Mountain State and its affiliate company, Super Blue HMO, maintains FOUR main provider networks.
Ø The PARTICIPATING network supports our traditional indemnity products including the New Blue product line which has a wide array of benefit levels. As our largest provider network, the "Par" network, includes contracted providers in nearly 7,500 locations throughout West Virginia and surrounding states.
Ø Mountain State's Super Blue Plus Preferred Provider (PPO) network includes providers in nearly 4,200 locations. This network serves PPO benefit plans in West Virginia and contiguous counties in surrounding states.
Ø The Super Blue Select Point of Service (POS) network is made up of primary care physicians in more than 885 locations in West Virginia and surrounding areas of contiguous states.
For over 60 years, Mountain State and its predecessor companies have provided members with the the benefits of its successful partnerships with providers.
Ø Contracted providers agree to bill us directly for services rendered. This means Mountain State is able to operate a nearly PAPERLESS system of health care service reimbursement. Our members don't have to bother with claim forms, because the provider is contracted to handle billing.
Ø Providers agree to accept our payments as payment in full, resulting in a savings to employers and health plans.
Ø Our members, when using contracted providers, remain responsible only for their deductibles, copayments and coinsurance, not for amounts billed above our established payment schedule.
Ø Our provider agreements include provisions that hold members harmless for services determined not to be medically necessary. Providers assume responsibility for the cost of services which may not be considered to be appropriate, reducing expenses.
Ø Our most advanced managed care agreements include provisions where providers assume the responsibility for scheduling, coordinating and informing us of hospital admissions, needed specialty care and testing. This gives us, as a managed care organization, the ability to impact the course of treatment in progress and recommend sound suggestions about alternative treatments or contracted practices through our care management efforts.
IN RETURN, we agree to pay our contracted providers promptly and fairly. We also integrate their concerns and suggestions in efforts to improve our service to the provider community and to our members.