Hospital Advocacy Program Basics You Need To Know!

We receive questions every day about the Hospital Advocacy Program and we know that being able to offer this program to a prospective member can be a huge selling point for you.  We want to make it easier for you to sell, so our goal here is to make the basics clear.

THE BASICS

No case can be started until a member has been active for at least 3 full business days and the member must remain active throughout the entire advocacy process.

Hospital advocacy can be used when a member has already or will be experiencing a hospital or surgical center event.  And yes, an ER visit is a hospital event and an ambulance ride can be included.

Every advocacy case starts with a call to AmeriPlan.  Although the Hospital Advocacy Program is administered by The Karis Group the case cannot be started without first calling AmeriPlan.  AmeriPlan facilitates the Karis group.

We cannot begin an advocacy case by email or by chat.  A phone call from the patient or their guardian is required.

It’s important to know what the definition of a case is.  A case is a single incident with expenses totaling at least $1500 that you must pay out of your own pocket.

The minimum out of pocket expense of $1500 must result from bills from the hospital or surgical center.  This may include the cost of the anesthesiologist, x-rays, lab work and more.  The cost of visits to the doctor’s office is NOT included in the $1500 minimum.  However, those doctor bills can be submitted along with the hospital bills for negotiation.  We cannot begin a case based on doctor bills.

Medical bills should never be sent to AmeriPlan.

BEFORE A CASE IS SUBMITTED REMEMBER THESE 5 THINGS

1.  You must be a member for 3 full business days and must stay active

2.  Bills must be from the hospital or surgical center

3.  Every advocacy case starts with a call to AmeriPlan

4.  Each case must total at least $1500 out of your own pocket

5.  The doctor office visits cannot be included in the $1500 minimum

PRE-MEMBERSHIP BILLS

If a current or prospective member has hospital bills that were incurred prior to becoming a member we can still help.  The only difference for these cases is that a $250 non-refundable fee must be paid prior to beginning the negotiations.

INSURANCE DEDUCTIBLES

We often get asked about is if we can negotiate insurance deductibles.  The short answer is NO.  But there is more to the answer.  Here is an example of how it works.  If the hospital bill is $5000 and your deductible is $5000 we will still negotiate the bill.  If the result of the negotiation leaves you with $2000 to pay the hospital, that $2000 will go towards your deductible.  Your deductible was not reduced.  So, if you have another hospital incident you will still have a $3000 remaining deductible that has not yet been met.

EXCLUSIONS

We cannot advocate for mental health services.  And, we cannot advocate for kidney dialysis.  This is because they are typically ongoing situations that have no definite end to treatment.  There may be other situations that fall into this category.

SUBMIT QUESTIONS

We welcome your questions.  Please send your questions to us by email at customersupport@ameriplanusa.com and we will try to answer as many as we can.