Choice Strategies partners with select Insurance Carriers to offer a direct, provider pay plan option to our employers. The Insurance Carriers, listed below, provide Choice Strategies with automated data feeds with condensed member claim information and medical provider billing information, on a regularly scheduled basis.
- Tufts Health Plan
- Harvard Pilgrim Health Care
The Data feeds allow Choice Strategies to process paperless claims and make payments to the medical provider on behalf of the member, via check. Please see the visual below for the provider pay process.
Provider pay models enable Choice Strategies to offer a Co-Share plan design, also known as “Percentage Pay”. With a Co-Share plan design, employers can choose to reimburse a predetermined percentage of each deductible claim up to the maximum annual election. For example, if the employer chooses to pay 75% of each claim, and an employee goes to the Doctor’s office and incurs a $100 expense, Choice Strategies will make a $75 payment to the provider. The medical provider processes the payment towards the member’s invoices and then issues a bill for the remaining balance. In this example, the employee would receive a bill for $25.
Members can see all payments made by logging in to their Choice Strategies Participant Portal via our website: www.choice-strategies.com.