- Call The Alliance Patient Experience Manager at 800.223.4139 prior to scheduling services.
Services covered at QualityPath level of benefits:
- The initial consultation with the QualityPath surgeon
- Pre-operative testing (lab, x-ray, and other tests as medically necessary)
- Services provided on an inpatient basis, including the hospital facility fees, the surgeon’s fee, and any anesthesia, pathology or radiology charges associated with the procedure
- The services of other medical professionals while the member is inpatient, including hospitalists and other specialists
- Post-operative care for 90 days after the surgery. (See warranty for information regarding complications.)
- Cardiac rehabilitation services performed by a QualityPath provider, in a QualityPath facility
Services under the warranty are covered under the QualityPath level of benefits. The warranty period begins the day of admission and covers the following care related to the QualityPath service:
- Hospital readmission and reoperation – 30 day warranty period
- Other treatment of complications – 90 day warranty period
Patient requirements to maintain the warranty include:
- Receiving all follow-up care from the QualityPath provider, excluding necessary emergency care.
- Complying with all post-discharge instructions, including outpatient cardiac rehabilitation.
The following services are not eligible for the QualityPath level of benefits. Check with your benefits administrator for coverage levels under the standard health plan benefits.
- All services provided by a non-QualityPath provider
- Post-discharge care that is unrelated to the procedure
- Unrelated readmissions during warranty period
- Coverage for the same procedure during the warranty period, when not due to complications related to the initial procedure
- Care related to the procedure rendered outside the 90-day warranty period
- Services provided by a QualityPath provider performed prior to member’s enrollment in the program
- Rehabilitation services outside the physician care plan
- Services provided inpatient unrelated to the QualityPath procedure