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Mike RocheMike Roche
Member Services Manager
608.210.6645
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Customer Service

We know that health care can be confusing. But it doesn’t have to be. At The Alliance we want employees to feel as confident about their health care choices as they do about other areas of their life.

Resources Available in the Consumers Section

Looking for information about QualityPath, or a list of our gym discounts? Maybe you’re interested in health guides from Consumer Reports. For all health and wellness resources, visit the Individuals & Families section.

Frequently Asked Questions

Who is The Alliance? How do they work with my employer?

The Alliance is a cooperative of employers who are committed to helping their employees make the best health care choices. They help your employer provide you with access to health care providers at a reasonable cost:

  1. The Alliance negotiates reduced rates from health care professionals and facilities on behalf of our member employers and their employees.
  2. If your employer’s health care plan allows you to choose the health care providers The Alliance has negotiated with, you pay these lower rates when you choose one of the health care professionals.
  3. We are not an insurance company — instead think of us as a link between your doctor’s office and you.
  4. We make sure you are charged the lowest negotiated rate.

Learn more: pdf Who is The Alliance?

Wondering what happens between the time you visit a doctor and the time you get your bill?

Going to the doctor sometimes seems like the easiest part of the equation. Find out what happens between the time you visit the doctor and the time you pay your bill.

  1. You visit the doctor.
  2. The doctor creates and sends a claim to The Alliance.
  3. We apply the agreed-upon rate to the claim for any services you received. In health care terms, we reprice the claim.
  4. Next, we forward it to your benefit plan administrator (also called a Third Party Administrator or TPA). This all happens within less than 3 days from the day we receive your claim.
  5. Your TPA reviews the claim and your health care coverage and pays any amount due to the provider under your plan, except for coinsurance and deductibles.
  6. Your TPA sends you an Explanation of Benefits.
  7. The doctor sends you a bill for the difference, if any, between the payment received from the TPA and what you owe based on your benefit plan, such as a co-pay or deductible.

Download our handy dictionary of medical terms every consumer should know!

Is my employer part of The Alliance?
You can find out by looking for The Alliance logo on your health ID card, or by searching for your employer’s name on The Alliance membership list.
How can I find a doctor or hospital that participates in The Alliance? Or if my doctor does?

Use our Find a Doctor website. This resource lets you take charge of your search for doctors, hospitals, clinics and procedures.

Find a DoctorThe search tool features simple navigation and mobile-friendly design for easy access whether you are on your smartphone, tablet or computer.

Explore your options by looking up procedures, specialties, facility types, physicians or quality scores. Enhance your search by sorting search results by name, distance, gender or languages spoken. Log in to view the estimated costs of more than 50 procedures.

Don’t see your preferred doctor in our network?
Nominate a provider: If you would like to encourage a doctor or facility to join The Alliance’s provider network, please complete our Provider Nomination Form. The Alliance will evaluate the request, and if appropriate, contact the provider and extend an invitation to join.

If you have questions, contact The Alliance customer service advocates by calling 800.223.4139 or emailing FindaDoctor@the-alliance.org.

Who do I contact about my benefits, including what's covered and what I'm responsible for?

To find out what is covered, check the health plan information you received from your employer. If you don’t have that, speak to your human resources representative or contact your benefit plan administrator.

Phone numbers are listed here.

Does my employer's plan cover breast pumps?

You may be wondering if breast pumps are covered under your employer’s health plan. The Affordable Care Act requires health plans to cover the full cost of breast pumps. However, some plans are exempt from this rule because they have “grandfathered” status. If your employer kept the same health plan they had before the ACA took effect, your breast pump may not be covered. Please talk with the person managing your health plan at work to find out if this is the case.

If your plan does cover breast pumps, please contact your benefits plan administrator for details on how to make your purchase and whether there are any requirements. Your plan may only cover certain types of breast pumps, or it may require prior authorization or a prescription from your doctor. Look at your insurance card for a phone number to call about your benefits.

If your health plan is grandfathered or you can’t get a prescription, you can use a flexible spending account (FSA) or health savings account (HSA). Breast pumps and supplies that assist lactation are considered medical expenses and are eligible for reimbursement.

Who do I call if my claim was denied or if I’m not sure if a claim was paid or not?

Your claims administrator has access to your benefit plan, including what type of services are covered and what you’re responsible for. When you’re not sure if a claim has been paid, call your claims administrator.

Phone numbers are listed here.

Who do I contact to find out about dental or prescription drug claims?

Your employer does not work with The Alliance to provide dental or prescription drug coverage. To answer these questions you will need to speak to a representative from one of these plans.

If you’re not sure who administers your dental or prescription benefit, please speak with your human resources representative.

Who do I contact to get approval or be precertified for surgery or another procedure?

Your claims administrator has access to your benefit plan, including what type of services are covered and what you’re responsible for. For questions about precertification, call the number on your health ID card or your benefit plan administrator.

A benefit plan administrator (also called a Third Party Administrator or TPA) works with your employer to process your claims. Select your employer from the list below to look up your TPA contact.

Phone numbers are listed here.

 

 

 

How can I make sure my claims are paid correctly?

Make sure you always show your health plan ID card when you visit the doctor or another health care professional. That way they will know how to process your bill. They’ll send your bill here first to ensure you receive the lowest cost available to you.

Want to learn more about The Alliance?

The Alliance is a not-for-profit cooperative of more than 240 employers committed to negotiating discounted pricing with health care providers and helping employees and their family members make the best health care decisions.

Read more…

Where can I find a dictionary of key insurance terms?

The Alliance has prepared a handy document that defines pdf key terms related to health benefits.

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