How Does OSF Direct Access Network Relate to My Health Benefit Plan?
OSF Direct Access Network (DAN) is a Preferred Provider Organization (PPO) Network designed to help to control the cost of health care by offering special pricing for medical services to members participating in your employer's medical plan.
Your benefits are designed to encourage you to use these contracted providers. Benefits MAY be available when you choose an out-of-network provider, at a REDUCED benefit to you. You may be subject to higher out-of-pocket expenses, lower benefit levels, or possibly no coverage at all.
The insurance card provided by your plan's Third Party Administrator (TPA) contains important information such as telephone numbers, pre-certifying procedures, and information on co-pays and deductible. Present your card to your OSF DAN medical provider, who will assist you in keeping medical services in-network.
Consult your plan's Summary Plan Description, contact your company's benefit administrator, or contact the TPA noted on your insurance identification card.
How It Works
OSF DAN providers will file claims to your plan's TPA. You may be asked to pay co-payments, co-insurance, and/or deductibles at the time of service. The TPA processes your medical claim by applying your plan's appropriate benefit levels and reimbursing the provider for services.
You will be sent an Explanation of Benefits (EOB) from the TPA that gives full detail of the processing of the claim, including any special pricing from OSF DAN. The provider may then bill you for any services not covered under the plan, including your remaining deductibles and co-insurance.
REMEMBER to contact your company's benefits department or the TPA noted on your insurance card for any questions relating to your plan's benefits and reimbursements.
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