Disclaimer

 

Reimbursement for Healthgram Covered Services

The Healthgram benefit plan administered by PPC covers expenses incurred for services from health care professionals. The plan has no networks or provider contracts. The policies and plans include a maximum plan provision that may limit the amount that will be considered by PPC when calculating reimbursement. The plan sponsor (your employer or other organization) has chosen the following maximum plan allowance:

• The lesser of the actual charge or the Plan Allowance as listed in the Healthgram fee schedule at the time of service.
• The Healthgram fee schedule is available at www.Healthgram.com.

Under this methodology, the patient may be responsible for the charges over the Plan Allowance as well as any applicable copays. We encourage every provider and member to understand the Healthgram Plan Allowance before the service is rendered to determine if the provider will balance bill the member for any overcharges.

Certain services are not covered by the benefit plan as outlined in the member's specific Master Plan Document. Facility fees are subject to outlier adjustments as outlined in the Provider User Guide. Transplants and other comprehensive procedures may be subject to carve-out case rate reimbursement. This Plan is not affiliated with a Preferred Provider Network or an Insurance Company.

Healthgram pays a fixed payment to all medical providers for all covered services. The amounts listed in the Fee Schedule are NOT allowables, they are payment amounts. Covered Healthgram payments are paid to the provider at 100%, less specified copays. Healthgram members have no coinsurance or deductibles.

Any amounts billed in excess of the Healthgram payment are not covered under the Plan document.

CPT^® Copyright 2008 American Medical Association. All rights reserved.
Fee schedules, relative value units conversion factors and/or related components are not assigned by the AMA, are not part of the CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT^® is a registered trademark of the American Medical Association.

Products and Services Provided by Primary Physician Care Subsidiaries

Healthgram^® is a registered service mark of Primary Physician Care Inc (PPC), licensed for use by PPC and its subsidiaries. PPC is a holding company and is not an insurance company. Therefore, products and services are provided exclusively by subsidiaries and not by PPC.
The product descriptions, if any, provided on PPC web sites are not intended to constitute offers to sell or solicitations in connection with any products or services.

Links to PPC Web Sites

PPC retains and reserves all rights to its domain names, trade names, trademarks and logos, copyrights and all other intellectual property. We reserve the right to withdraw permission for any link

Viruses, Worms, Use of Files

PPC cannot and does not guarantee or warrant that files available for downloading from this site are free of viruses, worms or any other destructive code circumstances.

Health Information

The health information on PPC web sites is provided by PPC solely for informational purposes as a public service to promote patient health. It does not constitute medical advice and is not intended to be a substitute for proper medical care provided by a physician. PPC will assume no responsibility for any issues arising out of the use, misuse, interpretation or application of any information supplied on PPC web sites. Patients should always consult with their doctors for all medical care.
Forward-Looking Statements

PPC web sites may contain forward-looking statements that include information about financial prospects, plans and objectives of management for future operations, economic conditions, trends and known uncertainties. PPC does not undertake any obligation to correct or update any forward-looking statements on the PPC web sites.
Trademarks

There are references throughout PPC web sites to various trademarks or service marks and these, whether registered or not, are the property of their respective owners.

Limitation of Liability

You agree by accessing PPC web sites that under no circumstances or any theories of liability under international or civil, common or statutory law including but not limited to strict liability, negligence or other tort theories or contract, patent or copyright laws, will PPC be liable for damages of any kind occurring from the use of PPC web sites or any information, goods or services obtained on PPC web sites including direct, indirect, consequential, incidental, or punitive damages, to the fullest extent permitted by law.

Right to Terminate Access

PPC reserves the right, but not the obligation, to terminate your access to any PPC governed web sites if it determines in its sole and absolute discretion that you are involved in any infringing activity.
Changes

We reserve the right to make changes to Healthgram benefits, all PPC web sites, the Healthgram fee schedule, and our Legal Disclaimer/Conditions of Use. We encourage you to review the web sites and these terms periodically for any updates or changes. Your continued access or use of these web sites and tools shall be deemed your acceptance of these Legal Disclaimers/Conditions of Use and any changes and the reasonableness of these standards for notice of changes.

Geographic adjustment factors are copyright protected by Yale Wasserman^®, DMD Medical Publishers Ltd.