In-Network Plus (INP), Preferred Provider Organization (PPO), and Out-of-Network (OON) Providers

The Plan has arranged for regional and national networks of hospitals and doctors to provide services and products to eligible employees and their covered dependents at negotiated rates.

To see which providers are INP and PPO, see the provider directories. Contact and claim-filing information for your networks will be provided on your Alliance Coal Health Plan ID card.

Choosing Your Providers and Benefit Levels

Each time you or a covered dependent needs medical care, you can choose any health care provider. The level of benefit coverage you receive depends on the provider’s status:

  • INP providers are hospitals, doctors, and other health care providers that have direct contracts with the Alliance Coal Health Plan.
  • PPO providers, also known as “In-Network” providers, are health care providers that are part of the PPO networks offered under the Plan.
  • OON providers are health care providers that are not INP or PPO.

An INP provider typically accepts the Plan's Allowable Charge as payment in full. This means any coinsurance for which you are responsible will be based on a lower, negotiated charge.

A PPO or OON provider does not necessarily accept the Plan's Allowable Charge as payment in full. As a result, you may be responsible for the difference between the amount considered by the Plan and your provider's actual charges; in other words, a PPO or OON provider may "balance bill" you for this difference.

You pay more when . . . you receive care from an OON provider. Benefits are paid at the OON benefit level.

You pay less when . . . you receive care from a PPO provider. Benefits are paid at the PPO benefit level.

You pay least when . . . you receive care from an INP provider. Benefits are paid at the INP benefit level.

For designated procedures, the Plan has identified Centers of Expertise. When you use a Plan-approved Center of Expertise for these procedures, the Plan pays 100% of Allowable Charges, and you avoid a 40% benefit penalty.

Your Health Plan ID Card

Remember to always carry your Health Plan ID card with you.

Due to changes in provider status, you should always show your Health Plan ID card to your provider – before services are rendered – and ask them to confirm whether their services will be covered at the INP, PPO, or OON level.

Note: You or your provider must properly file a claim within 12 months after expenses were incurred in order to receive reimbursement under the Plan.

Ancillary Services

If you are having a procedure performed by an INP surgeon at an INP hospital/facility, ancillary services may be billed by doctors and other providers that are not INP. “Ancillary services” refers to certain health care services (such as anesthesiologists and radiologists) that support the work of the main surgeon/physician performing the procedure.

Generally, if you don’t have a choice regarding the ancillary service provider at an INP facility, the INP benefit level will apply; this applies only for providers with whom you can’t make an appointment (i.e., they do not keep office hours or see patients in a clinic-type setting). This means:

  • For an unscheduled or emergency procedure that is performed at an INP facility, the INP benefit level will apply for all ancillary services related to that procedure (regardless of whether the ancillary service providers are INP, PPO, or OON).
  • For a scheduled procedure that is performed at an INP facility, the INP benefit level will apply if:

    • The ancillary services are performed by INP providers, or
    • The ancillary services are performed by PPO or OON providers and the main surgeon/physician is employed by and bills through an INP provider.

To receive the INP benefit level for a scheduled procedure, verify that both the hospital/facility and the main surgeon/physician are INP providers. Contact INP Provider Information at (918) 730-9586 for assistance.