Have there been any recent provider changes to the ppoNEXT network?
Yes, please click here to download the most recent provider changes in PDF
format.
Is ppoNEXT my insurance company?
No. ppoNEXT is a Preferred Provider Organization and offers you access to our broad network of physicians and medical facilities. ppoNEXT does not pay claims, process non-ppoNEXT provider claims or determine coverage and eligibility. We do not underwrite risk or serve as a claims administrator.
Where should I send my claim?
Participants can find the claims address on the back of their member ID card. If no claims address is provided, please contact your employer's benefits administrator or call our Customer Care Center at 1-800-860-6381 between 8 a.m. and 5 p.m. Central Time, Monday through Friday.
Whom should I contact with a provider complaint?
If you experience a problem with a network provider, contact our Customer Care Center at 800.860.6381 between 8 a.m. and 5 p.m. Central Time, Monday through Friday.
What if my doctor is not in the network?
You are encouraged to choose a participating ppoNEXT provider to reduce your out-of-pocket expenses, but you may obtain health care services from a non-participating physician. If your doctor is not a member of the ppoNEXT network you can select a new doctor who is in the network. We recommend you check with your insurance company or claims payor directly at the phone number on your ID card to determine your benefits and coverage.
How do I find out information about my benefits?
For benefits and eligibility information, please contact your insurance company or claims payor directly at the number provided on your ID card. Or you may contact your employer's human resources or benefits office for assistance. ppoNEXT is not your insurance company or health plan.
How do I get a directory?
Click on the Find a Doctor section of this web site for our online provider directory. Or you can contact your employer's human resources or benefits office.
How do I file a claim with my insurance company?
Usually, your ppoNEXT physician or hospital will send the bill to your insurance company for you. But if you must submit the bill yourself, send it to the claims address on your ID card. Some insurance companies require that a claim form accompany the bill. Check with your employer's human resources or benefits office for your claims procedure and any claim forms that might be required. ppoNEXT does not provide claim forms.
How do I get an ID card?
Please contact your employer's Human Resources or Benefits office for information about obtaining your ID cards.
How much of the provider bill should I pay?
An Explanation of Benefits (EOB) attached to the bill indicates how much of the bill you are to pay. If your bill does not have an EOB attached, or if you have questions about the EOB, please contact your insurance company or claims payor directly at the number provided on your ID card.
What if a network provider isn't available to treat my condition?
The options you have if an appropriate network provider is not available are outlined in your benefit plan. Contact your insurance company or claims payor directly at the number provided on your ID card for information about your benefits plan.
Should I carry my ID card with me at all times?
Yes. Your ID card with the ppoNEXT logo must be presented at the time you receive services to ensure access to our negotiated rates. Providers may not honor the discount if the proper ID card is not presented at the time of service.
What happens if my doctor terminates with the ppoNEXT network in the middle of a treatment program?
If your treatment began prior to the doctor's leaving the ppoNEXT network, he or she is responsible for concluding your treatment plan.
What should I do when the Explanation of Benefits (EOB) shows services I didn't receive?
You should contact the provider's office and verify the details of your care. We also recommend you contact your insurance company or claims payor directly at the number on your ID card to let them know of the discrepancy.
What do I do with a foreign medical bill for care I received outside of the U.S.?
Your insurance company or claims payor will provide you with the procedure for dealing with foreign medical bills. You should call them directly at the number provided on your ID card.
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