Q. What is a PPO Network?
A. A PPO (Preferred Provider Organization) Network contracts with hospitals, physicians, and other healthcare providers to participate in a network offering quality health care at competitive rates. Participating providers agree to pre-negotiated fee schedules. PPOs offer their services to health insurance companies, third party administrators (TPAs), and self-insured employers.

Q. What benefits do I get if I use Signature's providers?
A. The plan design (benefits and coverage) is determined by the member's insurer. Some benefit plans pay a larger portion of the claim if a member uses a PPO provider, which reduces the member's out-of-pocket expenses. As an example, if a member chooses a Signature Health Alliance PPO provider, their benefits may cover 90% of the claim, but if they use an out-of-network provider, only 70% of the claim may be covered. Some plans have a flat fee (co-pay), which you pay at the time of service. In this case, if you use a non-PPO provider, they may be responsible for a percentage of the total billed amount, as well as having a deductible to meet.

Q. Is Signature Health Alliance my insurance company?
A. No. Signature Health Alliance manages your PPO Network but does not pay claims or determine your medical coverage.

Q. How do I verify benefits, eligibility or pre-certify a hospital stay?
A. Contact your primary benefits administrator, insurance company or third party administrator listed on the back of the ID card. Signature Health Alliance does not provide these services. Hospital admissions and certain procedures may require pre-certification. Failure to do so may result in reduced benefits for the patient.

Q. Who do I call to check if my claim has been paid?
A. Call your claims administrator or insurance company as listed on your ID card.

Q. How do I select a provider?
A. Search for a provider through the Member's home page or check the provider directory provided by your insurance company representatives or employer. If you still have trouble finding a provider, call Signature Health Alliance at 1-800-264-3060 and our customer service representatives will be happy to assist you.

Q. Who is my insurance company and what is their phone number?
A. The name of your insurance company is on the back of your ID card along with the number. If you are unable to find it please call our customer service department at 800-264-3060 and they will assist you.

Q. What does Repricing a claim mean?
A. Repricing is applying the discount for using an "In-Network Provider" to charges submitted by your doctor's office. The discount and net charges, along with the original claim, are forwarded to the insurance company for payment.

Q. Do I need a referral to go to a specialist?
A. This policy varies among insurance groups using our network, but typically no referral is necessary. It is always good to consult with your primary benefits administrator prior to seeking care to verify the limits of your coverage.

Q. Are prescriptions and dental insurance covered through Signature Health Alliance?
A. No. If you have dental or prescription coverage as a part of your health insurance plan, you must consult your primary benefit administrator for details about these services.

Q. What is Signature Health Alliance's coverage area?
A. Signature Health Alliance's PPO Network covers the entire state of Tennessee.

Q. What is the difference between a Provider, a Client, and a Member?
A. A Client is a company or employer group that contracts with Signature Health Alliance to access our providers. A Provider is a physician, another healthcare professional or a facility that has a contract with Signature and provide health care to members. Members are the individuals that are employed by the company or employer groups.

Q. I need an insurance card, how do I get one?
A. Contact your insurance company or your employer group administrator. Signature Health Alliance does not issue the insurance cards.