PPO PRODUCTS & SERVICES
First Choice of the Midwest's mission statement: Promoting quality, cost
effective healthcare services and enhancing the relationship between providers, payers,
and members.
Claims Repricing:
First Choice of the Midwest provides local in-house repricing with a 1-5 day turn around time.
Customer Service:
Prompt and friendly cutomer service line for both members and providers at (888) 246-9949.
Benefits:
Benefits have been enhanced to encourage usage of PPO providers. Please refer to your plan benefit booklet to find any information on PPO/Non-PPO Benefit differentials, covered benefits, etc. Remember that First Choice of the Midwest is not your insurance company and does not pay claims. You need to call your insurance plan administrator for benefit questions.
It is the responsibility of the patient/member to make certain that the providers they see are in the First Choice of the Midwest's PPO network. They should ask questions when they are being referred elsewhere to ensure that their physician is trying to stay within the network.* The PPO network is subject to change, so for the most updated information on participating porviders, call First Choice of the Midwest at (605) 332-5955 or (888) 246-9949. Remember, the patient/member always have "freedom of choice". They can be elibible for benefits at both PPO and Non-PPO providers; however, their benefit will be greater at a PPO provider. First Choice of the Midwest has established pre-negotiated rates at PPO Providers versus seeing a Non-PPO Provider where they run the risk of having additional out-of-pocket expenses.
* Some services such as laboratory, anesthesiology, pathology, radiology, etc.,
received at a PPO hospital may be subcontracted by the hospital and may not be
participating in the PPO.
REGIONAL HEALTH PPO NETWORK:
First Choice of the Midwest has established contracts with providers throughout the Midwest. The network is comprised of the following provider types:
- Inpatient Hospitals
- Outpatient Hospitals & Surgical Centers
- Primary Care Providers
- Specialty Care Providers
- Behavioral Health Providers
- Chiropractic Care
- Home Health/DME Providers
- Eye Care/Vision Care Providers
First Choice of the Midwest members can call our toll free number (888) 246-9949 and request assistance in selecting a hospital, primary care or specialty care provider within the network.
FIRST CHOICE REPORTING:
PPO SAVINGS REPORTS:
- In/Out of Network Reporting
- Provider Specialty Report
- Inpatient/OutPatient Savings
- Top 25 Provider Report
- Top ICD-9 Code Report
- Top 15 CPT-4 Code Report
For more information on First Choice of the Midwest Products &
Services: info@1choicem.com
