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Q. Who is CAI?
A. CAI helps companies contain their healthcare costs by identifying
and accessing Preferred Provider Organizations (PPOs) which allow
the greatest coverage, discounts, and ease of access. This approach
helps reduce both the employer's and their employee's healthcare expenses,
resulting in the same quality of care at less cost!
CAI assembles the best combination of PPOs for employees based on
employee location and the providers at which employees have traditionally
spent healthcare dollars. These PPOs allow employees to access the
full spectrum of healthcare services (acute care hospitals, substance
abuse facilities, mental health facilities, laboratories, rehabilitation
centers, surgical centers, physicians, chiropractic services and other
specialties) at discounted rates. Additionally, CAI provides direct
negotiations for any bills not discounted through a PPO relationship,
resulting in greater savings for your company and you.
Q. Are you an insurance company?
A. No. Coalition America is not an insurance company, nor are we the
payor or a PPO. Our clients retain CAI to perform administrative services
in processing medical bills. We coordinate repricing of medical claims
using the appropriate PPO fee schedules, as well as negotiations on
out-of-network bills. We do work with many insurance companies on
behalf of employers.
Q. What is a PPO?
A. PPO is a group of physicians and hospitals that have agreed to discount
arrangements in exchange for increased patient volume. As competition
grows in the healthcare market, physicians and hospitals join PPOs
that will provide them with enough patients to sustain and enhance
their practices. Being a part of a PPO program does not limit your
freedom of choice in selecting a provider for treatment.
Q. How does CAI's service apply to me?
A. With PPOs in place, CAI will be able to lower the cost of most
provider claims, resulting in savings to the employee. Additionally,
CAI can help reduce your out-of-pocket expenses if you seek care from
a provider not in your Primary PPO.
Q. What if I go to a provider that does not belong to an affiliated
A. In cases where an employee visits a non-preferred physician or
hospital, CAI will attempt to negotiate and/or establish a contractual
relationship with the provider in order to achieve savings.
Q. How will I see savings in my healthcare expenses?
A. When you receive your EOB (Explanation of Benefits), there will
be a line item that states "ineligible amount", meaning
the amount that CAI has saved on your out-of-pocket expenses.
If you are a patient, plan participant or policy holder, please contact
your plan administrator and/or employer for questions about your insurance
plan, adding providers or questions about claims.
Q. Will the provider bill me for any of the discounted fees?
A. No. The PPO contracts and any direct negotiations by CAI preclude
the provider from "balance billing" you for any of the discounts
taken on your behalf. This does not include any copays, deductibles,
coinsurance or non-covered medical services for which you may be responsible.
If this balance billing should occur contact your plan administrator