Explaining ARS/ECS changes to your employees

Share the following information about Priority Health billing changes with your employees. Here is a printable version for distribution. (49KB DOC)

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Billing changes for radiologists and emergency room (ER) doctors

If you have your medical coverage through Priority Health, you’ll want to know about some process changes if you receive care from:

• Advanced Radiology Services (ARS) radiologists when you have x-rays, MRIs or other radiology services
• Emergency Care Specialists (ECS) when you go to the emergency room

This affects radiology services at these locations: Holland Hospital Metro Health MMPC Imaging Center Spectrum Health Blodgett Hospital Spectrum Health Butterworth Hospital Spectrum Health - Kelsey Campus Spectrum Health - Kent Community Campus Spectrum Health - Reed City Spectrum Health United Memorial Campus Three Rivers Hospital Zeeland Community Hospital

This affects ER services at these locations: Gerber Memorial Hospital Spectrum Health Blodgett Hospital Spectrum Health Butterworth Hospital Spectrum Health United Memorial Zeeland Community Hospital

You can still get care from these providers and you’ll still be covered according to the terms of your plan.

Advanced Radiology Services (ARS)

If you use radiology services, don’t pay more than you owe.

• Priority Health will pay Advanced Radiology Services (ARS) a market-based fee.
• When you receive a bill from ARS, compare it with your Explanation of Benefits (EOB) from Priority Health. You’re only responsible for your normal copays, coinsurance and deductibles. This is the amount listed as "member liability" for covered services on your EOB. ARS may ask you to pay more than you owe - this is called "balance billing."
• If you receive a bill from ARS that is more than the "member liability" on your EOB - or if you're not sure - call Priority Health Customer Service using the phone number on the back of your ID card, and they’ll take care of the issue. Don’t pay the bill.

Emergency Care Specialists (ECS)

If you go to the emergency room, Priority Health will mail a check for the doctor's bill directly to you.

• Priority Health will send you a check for the emergency room doctor's bill.
• This check will be for the amount of the bill minus any coinsurance or deductibles that are your responsibility to pay. Note: Due to HIPAA privacy regulations, the check will be payable to the patient (even if the patient is a child).
• The check will be attached to your Explanation of Benefits (EOB) for these services.
• You'll be responsible for paying Emergency Care Specialists (ECS) with this money, plus coinsurance or deductibles that are normally your responsibility to pay according to the terms of your coverage.
  

Understanding these changes

To keep the cost of health care under control, Priority Health negotiates market-based fees with medical services providers. The savings help keep premiums affordable. These providers have refused to reduce their higher-than-market fees, so they don’t currently have agreements with Priority Health.

Questions?

Contact Priority Health Customer Service by secure e-mail or phone. To send a secure e-mail, visit priorityhealth.com, click on Contact Us in the top right corner of your screen and complete the online form. Priority Health will reply by the end of the next business day. By phone, call the number listed on the back of your ID card. Representatives are available Monday through Thursday 7:30 a.m. - 7 p.m., Friday 9 a.m. - 5 p.m., and Saturday 8:30 a.m. - noon.