The Winsford Group
At Fountain Health we want to empower our members to take control of their health. To assist in that we have provided resources you may need over your health benefits journey.
- At Fountain Health we strive to be different from all other health insurance companies. We created a Care Manager team to support and assist members coverage with Fountain Health.
- You can reach the team at email@example.com
- PHCS (Private Healthcare Systems) is the insurance network you will utilize to find a provider that accepts your insurance.
- When your provider asks “What type of insurance do you have” You respond, “PHCS”.
- You can find a doctor that accepts PHCS here:
They will need to call American Plan Administrators at 888-624-6300.
APA tracks your eligibility and benefits.
- Select “Login to your Account”
- Click “Member”
- Click “Create Member Account”
Once the claims have been processed, you will be able to access them and download or print them.
You can request a new insurance card in two ways:
- APAs website: www.apatpa.com
- By contacting your care manager team at firstname.lastname@example.org
Dependents can get their own copy of the insurance card, however, only the primary insured name will be listed on the insurance card.
IPM is your pharmacy benefit manager. They are available 24/7 to assist you or any dependents with pharmacy-related questions at (877)860-8846.
- Click “Register Now”
Most providers will accept a fair payment for your plan; however, some providers may send you a bill for the difference between what your plan paid and the amount they charged if that happens we are here to help.
Identify balance bills by comparing the “amount you owe” on your Explanation of Benefits with the bill sent by your provider, if they don’t match send them to your Care Manager team at email@example.com
What you can expect:
You will be connected to ELAP and they will advocate on your behalf. You will be assigned a dedicated member service advocate to support and send regular updates. If necessary, we will provide comprehensive legal support at no cost to you.
- It is important that you contact the Care Manager team at (866) 609-1525 or email them at firstname.lastname@example.org as early as possible to ensure that your care is not delayed.
- They will put you in touch with our partner, ELAP who will help guide your provider on how to submit the claim. It is possible that your provider will refuse to do so, in those instances our team will help you find a new doctor who will.
You work hard for your money. The last thing you want to do is pay a medical bill without knowing if you are overpaying. Fountain Health has partnered with ELAP to review medical claims for potential errors and to ensure that charges are fair and reasonable and do not exceed your plan limits.
The only out-of-pocket expense that you should pay at the time of service is a copay or deductible (if applicable). You can contact your TPA to confirm copay and/or deductible amounts. Since ELAP’s review will often reduce the amount you owe, you could overpay by paying upfront and it is unlikely the facility will reimburse you. If the facility will not perform treatment without additional funds outside of your normal copay, then you should contact your Care Manager Team at (866) 609-1525 or email them at email@example.com immediately.
- Prior authorization is a process that requires approval by all insurance companies before you are able to get certain services or medications; typically prior authorizations are required for the higher cost services. The approval is based on whether the service or medication is medically necessary or appropriate for your care. Prior authorization reduces the risk that the insurer will deny the claim after you receive medical care. The goal of prior approval is to cut down on “unnecessary” costs.
We have developed a wellness journey based off the latest industry science that is dedicated to finding diseases in their infancy before they are life-threatening. Your Fountain Health medical team will guide you through a tailored program to screen for risks, diagnose diseases, and help you live a healthier life. Our wellness journey will continue to evolve as new technology and information is available to serve you better. Your health is our number one priority.
Click here for more information.
Contact the Health Coordinators team at firstname.lastname@example.org
The Health Coordinators are here to help you better understand the Wellness Journey. They will assist you in making appointments, answering questions, and ensuring your Wellness Journey goes well.
- Yes, Fountain Health covers $10 per member, per month towards multivitamins when ordered through the pharmacy benefit.
- If you have questions, please contact the pharmacy benefit manager, IPM.
- For more details click here.
Yes, you have general medicine coverage. You can access Teladoc by phone or computer.