Health Enhancement Program(HEP) – Frequently Asked Questions
Why do I continue to be billed for some portion of my dental cleaning visits?
In the first couple months after October 1, 2011, the dental visits were processed incorrectly. Most visits included cleaning by a dental hygienist and exam by your dentist and some included x-rays. The visits were processed to reflect only the cleaning as free and the “exam” and /or x-rays still subject to a patient portion. The entire visit should be free and billing will be corrected.
What if I was forced to pay $35, or was billed later for an ER visit that I shouldn’t have been?
A form is available on the Comptroller’s website which needs to be filled out by you the member and forwarded to either Anthem or UnitedHealthcare.
How do I know if my family members and I are in compliance with the new Health Enhancement Plan (HEP)?
You can check the compliance tracker on the Comptroller’s website. It is a checklist for the requirements for each family member based on age and whether they have any of the five health conditions. Or, you can call customer service at either Anthem or UnitedHealthcare.
What if I am having a problem complying with the HEP because I can’t make a required appointment or for some other reason?
Shortly all members
should receive a letter from Anthem or UnitedHealthcare (an earlier letter from Anthem was incorrect) which lets you know how to report your problems with compliance. It will explain that compliance will be somewhat relaxed for this first year of the HEP.
When does the year begin and end for healthcare compliance?
Generally the years will be measured from July 1 to June 30 of the next year to match what has been our usual enrollment period for health insurance and the state’s fiscal year. This first year the HEP did not begin until October 1, 2011, and our open enrollment period was extended so strict compliance will not be required by June 30, 2012.
Only those of us who are over 50 and very young children need physicals every year with the HEP
Why do I need an annual physical if the HEP says I only need a well visit every two or three years?
. Anthem and UnitedHealthcare have the record of your previous visits because they paid your doctor, so if you had a physical in the last couple of years you are in compliance. (If you weren’t covered by the state employee health care plan you can self report your previous visits to either Anthem or UnitedHealthcare.)
Why am I being charged a co-pay for a wellness visit or annual physical?
Generally, you should not be paying a co-pay for a wellness visit (whether you are in HEP or not) or a required
screening or test. However, sometimes a doctor performs a test or screening that is not universally/nationally recognized to be mandatory at a particular age or health status. For instance, pap smears and mammograms and colonoscopies have no co-pay, but an EEG done at an annual physical for an otherwise healthy adult member would be subject to a co-pay and if your colonoscopy will be done by a specialist (not your primary care doctor), any preliminary visit with that doctor would have an office visit co-pay. Another reason for a co-pay could be simply that the visit was not coded correctly
. You might have to have your doctor re-submit the claim.