FAQs

Am I eligible under this health plan?
Is a specific service/procedure covered?
What amount of the bill am I responsible for?
I've lost my card. How do I get a new one?
Are my children covered under the health plan?
What if my child is away at college, is he or she covered?
What is the difference between my cost if I see an out-of-network provider?

You can find this information under the group section of our site.  Click here to login into the group section.

Am I eligible under this health plan?
I've lost my card. How do I get a new one?
What if my child is away at college,  is he or she covered?

You can find this information under the group section of our site.  Click here to login into the group section.

Do I need a referral to see this provider?
Do I need to have a precertification for this service?

You can find this information under the group section of our site.  Click here to login into the group section.

Is my doctor in the network?
How do I find a specialist in my neighborhood?

Click here to find information about your provider.

Is the member eligible under this health plan?
What is the member's co-pay or co-insurance? Is there a deductible?
Is the service we provide covered under the member's benefits?

Each member’s ID card will have the name, address and phone number of the third-party administrator who processes claims and manages eligibility. Please contact them directly for eligibility information. For assistance in finding the correct third-party administrator, click here.

Click here to find more information on joining HealthSpan.

Please contact the third-party administrator directly with claims issues. If you are unable to get your claim issue resolved, click here for information on claims reimbursement appeals.

Do I need to get/give a referral for this service?
Do I need to have a precertification for this service?
How do I get preauthorization for this service?
How do I check on the status of an authorization?
Who do I contact to get more days authorized?

The information can be found in the group section of our site.  Click here to login into the group section.

HealthSpan provides the following services:

• Network Access through the HealthSpan Preferred Network includes substantial negotiated savings on hospital, physician and ancillary services.
• Complete Care Management Services including Utilization Management, Case Management, Disease Management, Nurse Health Coaching (e-based or telephonic), and On-site Wellness, which includes Health Screening and Health Risk Assessment, and Data Management, including predictive modeling with evidence based medicine protocols.
• On-site Wellness Options, which provide the tools to improve employee health and productivity, and assist in controlling the cost of health care expenditures.
• Employee Assistance Program (Life Management Systems) provides assessment, brief counseling and referral assistance to the client's employees and their household members regarding all types of personal and emotional concerns. This program provides formal training for compliance with the Ohio Bureau of Workers' Compensation Drug-Free Workplace Program and the U.S. Department of Transportation regulations.

HealthSpan offers carrier competitive discounts.  Please contact Sales Managers, Chris Crapsey  at 513-551-1472 or Diane Oliver at 513-551-1473 for more information.

The TPA may use their repricing vendor, if approved by HealthSpan, or HealthSpan can direct the client to an approved vendor.

HealthSpan is open to working with quality TPAs and wants to be sure the relationship will be a positive one. As mentioned before, we ask the TPA to complete an RFI and this information is reviewed by our management team. Setup time is determined by many factors.

Many TPAs have their own relationships with networks in other markets, be they primary networks, wrap or travel networks. HealthSpan is happy to make a recommendation upon request.

We believe the best way to impact overall health cost is through a combination of excellent discounts and focused care-management services. Therefore we believe a fully integrated approach best serves our customers. When the client is based in Greater Cincinnati and the majority of employees reside in this market, HealthSpan's Care Management is required.

We understand that some of our TPA partners may also offer Care Management services. We are open to discussing case by case situations when the prospective customer's employee base in largely out of our service area and when unique opportunities are presented.
 

Yes, HealthSpan's Care Management services are a stand-alone product and can be utilized nationally.

HealthSpan offers clients the choice of three HIPAA compliant Wellness options. These options can be purchased with the Network, the Care Management program or on a stand-alone basis.

Please contact one of our Sales Managers to determine which option is the best for your client.

Available features include:

• On-site biometric health screenings with blood draw, testing every organ of the body, and includes PSA and thyroid tests
• Health Risk Assessment tool available by paper and online
• An interactive web site
• Confidential employee test results provided online and in hard copies
• Employer aggregate report
• Nurse/coach follow up
• HealthSpan E-Coach

HealthSpan provides the following advantages to the customer:

• Excellent and consistent network stability as evidenced by physician retention of 98%
• Strong commitment to health and wellness with solutions and tools that improve the health of our clients' employees
• Client is assigned his/her own nurse/health coach who provides members actionable assistance in improving health (i.e., diabetes, weight, smoking cessation) as well as the traditional services of utilization review and case management
• Local provider ownership offers a cost-effective option for employers who want responsive service as well as savings
• Excellent reputation with employers, brokers, TPAs and providers

Please contact our Sales Managers, Chris Crapsey at 513-551-1472, lccrapsey@health-partners.org or Diane Oliver at 513-551-1473, dmoliver@health-partners.org.
HealthSpan's Toll-Free number is 888-914-7726.

Provides you with tools and resources to enable you to actively participate in your health and healthcare. The program is designed to meet your needs by allowing you to choose the type and extent of information and support that is best for you.

You can have access to a Personal Nurse Coach for support, education and guidance.

You will receive health tips, reminders, or targeted e-mails.

You will have access to a Web site to provide you with information to assist you in self management of life style changes and/or chronic condition management.

Web Based or Booklet Form self management programs for chronic conditions may be available to you. Contact a HealthSpan Personal Nurse Coach for details.

You will control the amount of contact with your Personal Nurse Coach. You can choose no telephonic contact to weekly/monthly/quarterly depending on your needs.

Personal Nurse Coaches are licensed nurses with additional training in health coaching who become actively involved with you in your health, treatment and recovery process. They evaluate all the information related to your condition, and work with you, your family, your physician, and other care providers to promote the best possible outcome.

The goal of Personal Nurse Coaches is to promote wellness by educating and empowering you to make healthy life style decisions, assisting you with setting attainable goals, develop an agreed upon plan to reach those goals, and assist you to collaborate with your physician and health care providers in meeting these goals.

Personal Nurse Coaches are assigned to specific employer accounts. They are available to act as your advocate and educator to ensure you are an informed consumer in care decisions.

Personal Nurse Coaches are available to support your changing needs, from facilitating precertification to providing information and education about your acute illness or ongoing condition.

Personal Nurse Coaches collaborate with your Third Party Administrators (claims administrators), stop loss carrier, and healthcare providers to coordinate information crucial to your benefits and health care determinations.

Personal Nurse Coaches shall not disclose to, or discuss your confidential information with any other person or entity, inside or outside of HealthSpan, unless required for legitimate business purposes or to meet state or federal requirements.

Personal Nurse Coaches do not provide names or directly identify your confidential information with your employer.

Works with you to help reduce symptoms associated with chronic disease.

Works with you to improve your overall health and quality of life.

Works with your doctor to minimize the occurrence of complications and hospitalizations.

Works with you and your physician to ensure the most appropriate use of your healthcare benefits.

Provides you with education, resources, motivation and support to achieve health habit improvements.

Helps your doctor arrange for care across multiple HealthSpan providers, facilities and other care settings.

Call HealthSpan at 1(800) 972-7726 to talk directly to a Personal Nurse Coach.

If mailed a consent form, sign it and return to HealthSpan immediately.

Remember, at any time you can contact your benefits manager or Human Resources for HealthSpan’s phone number and request Personal Nurse Coach services.

If you have questions regarding your treatment plan or diagnosis.

If arrangements for care support (home health, transportation, medication pick-up, etc.) fall through.

If you plan or incur a hospitalization.

If you are thinking you may need to go to the Emergency Room.

If you need information about available community resources.

If you need assistance in arranging for care. 

If you need someone who will be an active listener, and there for your in a difficult time.

HealthSpan E-Coach is a unique personalized tool that may be available to assist you in achieving your specific health and lifestyle goals. By working with your own personal nurse health coach, you will be able to identify the goals appropriate for you and access resources including tracking mechanisms, articles, and daily messages.

To find out if you are eligible for HealthSpan E-Coach and how to enroll please contact HealthSpan Medical Management at 513-551-1420 or 1-800-972-2276 and ask to speak to a Case Manager for information about HealthSpan E-Coach. You may also go to www.healthspane-coach.com where you can take a tour and learn more about the site.