Prime Source Mortgage Benefit Overview & FAQ:

PLEASE USE THIS INFORMATION AS A GUIDE TO UNDERSTANDING YOUR HEALTH BENEFITS WITH PRIME SOURCE MORTGAGE

  • WHAT IS A VALUE BASED PAYMENT PLAN?

Value-based payments is a transparent way of determining how much hospitals will be paid for certain services. It works by reimbursing hospitals based on a reference price: Medicare (plus a percentage). Because it is fully transparent and based on costs, the end result is a price that is fair to both the hospital and the patient. Value-based payments provides open access to facilities with no network restrictions. 

  • HOW DOES THIS PLAN DIFFER FROM A PPO?

Value-based payments affects care at hospitals, outpatient car facilities, surgery centers and dialysis. Physicians and other non-hospital providers are covered under the (PPO) network. When you see your physician or a specialist, your plan is unchanged. Our PPO plan gives you access to a wide network of physicians, and you will pay the lowest rates when you use in-network physicians. You are also covered when you go out-of-network,although your costs may be higher.

  • WHY DID PRIME SOURCE CHANGE TO THIS TYPE OF INSURANCE?

 

  • HOW DOES IT WORK WITH MY DR.?

VBP only applies to certain medical procedures and facility claims such as hospitals, surgery centers, outpatient facilities and dialysis.  Physicians and other non-hospital providers are covered under our (PPO) network.

Your physician will recommend a facility, as usual.  they wi then pre certify your treatment based on the plan guidelines.  A fair price is set for the service, based off of the rates established by Medicare.  The hospital (or other facility) is advised up front of the price - which is almost always lower than what the hospital would normally charge  You will be responsible for the deductible and coinsurance as usual, up the the annual out-of-pocket maximum.  

  • HOW DO DOCTORS VERIFY COVERAGE?

 

  • HOW SERVICES WORK WHEN PRE-AUTHORIZATION IS REQUIRED/NEEDED:

 

  • PATIENT ADVOCACY CENTER

he Patient Advocacy Center (PAC) is a service offered to members of our Value-Based Payments (VBP) Health Plan. If you receive a balance bill from your provider for an amount above the de-ductible and co-insurance, please contact HST’s Patient Advocacy Center. A Patient Advocate will guide you through the process and handle all communication on your behalf.
Tel: (888) 837-2237
E-mail: patientadvocacy@hstechnology.com
Fax: (949) 891-0420    

  • HST CONNECT

The HST Connect mobile app offers 24/7 access in English or Spanish. Allows you to view comparison pricing for healthcare services and access key health plan information. In addition, you will receive messages from Your Health Plan.
HST Connect Allows You To:
  • Find a Doctor or Hospital: Search for a physician or facility in your geographic area by specialty or procedure.
  • Member Information: Select a primary care physician, access your insurance card, view your deductible, copays and co-insurance.
  • Procedure Comparison: Look up procedure services and compare pricing against other facilities in the area.
  • Navigate Directions: Directions from your location to a physician or facility. Works with both Google and Apple maps.

  • ACCESSING ONLINE BENEFITS INFORMATION AT WWW.CAPITOLADM.COM