“The Families First Coronavirus Response Act requires private health plans (including insured, self-insured, and grandfathered, as defined in section 1251(e) of the Patient Protection and Affordable Care Act)) and government programs (including Medicare and Medicaid) to provide coverage for COVID-19 diagnostic testing and related services free of charge (without cost-sharing, such as deductibles, copayments, and coinsurance) to the public, through the end of the national COVID-19 emergency period.

 Covered services and related cost waivers apply to diagnostic testing, healthcare provider services (in-person and telehealth), and facility costs (physician office, urgent care center, and emergency room) to the extent the costs are related to the evaluation and diagnosis of COVID-19. Prior authorization or other medical management requirements for such services do not apply through the end of the national COVID-19 emergency period. If the visit does not result in a COVID-19 test, or provides services unrelated to COVID-19 testing, cost-sharing and plan limitations may apply. The Families First Coronavirus Response Act does not require group health plans or insurers to cover treatment for complications related to COVID-19. If testing finds COVID-19 to be present, treatment of the complications will likely be subject to normal cost-sharing and network requirements.”

 

Is my provider in-network?

Please visit the Mercy Provider Directory to find out or call us at 1-877-875-7700.

How can I find in-network providers, or providers in my area? Will you send me a list of providers?

Please visit the Mercy Provider Directory or call us at 1-877-875-7700.

Where is the closest urgent care center?

Please visit the Mercy Provider Directory to find out or call us at 1-877-875-7700.

What is a deductible?

Your deductible is generally the amount of covered medical expenses you pay before plan benefits are paid. For more information, consult your Plan Document:

  • If you belong to the Clayco Group Health Plan, click here. *coming soon
  • If you belong to the Crystal Oaks Group Health Plan, click here. *coming soon
  • If you belong to the Hermann Area Hospital District Group Health Plan, click here.
  • If you belong to the Integrity Home Care + Hospice Group Health Plan, choose your plan:
  • If you belong to the Suntrup Automotive Group Health Plan, click here. *coming soon

What is a copay?

A copay is generally the amount you pay per visit for covered medical expenses. This amount is usually not counted toward your deductible or out-of-pocket totals. For more information, consult your Plan Document:

  • If you belong to the Clayco Group Health Plan, click here. *coming soon
  • If you belong to the Crystal Oaks Group Health Plan, click here. *coming soon
  • If you belong to the Hermann Area Hospital District Group Health Plan, click here.
  • If you belong to the Integrity Home Care + Hospice Group Health Plan, choose your plan:
  • If you belong to the Suntrup Automotive Group Health Plan, click here. *coming soon

I received a bill. Why didn’t my benefit plan pay my claim?

There are several possible explanations for non-payment on a claim. Please contact us or call 1-877-875-7700 so that our staff can help you determine the reason.

What kind of plan do I have?

You have what is generally known as an “Employer Sponsored Group Health Plan.” You may also hear the term “Self-Funded Group Health Plan.” For more information about what this means for you, please contact us or call us at 1-877-875-7700.

Will you send me a copy of my benefits?

You can obtain a copy of your Plan Document any time using the appropriate link below:

  • If you belong to the Clayco Group Health Plan, click here. *coming soon
  • If you belong to the Crystal Oaks Group Health Plan, click here. *coming soon
  • If you belong to the Hermann Area Hospital District Group Health Plan, click here.
  • If you belong to the Integrity Home Care + Hospice Group Health Plan, choose your plan:
  • If you belong to the Suntrup Automotive Group Health Plan, click here. *coming soon

 

 

Will you send me a copy of my Explanation of Benefits (EOB)?

To check the status of a claim: click here.

For a guide to self-registering on the claim status site: click here.

My doctor wants me to go to a particular location for service. How will it be paid?

Typically, your Plan Document will specify how much of a covered service will be paid depending on the location. You can call 1-877-875-7700 for more information. or access your Plan Document at the appropriate link below:

  • If you belong to the Clayco Group Health Plan, click here. *coming soon
  • If you belong to the Crystal Oaks Group Health Plan, click here. *coming soon
  • If you belong to the Hermann Area Hospital District Group Health Plan, click here.
  • If you belong to the Integrity Home Care + Hospice Group Health Plan, choose your plan:
  • If you belong to the Suntrup Automotive Group Health Plan, click here. *coming soon

Where can I find the questionnaire I need to fill out?

You can download our most frequently used questionnaires by clicking here.

Why do I have to inform you about having other insurance?

In order to process your claims accurately, we must be aware of any other entities that might also be handling claims for you. Depending upon the circumstances, one plan may be primary and another plan may be secondary for certain individuals. If you have questions regarding the order of benefits, please contact us or call us at 1-877-875-7700.

How do I update my address?

Our records are updated through information submitted by your employer. The best way to update your address is through your workplace’s Human Resources department. If you have further questions regarding address changes, please contact us or call us at 1-877-875-7700

What do PPO and NPPO mean?

PPO and NPPO are abbreviations used to denote a provider’s network participation. PPO stands for Preferred Provider Organization, and generally means that a provider is a participating provider. NPPO stands for Non-preferred Provider Organization, and generally means that a provider is not a participating provider. You may also hear the terms “in-network” and “out-of-network,” or “par” and “nonpar.” These are all ways to denote whether or not a provider participates with a network.

In general, plans are designed to provide the best benefit when a PPO or in-network provider is utilized. To find out if your provider participates with the network on your plan, please visit the Mercy Provider Directory, contact us, or call us at 1-877-875-7700.