Frequently Asked Questions about Integrity Health
Are my benefits changing?
The benefit levels have not been changed for the Toms River Schools Health Plan. Administrative changes are being made to improve plan services.
Will I get credit for the deductible amount already applied?
Yes. We have obtained the necessary information from your prior carrier. The first Explanation of Benefit report (EOB) that you receive from Integrity Health will reflect these credits. If you believe this information isn’t accurate, please do not hesitate to contact member services at 800-922-5186. We want to make sure you are properly credited.
Do I need an Integrity Health claim form?
No. In-Network providers will submit claim forms directly to the claim submission address shown on the back of your ID Card.
When visiting Out of Network providers, be sure to request a document that can be submitted to Integrity Health for appropriate reimbursement. Most provider offices have the capability of producing a standard 1500 form which contains all the information necessary to process a reimbursement.
Many times during an In-Network Hospital Stay you have no control over the providers who take care of you. What happens in those cases?
During an in-patient stay at a participating facility all ancillary providers will be paid as in-network.
Last summer, I was in the middle of care with a provider who was In-Network with my prior carrier but is Out of Network now.
During the first three-month transition to Integrity Health, we considered that provider in-network, and we made every effort to secure their participation on an in-network basis. The transition period ended September 31, 2008.
How is the Integrity Health program different from every other health plan?
What really sets the Integrity Health program apart is our transparency and advocacy for employee health, and especially early care. We promote care in unprecedented ways, by arming you with detailed knowledge about your options, coverage and claims, providing no-hassle, plain-language bills and aggressively promoting early care.
Is Integrity Health an insurance company which makes money by denying healthcare claims?
No! Sadly, that is all too common. Integrity Health is a health benefits company managing a unique design of health benefit programs for public and private sector employers. Although it is not an insurance company, Integrity Health offers plan sponsors and their employees a customized and complete administrative program for healthcare coupled with insurance protection from a rated carrier. Integrity Health provides plan sponsors with what they need—a turnkey program of service providers offering state-of-the-art TPA, disease management and network services.
May I visit the doctor of my choice?
Yes. Integrity Health allows employers and health plan sponsors access to a customized provider network as inclusive as any available. The Integrity Health program is based on the premise that encouraging access to healthcare is wise, not only for health purposes, but financially as well. However, as with any health plan, if you see a doctor who does not participate in your network, your out-of-pocket costs will be higher, and you may need to file claim forms.
How do I find out if my doctor participates in my networks?
Call 1-800-922-5186 during business hours or login to find a doctor, hospital or lab.
What is the advantage of going to a doctor or hospital in my network?
Your out-of-pocket costs will be lower because your coverage is based upon an agreement with those doctors and hospitals. Negotiated discounts and savings are passed on to you.
If my doctor does not participate in my network, can she or he join?
Yes. If you give us your doctor's name and contact information, we will ask your doctor to join. Most doctors enjoy participating in networks qualified by Integrity Health because by having members go to My Health Gateway we take the headaches out of filing a claim. One reason providers drop out of other networks is because of billing hassles. In most cases, we have eliminated these concerns. Of course, your doctor can call us to join at any time.
What is My Health Gateway?
My Health Gateway works like an airline boarding pass and helps you manage your healthcare account. It gives you timely information on your participating pharmacies and labs, co-pay instructions, benefit plan information, remaining deductibles and a welcome summary of coverage for each doctor or hospital visit. It makes sure you know whether the doctor or hospital you select is in or out-of-network. It even gives directions to your doctor's office.
How do I get to My Health Gateway?
Log in and click on My Health Gateway. Input your name and the name of the doctor or provider you want to visit and print your A Health Gateway ticket ID, or a Health Gateway ticket ID can be immediately emailed or mailed to you or to your doctor, whichever you prefer. During business hours, you can also call 1-800-922-5186 to speak with a representative.
Must I go to My Health Gateway before visiting a doctor or hospital?
No; we strongly encourage it, but it's your choice. The overwhelming majority of Integrity Health members enjoy going to My Health Gateway because it has so many advantages.
What are the advantages when I go to My Health Gateway?
It is an important and easy way to protect your health. My Health Gateway automatically captures medical information that goes into your secure, confidential, password-protected health record called My Health Advocate. With that record Integrity Health can confidentially notify you when it's time for covered screenings, tests, check-ups and procedures that protect your health. In addition, using a My Gateway ticket ID eliminates common mistakes in billing and makes sure you and your plan are not charged inappropriately. My Gateway ticket ID helps make sure that your healthcare accounts are current and accurate. It gives you timely information on your preferred pharmacies and labs, co-pay instructions, benefit plan information, remaining deductibles, and a guarantee of coverage for each doctor or hospital visit. It makes sure you know whether the doctor or hospital you select is in or out-of-network.
What is My Health Advocate?
My Health Advocate is your confidential, password protected, personal electronic health record. After logging in, you have instant access to all your medical data, including the results of lab tests, health history, pharmacy records, and claims data. Because My Health Advocate electronically and confidentially captures this information when you go to your doctor, pharmacy, or lab, it is able to identify potential health risks and let you know, confidentially, the best way to stay healthy. My Advocate's database spots medical issues which may need early attention before required treatments become more invasive and expensive. The Advocate notifies you whenever it electronically spots a problem, such as a pharmaceutical conflict, or when it's time for a covered check-up or screening.
Why should I visit www.integrityhealth.com?
With this convenient, secure website, we can work together to promote your health. We urge you to visit it daily to:
Enter My Health Advocate to see the results of lab tests, health history, pharmacy records, and claims data, chart your progress on key health indicators, store your information where you can find it quickly and easily, and explore a range of health and wellness topics. You can use interactive tools to learn about conditions, treatments and medications and make well informed health care decisions.
Go to My Health Gateway to get a summary of your preferred pharmacies and labs, co-pay instructions, benefit plan information, remaining deductibles, and a current indication of coverage for each doctor or hospital visit.
Find participating doctors, hospitals, and labs, download and print claim forms, your claims history and account transactions, and learn more about your plan and its benefits.
Discover important health industry-related developments which affect you.
Familiarize yourself with standards of care for particular disease states.
Receive helpful health tips about a variety of topics of particular interest to you.
