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How does this whole system work? Northeast Health Direct is a Preferred Provider Organization (PPO) that contracts with doctors, medical labs, hospitals and other healthcare providers. Northeast negotiates discounts with these providers to lower the fees that you pay for their services. You benefit with better service and lower costs. We update our membership list regularly so that you know what providers are currently in the network. We also work closely with your Benefits Administrator who is responsible for determining member eligibility, processing your medical claims and advising you about benefit coverages. You can use these three links to find helpful information. Take me to the provider search page. Help me find my benefits administrator. Tell me what to do before I make a doctor’s appointment. What is the difference between an (HMO) and a (PPO)? Health Maintenance Organizations (HMO) were established in the 1970s to combat rising healthcare costs. But to control costs, many HMOs employ their own doctors, leaving members with little or no choice in healthcare providers. Restrictions are often placed on the choice of specialists as well, and referrals from a Primary Care Physician (PCP) are often required before members can see a specialist. Restrictions are often placed on the types and quantity of tests and treatments available to members. It is the restrictive nature of the HMO that gave rise to the popularity of the Preferred Provider Organization (PPO). The emphasis of a PPO is to allow members the flexibility to see any provider they wish, though consistent cost savings are derived from a patient’s relationship with an in-network provider. Therefore, the greatest benefits of PPO membership go to those employers who are members of a large and growing PPO network. How large is your network? Our comprehensive network of over 11,000 doctors, hospitals and other healthcare providers gives you a significant choice of providers to select from to meet your healthcare needs. Our coverage area includes the state of Connecticut, western Massachsetts, southern Vermont, western New Hampshire and Westerly, Rhode Island. Within this region we represent several hundred small businesses. And we are on track for continued growth in the current year. The popularity of Northeast Health Direct’s PPO is a direct result of Northeast’s ability to generate substantial savings for our customers from the discounts we have negotiated with our providers. How does Northeast Health Direct control costs? We have significant experience working with self-insured employers where cost control is an absolute necessity. Northeast Health Direct reduces the rate of increase in member company medical costs by negotiating deep discounts with our large and growing provider membership base. What does Northeast Health Direct consider a deeply discounted fee structure? Northeast Health Direct generates average savings in excess of 30% to its member employers.
See for yourself the actual savings of three businesses that are a part of the Northeast Health Direct program... If you’ve shopped at all, you’ll know these discounts are significantly higher than those generated by traditional PPO programs. Does Northeast Health Direct restrict access to specialists? Northeast is an open access PPO. As a result, in most instances you do not need a referral from your Primary Care Physician (PCP) to obtain access to a specialist. Please contact your benefits administrator to verify the proper procedure for your particular plan. Help me find a provider in your network. Did you find what you were looking for? If not, e-mail us or call 800.423.6619 and we will give you a prompt response to your request. |