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4. Can I use a physician or facility not listed in the AHPO directory?

Yes, providers not participating in the networks your benefit plan accesses are considered ‘out of network’ providers. Most design a plan that allows covered employees and covered dependents freedom of choice to obtain medical services from any hospital or physician they choose. Keep in mind, however, that your out-of-pocket expenses will be lowest when you receive care from participating providers. Lower out-of-pocket expenses are the result of: a.) lower fees offered by the participating providers; b.) higher benefit levels offered by your company for using participating providers; and c.) no balance-billing by participating providers (that is, hospitals and physicians accept the contracted payments as payment in full…when you receive care from a provider that is not in the network, the provider may bill you for the balance between the provider's billed charges and the amount your plan pays as "usual and customary").
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Accountable Health Plan of Ohio (AHPO)
C/O The Emerald Health Network
1301 E. 9th Street
Tower at Erieview, 24th Floor
Cleveland, OH 44114
PHONE (216) 902-7529 � TOLL-FREE (866) 744-5152 �  FAX (216) 479-2039