Frequently asked questions
1) Who is my insurance carrier?
The PPO plans for The Texas Annual Conference are self-funded plans, which means there is not a traditional insurance carrier associated with the plan. The Conference funds the claims. When a provider asks you who is your insurance carrier, let them know that Aetna (as indicated on your ID card) is the PPO and Boon-Chapman is the claims administrator. Your ID card identifies where they should mail the claims.
2) How do I handle a claim problem?
Call the vendor that handles the benefit in question. You should receive a written response in 3 weeks or less. If you are appealing a claim decision, you must send these in writing.
The address is:
Boon-Chapman Benefit Administrators
P.O. Box 9201
Austin, TX 78766
If you still disagree with the vendor’s payment after you receive the response to your written appeal, you can send an appeal letter to Ms. Barbara Kilby, Health and Pension Benefits Administrator, 5215 Main St., Houston, TX 77002.
3) What services require preauthorization?
The following services require preauthorization:
Skilled Nursing Facility admission
Outpatient Procedures-Arthroscopy, Blepharoplasty, Cardiac Catherization/Surgery, Carpal Tunnel Surgery, Septoplasty
Diagnostic Tests-Computerized Tomography (CAT scan), Magnetic Resonance Imaging (MRI)
Durable Medical Equipment
Home Health Care
Substance Abuse Treatment or Services
4) Who reviews the preauthorization or precertification?
PRIME Dx handles all reviews of preauthorization or precertification.
You may call PRIME Dx at (800) 477-4625, Monday thru Friday, 8:00 AM-5:30 PM. Voicemail is available after business hours, and messages are returned the following business day. Fax number is (800)213-5108.
5) What is case management?
PRIME Dx will assign a registered nurse case manager when a patient’s condition requires complex, specialty or long-term care. The case manager will attempt to coordinate healthcare services through direct interaction with the patient, family or physician’s office, in an effort to achieve quality, and the most appropriate medical care in a cost-effective manner. Your case manager will send you a letter that provides you with information about case management services, as well as his/her contact information.
You may call your assigned case manager at 1-800-477-4625.
6) What pharmacies are in my prescription drug network?
Script Care’s network includes over 60,000 pharmacies including all major chains. A full pharmacy listing can be found at www.scriptcare.com.
Script Care Customer Service phone number is 1-800-880-9988, or you can email your questions to firstname.lastname@example.org. Customer service is open 24 hours a day, 7 days a week.
7) How do I find out how much a specific drug will cost me?
A copay calculator is available on Script Care’s website at www.scriptcare.com.
8) Where can I find out about adoption services?
Visit the the Policies & Plan Documents page under the Useful Information section of this site and look for Policy 145 Baby Adoption for more information.
9) I’m covered under my spouse's medical plan. Can I still participate in the Day of Wellness?
Yes, you are eligible for incentives and reimbursement of registration fees.
10) Who can I contact if I have more questions?
Go to the Useful Information section of this site and click on Who to Contact for a complete list of contact information.
11) I am turning 65 next month and will continue to work full time. What do I need to do?
You need to register for Medicare Part A (hospital insurance, usually free). Tell the Social Security Office that you will defer enrollment in Part B because your employer plan will continue to cover you. When you eventually retire, there will be no penalties for you to enroll in Part B or Part D.
12) Who is PrimeDx and when do I need to contact them?
PrimeDx is the Utilization Management company. They would need to be called to precertify or get authorization for inpatient hospital stays and certain outpatient services, as well as when pregnant or possibly becoming a transplant candidate. Either the participant or the provider must call PrimeDx prior to receiving certain services. There is a penalty applied to the claim when services are not precertified. The penalty will be the patient’s responsibility so it would be in your best interest to make sure that the provider has called PrimeDx to have the necessary services approved. Please refer to your Plan Booklet for further information about pre-certification requirements. The number to call for precertification or preauthorization is 1-800-477-4625.
13) Methodist Hospital sent me a bill for the deductible amount...
Call Methodist Hospital directly and talk to the billing department. Explain that you are clergy (or laity) covered under the Texas Annual Conference Group Health Plan, and the hospital will implement the agreed-upon benefits and not collect deductibles and coinsurance.
14) How do I find a physician at Methodist Hospital?
There are several ways to identify physicians who practice at Methodist Hospital:
- Ask friends and other participants for a recommendation
- Go to the PHCS website and do a search on Methodist Hospital
- Call Methodist Hospital customer services at 1-832-667-5900
- Call Charles Millikan at Methodist Hospital at 1-713-441-3429
15) Who is responsible for initiating preauthorization?
The member or patient is responsible for initiating any preauthorization. The physician who orders or schedules the admission is responsible for providing the clinical information.
16) How do I find a PPO provider?
Contact the PPO network that is listed on your ID card by phone or via their website to get information regarding PPO providers in your area. Aetna Signature Administrators is the PPO network (www.aetna.com/asa). To receive the best benefit, you must use a PPO doctor, hospital or other facility.