MED TAC - Frequently asked questions about your health plan





	Frequently asked questions: If you have a question about an inquiry letter sent to you by MED TAC please feel free to contact us at 1-800-347-9355 or E-mail info@medtac.com Click the number before the question to jump to the answer: 1. Must I have a referral from my physician to see a specialist? 2. How do I find out if my doctor is in the Participating Provider Organization? 3. If my physician is not in the Participating Provider Organization, how can I get him into the Participating Provider Organization? 4. How current is the online list of providers on MED TAC's web site? 5. Why does the Participating Provider Organization have my doctor's address wrong? 6. My doctor never heard of my Participating Provider Organization. He says he is in another Participating Provider Organization. 7. My doctor is listed in the Participating Provider Organization on MED TAC's web site. Do I still need to confirm that he is in the Participating Provider Organization? 8. What is the phone number for my Participating Provider Organization? 9. Will I be getting new MED TAC Cards? 10. How do I get another MED TAC card? 11. Must my dentist be in the Participating Provider Organization? 12. What card do I show my dentist? 13. Why does MED TAC ask me the name and address of my spouse's employer? 14. Why does MED TAC ask for accident details on some of my claims? 15. If I have an emergency or seek medical attention while travelling (on business or vacation) and utilize a doctor or facility outside of my Participating Provider Organization network, will I incur out of network costs? 16. I elected the Participating Provider Organization Plan but my son attends college outside of the Participating Provider Organization network. Will all his medical costs are out of network costs? 17. Must I have pre-authorization for speech therapy and counseling? 18. My daughter turns 19 this year - can she still be covered under my health plan? 1. Must I have a referral from my physician to see a specialist? A: No, the PPO (Participating Provider Organization) plan does not require a referral from a primary physician. return to top 2. How do I find out if my doctor is in the Participating Provider Organization? A: From the MED TAC web site at www.medtac.com click the Managed Care link (or just click here). If you live in New England, select Health Care Value Management Inc. Then select Providers to search for your doctor or Hospitals to search for the hospital. If your doctor or hospital is in the Participating Provider Organization, his or her name will appear. If you live outside New England, select the appropriate Participating Provider Organization that applies to you. Then select Search for Physician or Search for Facility and follow the directions to search. return to top 3. If my physician is not in the Participating Provider Organization, how can I get him into the Participating Provider Organization? A: If your doctor is currently not a member of the Participating Provider Organization, you may try to add him into the Participating Provider Organization. There are forms available online for you to fill out to add the doctors. (Follow directions in question above to get to the appropriate web site) Please make sure with your doctor in advance that he or she is interested in being added. Please keep in mind that adding a doctor is not done overnight. It is a time consuming process that my take a few months. return to top 4. How current is the online list of providers on MED TAC's web site? A: The Participating Provider Organization web sites are updated monthly. return to top 5. Why does the Participating Provider Organization have my doctor's address wrong? A: It is the doctor's responsibility to advise the Participating Provider Organization of any address changes. return to top 6. My doctor never heard of my Participating Provider Organization. He says he is in another Participating Provider Organization. A: The different Participating Provider Organization's have contracts with a number of different affiliates. All employees who elected the Participating Provider Organization should have a new card with a sticker that identifies the Participating Provider Organization /affiliate for them. return to top 7. My doctor is listed in the Participating Provider Organization on MED TAC's web site. Do I still need to confirm that he is in the Participating Provider Organization? A: Yes, you should always confirm that the doctor is in the Participating Provider Organization. If the provider terminates his relationship with the Participating Provider Organization, it can take anywhere from 3 days to 2 months to pull him off the website, depending on how promptly the doctor advises the Participating Provider Organization. return to top 8. What is the phone number for my Participating Provider Organization? A: HCVM is 781-762-5511. MEDCO is 800-952-5277, PROAMERICA is 1-800-523-3669, NPPN is 1-914-343-1600, SLOAN LAKE is 303-504-5319 return to top 9. Will I be getting new MED TAC Cards? A: All medical participants will be getting ID cards with the appropriate Participating Provider Organization sticker. return to top 10. How do I get another MED TAC card? A: Contact your Human Resource Department. return to top 11. Must my dentist be in the Participating Provider Organization? A: No, our dental plan is not a Participating Provider Organization. You can choose any dentist you like. return to top 12. What card do I show my dentist? A: Your MED TAC card should be presented to any doctor, dentist, hospital or medical facility. If you have a separate Prescription plan such as Express Scripts or PCS, you should give that RX card to your pharmacy. return to top 13. Why does MED TAC ask me the name and address of my spouse's employer? A: MED TAC requests this information once a year for the purpose of COB (Co-ordination of Benefits) If your spouse is employed and is covered by his or hers employer for medical or dental benefits, MED TAC would be the secondary payer, not primary for your spouse. Dependent children may also have dual coverage. Please note, upon receipts of employment name and address, MED TAC will correspond directly with said company. return to top 14. Why does MED TAC ask for accident details on some of my claims? A: If a claim is received due to an accident, MED TAC is required to ask for accident details to determine if the accident may be work related in which case the claim would be for Workman's Compensation. If the accident is an Auto accident, then the Auto insurance pays primary. All claims will be released once the employer has responded to MED TAC inquiries. return to top 15. If I have an emergency or seek medical attention while traveling (on business or vacation) and utilize a doctor or facility outside of my Participating Provider Organization network, will I incur out of network costs? A: No, if it is a medical emergency and you are not within your Participating Provider Organization area, you will not incur out of network costs. return to top 16. I elected the Participating Provider Organization Plan but my son attends college outside of the Participating Provider Organization network. Will all his medical costs are out of network costs? A: If a child is attending school outside of your network, all the out of network charges will be waived. If the claims come through showing out of network charges, call MED TAC Claims (800-347-9355) and explain the situation and they will waive the out of network charges. Be sure to provide Full Time Student Status for Fall and Spring semesters. This will avoid the pending of any claims. return to top 17. Must I have pre-authorization for speech therapy and counseling? A: All speech therapy requires proof of medical necessity. Counseling does not require any proof of medical necessity nor pre-authorization. return to top 18. My daughter turns 19 this year - can she still be covered under my health plan? A: Check with your Human Resource Department for the definition of an eligible dependent. If your dependent is over the eligible age and not a full time student, he or she can elect COBRA coverage as your dependent and will be responsible for paying the full cost of the insurance. return to top CLICK HERE FOR SAMPLES OF MED TAC'S FORMS.