The third party administrator (TPA) that the State employs
to pay your healthcare bills is AETNA. This change was effective as of January 1,
2014. Your medical bills are administered in accordance with AETNA’s
policies and procedures.
You need to
pre-certify for many of the medical procedures. Under AETNA
there are 26 procedures that require pre-certification. Your provider is
required to accomplish the pre-certifications if he/she/they are
“in-network”. If the provider is not in-network, you will have to do the
pre-certification and if you have the procedure done out of network, the
amount that will be paid by Select Benefits will be a lesser amount. You
should make sure your provider is a members of the AETNA
network. If you have a procedure scheduled make sure that you have pre-certified.
The penalty for not pre-certifying can be very costly.
Editorial on the AlaskaCare Health Plan. It discusses
changes to who takes the financial risk of paying health claims, determining how
much to charge for premiums, and who handles the appeals and grievances.
for state to retake control of AlaskaCare Feb 15, 2015