, surgical; with lateral release McBride Orthopedic Hospital 4.10 $4,510.00 $10,753.81 $6,243.81




MRI, pelvis; without contrast McBride Orthopedic Hospital 4.10 $600.00 $3,654.40 $3,054.40




Breast reconstruction, immediate or delayed, with tissue expander Surgery Center of Oklahoma 4.09 $5,555.00 $19,724.65 $14,169.65



Arthroscopy, knee, surgical; with meniscectomy Surgery Center of Oklahoma 4.09 $3,740.00 $13,742.15 $10,002.15





Probing of nasolacrimal duct, w/ or w/o irrigation; w/balloon dilation Surgery Center of Oklahoma 3.96 $2,520.00 $3,437.44 $917.44











124.31Average Miles Traveled:

We have heard many times from our bankers, “What does my risk category mean and how do you calculate my rate increases year to year?” Below you will find a thorough explanation of what your rate means and what the actuary, Milliman, uses to calculate it.

What Are Risk Categories? AHPT has designed an innovative way of determining rates; to

not only offer competitive pricing to our community banks, but

also to shield them from volatile rate increases. Each bank in

AHPT shares the risk among all 140+ banks in order to combat

market volatility.

AHPT’s rating structure is based on ten risk categories which

are numbered and color-coded. The “0” rate bucket is the

average rate with numbers going higher for banks with higher

risk, and going lower for banks with lower risk.

What Does My Bucket Mean? Your bank’s risk category indicates your bank’s health “risk.” Your risk is calculated on many factors that include everything from the demographics of your group, to your location, to what health conditions exist in your bank and the drugs used to treat them.

What Factors Are Used To Determine My Risk? Calculating a bank’s risk factors involve looking at multiple factors. Contrary to popular belief, your claims history accounts for a very small portion of the information that is used to calculate your future bucket and increases.

1) Morbidity Score - up to 50%

Your morbidity score includes health factors, diagnoses, and prescriptions, which indicate ongoing, potentially expensive conditions. “Shock” claims that have little future health impact are not included in this score.

2) Demographics Score - up to 50%

The demographics of your group include such items as average age of the group as a whole, gender makeup, coverage tier of each member (single vs. family), location, and number of employees in each age group.

3) Claims/Loss Ratio – 0% - 75%

Depending on your group size, your claims can count for as little as 0% of your risk assessment, up to 75%. Loss ratios are not an effective measure of overall health for many groups. If you have under 100 covered lives, your loss ratio will account for a very small percentage of your bucket calculation. If you have under 25, it will count for 0%.

How Are Rate Increases Calculated? 1) The Rate Increase Needed for the Trust

First, the rate increase necessary for the entire Trust is calculated. This is calculated on claims verses premium or loss ratio or dollars in, dollars out. The amount Milliman calculates we will need for claims in the following year is added to the current contributions and then distributed among the banks.

2) Your Bucket – Stay put, move up, or move down

Using your bank’s specific risk factors, it is determined if your bank will move up or down a bucket for the following year. Due to risk sharing, you can only move up or down ONE bucket per year and only move a bucket if it is determined that the bank’s risk indicates a bucket shift of MORE than one bucket. For example, if Milliman indicates a bank should move from a “0” to a “+1”, the bank will stay at a “0”. If Milliman indicates that a bank should move from a “0” to a “+2”, then the bank will move to a “+1”.

3) The Total Rate Increase

The Trust increase and the risk category are then added together to come up with the total rate increase for a particular bank. If the Trust increase is a 12% and the bank moves up a bucket, the difference in cost will be added to the 12%. If the bank is going down a bucket, the difference in buckets will be subtracted from the 12%.

Rate Bucket Quick FAQ ✔ No matter how good or bad a claims year you have

had, you can only move ONE bucket per year.

✔ Your bank is only moved up or down a bucket if,

without the risk share of AHPT, you would have moved more than one bucket.

✔ Your bucket is not based on Loss Ratio

✔ You can lower your bank’s risk by employing Go for

Green strategies

Tips to help you use your Plan

**HSA qualified plans must meet deductible prior to 100% coverage benefits If you have other health insurance, please call us at 1-800-521-1711

Customer Service & Online Services If you don’t know whether something is covered, ask us! Send us an email or give us a call, we are here to help you.

Main Number: 1-800-521-1711 Customer Service Direct: 1-800-324-9396 Email: [email protected]

Visit us anytime at www.advantagehealthplans.com. Get

education and information about your plan, view current claim status, EOBs, deductible and out-of-pocket balances, PPO information, and much, much more. Keeping up with your health plan can be as easy as keeping up with your friends. Like us on Facebook!

Advantage Premier ProvidersTM The Trust has contracted with a select group of providers to provide services to our participants at greatly reduced rates! These rates are so much lower, in fact, that your Trustees voted to make this an enhanced benefit in order to save your Plan money. When you use an Advantage Premier ProviderTM for a covered surgery or medical service the Plan will pay the Covered Charges at 100%. And you will

save your Plan up to 70%! To learn more and read the terms and conditions, please visit our website.

Rx Benefits Free OTC Drugs! AHP offers coverage for certain over-the-

counter medications for FREE! The following over-the counter medications are available under this benefit:

Zantac 75, Tagamet HB, Axid AR and Pepcid AC; Prilosec OTC (14, 28 and 42 day supply) Claritin/D / Loratadine/D Zyrtec (cetirizine) and Zyrtec-D 12 Hour (cetirizine/pseudoephedrine) Prevacid (lansoprazole) Zegrid OTC (Omeprazole OTC) Allegra OTC Allegra-D Nexium 24HR

Obtain a written prescription from your doctor for the OTC medications above and take the OTC prescription to a pharmacy to have it filled. Tell the pharmacist that your prescription drug plan does offer coverage for OTC medications on the list above. Therapeutic Alternatives? Did you know that, there are many generic and therapeutic equivalent medications that you could be getting for FREE or for a greatly reduced co-pay? Find out whether your name brand

medication has a therapeutic alternative by visiting www.advantagehealthplans.com.

MRI’s and More for Free! Did you know you are not required to use the imaging center your doctor recommends for CAT, PET, and MRI scans? Get concierge service and NO out-of-pocket by calling One Call! When you call, not only will they help you locate a provider near you and book the appointment for you, but it will be at no cost to you! If you use OneCall to book your imaging appointment, it will be paid at 100%!

Lab Benefits at 100% Let your doctor know that if you use a LabCard lab provider, your lab charges will be paid at 100%! Check www.advantagehealthplans.com for locations and instructions.

Diabetes Management You can get a free glucose monitor and discounted supplies! Call Edgepark at 1-800-321-0591, and they will send you a no-charge monitor kit. Visit www.advantagehealthplans.com to learn more!

Maternity Management This program is designed to promote healthy pregnancies by identifying any risk factors that could cause early delivery or a low birth weight baby. Did you know you can get free education materials and free baby items if you are pregnant and join our Maternity Management program? As soon as the physician confirms the pregnancy, the mother-to-be, calls the Prenatal Nurse line at 1-866-978-2029, extension 590, between the hours of 8 a.m. and 4 p.m. (CST), Monday through Friday.

Care Management Care Management identifies members who have been diagnosed with a serious illness, works collaboratively with their physicians and providers to develop plans to address the patients’ needs and coordinate care. The assigned Care Manager, who is a registered nurse, evaluates the member’s medical condition, develops and executes a plan of care, coordinates community resources in lieu of benefits and monitors progress for the maximum health potential. The Case Managers serve as the advocate and liaison between members and all providers and are available 24 hours a day, 7 days a week.

Pre-Certification Pre-certification is required for all in-patient hospitalizations, out-patient surgeries and sleep studies. Will your procedure require an operating room or sterile environment? If so, then it probably requires pre-certification. Any procedure done in an operating room or sterile environment setting; whether or not it is a cutting procedure, requires pre-certification.

Know Before Your Surgery Does your surgery require an implantable item? Some examples of implantable items are things like pins, screws, plates for joints and pacemakers. If so, talk to your doctor and surgical team beforehand. AHPT requires an invoice for this to be a covered charge and reimbursement is limited to twice the invoice cost to the provider. This requirement is in place to protect you and your Plan against outrageous markups common on these items.

http://advantagehealthplans.com/Contact.php

http://advantagehealthplans.com/Contact.php

mailto:[email protected]

http://www.facebook.com/pages/Advantage-Health-Plans-Trust/156752434002

http://www.advantagehealthplans.com/

http://advantagehealthplans.com/pdf/2010%20Mother%20and%20Child.pdf

NO COST TO YOU!THAT’S RIGHT, A 100% BENEFIT.

Free surgeries such as a knee replacement? Free labs, MRI/PET/CAT scans, and over the counter drugs? That’s right. Keep reading to learn more how you can get 100% covered benefits!

13431 N. Broadway • Suite 130 • Oklahoma City, OK • 731141.800.521.1711 • www.advantagehealthplans.com

©2013 Advantage Health Plans Trust

The Trust has contracted with a select group of providers to pro-vide services to our participants at greatly reduced rates! These rates are so much lower, in fact, that your Trustees voted to make this an enhanced benefit in order to save your Plan money. When you use an Advantage Premier Provider for a covered sur-gery or medical service the Plan will pay the Covered Charges at 100%. And you will save your Plan up to 70%! To learn more and read the terms and conditions, please visit our website.

Free ScanS through onecall!Has your doctor recommended an MRI, CAT scan or PET scan? Book your appointment with a OneCall provider and it will be covered at 100%. Just call 1-888-458-8746 and talk to a helpful and friendly OneCall representative to get started.

Free labwork through labcard/QueSt diagnoSticS! When you need labwork, let your doctor know that your labwork will be covered at 100% if a LabCard/Quest Diag-nostics lab is used!

Free over-the-counter drugS! AHP offers coverage for certain over-the-counter medications for FREE!

✔✔ Zantac 75, Tagamet HB, Axid AR and Pepcid AC✔✔ Prilosec OTC (14, 28 and 42 day supply) when used as the legend version for Prilosec or Omeprazole which

are available only by prescription;✔✔ Claritin/D / Loratadine/D✔✔ Zyrtec (cetirizine) and Zyrtec-D 12 Hour (cetirizine/pseudoephedrine)✔✔ Prevacid (lansoprazole)✔✔ Zegrid OTC (Omeprazole OTC)✔✔ Allegra OTC✔✔ Nexium 24 Hour

©Copyright 2013

Type Procedure Name Incentive

Diagnostic Colonoscopy $200

Diagnostic Upper GI Endoscopy $200

Diagnostic Sleep Study $100

Outpatient Cataract Surgery $100

Cardiac Doppler Exam Of The Heart $50

Cardiac Heart Echo Imaging $50

Cardiac Heart Perfusion Imaging $100

GO GREEN TO GET GREEN!

WHAT ARE GREENPLUS REWARDS?

Cash rewards for employees and their families who use Healthcare Blue Book to shop for green or fair price providers for specific procedures

GreenPlus is incorporated directly into Healthcare Blue Book for approved procedures

Just follow a simple rule: Go Green to Get Green!

Selecting a green provider for select procedures qualifies you for a reward

Healthcare Blue Book identifies reward eligibility and sends the reward directly to the employee

No forms for employee to submit

WHAT PROCEDURES EARN GREENPLUS

REWARDS?

Procedures that have the highest cost variability between providers have been chosen to earn rewards

Rewards are between $50-$200 based on the savings to your Plan

The list of procedures that can earn you rewards is at www.advantagehealthplans.com

HOW DO I EARN CASH REWARDS?

Earn cash rewards by visiting green providers! When you or your family visits a cost effective provider you will receive a quarterly cash reward. You are eligible to receive multiple rewards for procedures rendered on the same day. You can also receive more than one reward within a billing cycle for eligible procedures. HAVE QUESTIONS?

GreenPlus support can be accessed at any time by sending an email to [email protected]. A Healthcare Blue Book representative will respond to your email Monday through Friday during regular business hours (8am to 5pm CT).

www. .com advantagehealthplans

1-800-521-1711

WEBSITEINFORMATION

Have you visited our website lately? If not, you’re missing out! We designed our site with you in mind. Not only can you view all of your claims and EOBs, but you’ll find a wealth of information at your fingertips, accessible anytime.

You can even email customer service or request information, and our award-winning team will get back to you quickly. Check it out today and find out just now easy accessing your health plan can be, at www.advantagehealthplans.com.

www.advantagehealthplans.com

RegisteR today! HeRe’s How:1. Go to www.advantagehealthplans.com2. Click the red and blue “MyAHP” button3. Read the introduction, then click “Get Started” 4. Click the bottom “Register” button5. Enter your user type, group ID (found on the

back of your ID card), and social security num-ber

6. Complete the personal information section on the next screen. You will need to specify a pass-word and security question in case you forget your password.

7. You are registered!

wHat Can you View online?✔ Current Claims Status

✔ Explanation of Benefits (EOB)

✔ Deductible Balances

✔ Out-of-pocket Balances

✔ Section 125 Claims

✔ PPO Information

✔ Premier Provider Qualified Procedures & Locations

✔ 100% Benefit Information

✔ Frequently Asked Questions (FAQs)

✔ Maintenance Drug Lists

✔ Over-the-counter Drug Lists

13431 N. Broadway • Suite 130 • Oklahoma City, OK • 731141.800.521.1711 • www.advantagehealthplans.com

Documents

2014 Annual Member Group Meeting - Advantage … AHP Member...2014 Annual Member Group Meeting 9/13/2014 1 Chairman Roi Nelson Trustee Guy Sims Trustee Jeff Nunn Trustee Lynn Kinder