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Bowdoin College Health Plan Preferred In-Network Providers

Why is Bowdoin College offering a “Preferred In-Network” benefit?

There are a number of reasons why Bowdoin College has decided to offer the Preferred In-Network benefit. The most important reason is to help both you and the College get the best value out of the money spent on health care. Rising healthcare costs are a challenge for everyone, and this is one way to receive high quality care at a lower cost.

What does it mean to use a “Preferred In-Network” provider?
Effective March 1, 2011, the Bowdoin College Health Plan initiated a new “Preferred In-Network” benefit.  If you choose to receive your healthcare from a Preferred In-Network provider, you will have:

• No deductible
• Lower out-of-pocket costs

Who are the Preferred In-Network providers?
At this time, the Preferred In-Network quality providers include:

  • Mid Coast Hospital (Brunswick)
  • Maine Medical Center (Portland)
  • Maine Heart Center (Portland)
  • OA Centers for Orthopaedics (all locations including Brunswick)

Preferred In-Network Providers Video
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How are the savings applied to the plan?
You will not have to pay a deductible on any facility charge and/or professional services billed directly by one of the preferred in-network providers, and the calendar year out-of-pocket maximum is reduced from $1,500 to $1,000 for individuals and from $3,000 to $2,000 for families.

The coinsurance for regular in-network services is currently 10% of the Anthem-negotiated price, before the new Preferred In-Network discount is applied. The new Preferred In-Network savings further reduce this amount. The plan accordingly will pay less than 90% as a result of the negotiated additional discount. The savings to the plan are applied to eliminate your deductible and reduce your out-of-pocket maximum that would otherwise be charged for services at these providers.

I went to a Preferred In-Network provider and I still had to pay a deductible on part of it.  Why?
Your savings will depend on individual circumstances, including the amount of your hospital charges and the amount of other covered charges you incur during the year that are applied to your deductible and out-of-pocket responsibilities. The Preferred In-Network provider benefit only applies to facility charges and/or professional services that are billed directly by Mid Coast Hospital, Maine Medical Center, Maine Heart Center or OA Centers for Orthopaedics. For example:
• If you sought treatment from the emergency room at a non-preferred facility and you were then referred to Maine Medical Center, the regular deductible would apply to the bills from the non-preferred facility and the emergency room physicians group, but there would be no deductible for the services billed directly by Maine Medical Center, a Preferred In-Network provider.
• If you had surgery at Maine Medical Center, you may have received a separate bill for the radiologist who read your X-rays, but this bill did not come directly from Maine Medical Center. The new Preferred In-Network benefit would not apply and you would need to pay your regular deductible for the radiologist’s services.
• If you had surgery at Maine Medical Center, their direct bill to you would include the fee for the anesthesiologist. Since the anesthesiology fee was directly billed by Maine Medical Center, a Preferred In-Network provider, you would not have to pay your regular deductible.

What happens if I go to a provider that is not on the Preferred In-Network provider list?
Nothing—your current benefits do not change! If you wish to go to a provider who is not a Preferred In-Network provider, you may do so and the regular deductible ($300 for an individual and $600 for a family) and out-of-pocket maximum ($1,500 for an individual and $3,000 per family) will apply. You can find more information on the summary of benefits. 

How did these providers become Preferred In-Network providers? Why did the College choose them?
Bowdoin College is concerned about employees’ health and well-being. The College also wants to make sure we get the best value for the money that you and the College spend on healthcare. It is also important to find providers in our community that provide quality care at a reasonable price. Mid Coast Hospital, Maine Medical Center, Maine Heart Center and OA Centers for Orthpaedics are high-value, local providers.

What do you mean by “high value” providers? Does this mean they are the cheapest?
No, not at all. Choosing healthcare can be very complicated, and value is measured by both cost and quality. When you choose a doctor or hospital, the price is important, but the quality of care and outcome is even more important. The College entered into discussions with various facilities based on experience and has initiated this preferred network based on these discussions.

My hospital isn’t on the list. Why not?
The College wanted the Preferred In-Network to include high value providers in our community. In March 2011 Mid Coast Hospital, Maine Medical Center, and Maine Heart Center engaged in discussions and agreed to partner with Bowdoin College to implement strategies to maintain and/or improve high quality efficient care. In January 2012, all OA Centers for Orthopaedics will be added to our preferred in-network provider list.  If your hospital is not on the list, it does not mean that your hospital or provider does not provide quality care.

How often will the Preferred In-Network provider list change?
The Preferred In-Network provider list will be reviewed annually at open enrollment. Providers may be removed from or added to the Preferred In-Network provider list at that time.