2011 Access to Healthcare Network Member Manual. Please consult Access to Healthcare Network when reviewing.

1. Access to Healthcare NetworkMember Manual

2. Access to Healthcare Network Chapter 1 Welcome to Access to Healthcare Network!

3. Access to Healthcare Network Your Health – Your Responsibility Your Health – Your Financial Responsibility

5. If you access services without showing your AHN card, you may be responsible for full billed charges, and/or be refused service.

7. Membership Dues – Depending on your payment plan, dues are paid every 3 months, 6 months or 12 months.

11. It is your responsibility to read the manual and understand the policies that you must adhere to as an AHN member.

13. Access to Healthcare Network Contacting your Care Coordinator You will be given the name and extension number of your care coordinator. Please write it in your manual for future reference. Calls to your Care Coordinator will be returned within 48 hours. If you need immediate assistance, you can call the main number and ask for the Care Coordination Supervisor or the Member Services Manager.

14. Access to Healthcare Network Contact your Care Coordinator when… You don’t know how much to pay You go the Emergency Room You have been referred for a procedure or surgery You have been referred to a specialist

15. Access to Healthcare Network Contact your Care Coordinator when… You have been referred for a radiology or diagnostic test You are going to have an in-office procedure done You have questions about where to receive AHN discounted rates for medical services

17. Primary Care Home A Primary Care Provider (PCP) will be assigned to you upon joining AHN. You must choose your PCP from a list of providers in our Network. You are encouraged to make an appointment with your new PCP as soon as possible.

18. Access to Healthcare Network What is a Primary Care Provider (PCP)? Your main health care provider Usually a doctor but may be a physician assistant or nurse practitioner A PCP sees will see you for common medical problems and annual exams

19. Access to Healthcare Network What is the main role of a PCP? To provide preventative care To identify and treat common medical conditions To assess the urgency of your medical problems To make referrals when necessary

20. Access to Healthcare Network Choosing your Primary Care Provider (PCP) You will be able to choose from the list of AHN participating PCPs You can select different providers for each member of your family You many not have an out-of-network PCP and remain a member of AHN

21. Access to Healthcare Network Changing your Primary Care Provider (PCP) You have the freedom to change your PCP. To change your PCP, you must call your Care Coordinator.

22. Access to Healthcare Network Chapter 4 After Hours Care

23. Access to Healthcare Network After Hours Care The main benefit of being a member of AHN is that you will be able to access a wide range of preventive and low cost services to avoid having to visit the emergency room. Using your membership wisely is good for your health and your pocketbook.

24. Access to Healthcare Network After Hours Care If you need medical care and your primary care office is closed or you cannot get an appointment, you have several options.

25. Access to Healthcare Network After Hours Care Option 1: Contact your provider’s office and talk to the on-call physician. Option 2: Go to one of the Urgent Cares listed in the back of your manual. Option 3: Call the 24-hour Health Hotline at 982-5757. Option 4: Go the emergency room.

27. Remember to get a note from the referring physician so you can get the $400 per day rate.

29. Access to Healthcare Network Emergency Room Policies There are only two ways you can receive a discounted rate or an ER visit. If you do not satisfy these conditions, you will be responsible for full billed charges.

32. Access to Healthcare Network Emergency Room – Fees The AHN discounted fee must be paid at the time of discharge. Any charges owed to an AHN provider must be paid within 5 business days. Any charges owed to a non-AHN provider are not discountable and are the responsibility of the member.

33. Access to Healthcare Network Chapter 5 AHN Services – Fees and Policies

34. Access to Healthcare Network Basic things to remember about AHN: We are not health insurance You must pay at the time of service You are not allowed to set up payment plans You will not be billed for any services

35. Access to Healthcare NetworkServices Not Currently Available: Any and all services at Renown South Meadows Reduced lab fees through Urgent Care Hepatology Perinatal Care Maternal and Fetal Medicine Infertility Treatments Neonatology Cosmetic Surgery Pediatric Surgery Bariatric Surgery Lasik Eye Surgery

37. Access to Healthcare Network In-Office Procedures Any service obtained through your PCP must be paid at the time of service, including any in-office procedures. Any in-office procedures must be priced by your Care Coordinator ahead of time. If you get an unexpected procedure, you must contact your Care Coordinator immediately.

39. Access to Healthcare Network Prescriptions As a member of AHN, you the following options to access medications: Safeway Pharmacy Scolari’s Pharmacies CVS Caremark Prescription Discount Card

40. Access to Healthcare Network AHN Prescription Discount Card In order to receive a discount at AHN participating pharmacies, you must present your card which is located on the back of your member card. If you do not present your card, you will be turned away. If you lose your prescription card, contact your Care Coordinator for a replacement.

41. Access to Healthcare Network AHN Prescription Prices

42. Access to Healthcare Network Canada Prescription Service You may choose to go through our affiliate, licensed in Nevada for less expensive prescriptions. Call 888-550-5501 for more information. RxAccess4u – Prescription Assistance Program This services may be able to help you obtain free or vastly reduced prescriptions. Call 877-827-2897 for more information.

43. Access to Healthcare Network Blood Tests and Other Lab Work Sometimes your PCP will want you to have a blood test or other lab work done to gather more information about your health.

46. Access to Healthcare Network Lab Pricing Lab work at both Saint Mary’s and Renown outpatient labs are $5 per test. Sometimes your provider may request a panel made up of multiple test. Remember that you need to pay at the time of service.

47. Access to Healthcare Network Lab Locations Renown Outpatient Lab is located at 1155 Mill Street in Reno. Park in the Second Street parking garage, use the entrance marked “Center for Medicine C.” Saint Mary’s Outpatient Lab is located at 235 West Sixth Street in Reno. Enter through the Arlington Street entrance and go directly to the Admitting Desk.

48. Access to Healthcare Network Pap Smears and Annual Exams You will have two charges, one for the physician and a second for the pathologist. You will pay the physician at the time of service. Your Care Coordinator will contact you with the charge due the pathologist.

50. Access to Healthcare Network Pap Smear Pathology Fees Fees must be paid within a short time after your pap smear is done. Your Care Coordinator will contact you with how much to pay. The bill must be paid within 5 business days.

52. Access to Healthcare Network Radiology Bills Most radiology testing will be done on an outpatient basis and must be paid at the time of service. For radiology inpatient radiology, a bill will be sent to your Care Coordinator who will contact you with the price. You will have 5 days to pay the bill in full.

53. Access to Healthcare Network Pathology A pathology test is done when your PCP collect a sample of tissue from your body (a biopsy) and sends it for examination. Virtually all hospital based surgeries and exploratory procedures will involve a tissue sample being taken and sent to a pathologist.

54. Access to Healthcare Network Pathology Bills A bill for pathology will be sent to your Care Coordinator one to two weeks after the specimen is taken. Your Care Coordinator will contact you with pricing. You will have 5 business days to pay the necessary providers in full.

56. Access to Healthcare Network Referrals to Physical/Occupations/Speech Therapy In order to access services, your provider will need to fax a referral to your Care Coordinator. You will be contacted with pricing information so you can schedule an appointment.

57. Access to Healthcare Network Payments – Physical/Occupational/Speech Therapy You must pay either after each appointment or at the next appointment. Call your Care Coordinator for prices.

58. Access to Healthcare Network Durable Medical Equipment (DME) This is a term used for medical devices such as wheel chairs, canes , crutches nebulizers and blood sugar testing equipment. Your health care provider will write a prescription if you need to use a medical device. Contact your Care Coordinator if you don’t know the cost of a DME.

59. Access to Healthcare Network Hospital In-Patient and Out-Patient Stays – What is the difference? In-Patient means you are going to stay in the hospital for 24 hours or more. Out-Patient means that you will be going home the same day.

60. Access to Healthcare Network Out-Patient Hospitalization Some common reasons for going to the hospital on an out-patient basis are to have a surgery, procedure, test or therapy that is minor enough that you will not have to spend the night.

61. Access to Healthcare Network Tests, Surgeries and Procedures Some procedures and tests cannot be done in your healthcare provider’s office. These tests and procedures must be done in a hospital setting by a technician or employee of the hospital.

62. Access to Healthcare Network Referrals – Out-Patient Tests (Radiology, EKG, EEG, etc.) Your provider will fax the referral to your Care Coordinator. Your Care Coordinator will call with pricing and contact information so you can set up an appointment. These services must be paid a the time you get them.

63. Access to Healthcare Network Referrals – Out-Patient Procedures and Surgeries (Colonoscopy, Biopsy, etc.) Your provider will need to contact your Care Coordinator to schedule you for an Out-Patient procedure. Your Care Coordinator will determine the cost. Contact your Care Coordinator immediately to make sure they are aware of this.

64. Access to Healthcare Network Payment – Out-Patient Procedures and Surgeries Will always involve payment to at least two providers. They may also include services such as: anesthesia, radiology and pathology. Your Care Coordinator will call you once hey have pricing information for all providers involved.

66. If payment is not made at least two days prior, your surgery or procedure it may be cancelled.

68. Access to Healthcare Network In-Patient Hospitalization The discounted rates do not include doctor’s fees. These fees will be billed separately at AHN rates. If you wen to the emergency room before being admitted, you will also receive a bill from the ER doctor.

71. The hospital where you will be having the surgery.

72. The Anesthesiologist you will administer the anesthesia during your surgery.

74. Access to Healthcare Network What is a Hospitalist? A Hospitalist is a physician, usually an internist, who specializes in the care of hospitalized patients.

75. Access to Healthcare Network Hospitalists If you are admitted you may see a Hospitalist. AHN does not have a contract with all Hospitalists in your area. The rates below only apply to AHN providers.

76. Access to Healthcare Network AHN Pregnancy Programs Please contact your Care Coordinator for more information in regards to the AHN Pregnancy Programs.

77. Access to Healthcare Network Ancillary Care The services that follow do not require a referral from your Primary Care Provider.

78. Access to Healthcare Network Dental Services Our primary dental provider is Absolute Dental. If available, you can choose from a one of our private dentists. Call your Care Coordinator to find out if a private dentist is available.

79. Access to Healthcare Network Absolute Dental Your first visit will include filling out paperwork, x-rays and the consultation. At the end of the visit, the dentist will go over the treatment plan for future appointments. Expect your first visit to last at least 1 ½ hours.

80. Access to Healthcare Network Absolute Dental The price of a standard teeth cleaning is $30. If you have not gone to a dentist within the last year, expect to pay more for a deeper cleaning. You will be informed how much to bring to your cleaning appointment after the initial exam is completed on your first visit.

81. Access to Healthcare Network Private Dentist There is a very limited selection of private dentists in the Access to Healthcare Network. Please call your Care Coordinator for availability. AHN cannot guarantee that one will be available to see you.

83. Access to Healthcare Network Optometry – Eye Exams Discounts are not provided for services or materials arising from: Orthopedic or vision training Medical and/or surgical treatment Corrective eye wear required by an employer Services provided as a result of Worker’s Compensation Law Services or materials provided by any other group

85. Access to Healthcare Network Mental Health Providers If you would like to meet with a counselor for confidential individual or family therapy, or would like help with substance abuse or other addictions, you can contact any AHN Mental Health provider directly.

86. Access to Healthcare Network Mental Health Providers - Rates Please note: These fees do not apply to Reno Psychiatry, who receive specialty rates.

87. Access to Healthcare Network Chiropractors You do not need a referral. Call for an appointment and identify yourself as an AHN member to receive the discounted rate.

88. Access to Healthcare Network Massage Therapy You do not need a referral Call to make an appointment and identify yourself as an AHN member to receive the discounted rate.

89. Access to Healthcare Network Acupuncture You can call an acupuncturist directly to set up an appointment. Identify yourself as an AHN member to received the discounted rate.

90. Access to Healthcare Network Naturopathy Naturopathy physicians use natural treatment approaches. Call to directly to make an appointment and identify yourself as an AHN member.

91. Access to Healthcare Network Chapter 6 Bills- Payment After the Time of Service

92. Access to Healthcare Network Bills – Payment After the Time of Service The most important thing to remember about Access to Healthcare Network is that all services are paid at the time they are received. However, some services cannot be paid at the time they are received such as: pathology or follow-up lab work.

96. Access to Healthcare Network Relationships With Your Providers It is important to have a good working relationship with your health care provider When you meet with your providers, give them your undivided attention and be sure they do the same for you. Be honest with your providers so they can treat you appropriately.

97. Access to Healthcare Network Appointments with your PCP You should schedule and appointment within 90 days of joining AHN. Establishing care will make it easier and faster to see your provider for future appointments. Your Primary Care Provider’s information is printed on the front of your AHN card.

98. Access to Healthcare Network Appointments With a Specialist Call your Care Coordinator when your PCP refers you to a specialist. Your Care Coordinator will give you the contact information you will need to schedule your appointment. If you need to schedule a follow-up visit, you will be able to call the specialist’s office directly.

102. Access to Healthcare Network Punctuality It is important to be punctual for all medical appointments. A provider may ask you to come early to your first appointment to fill out paperwork. If you show up on time and have to wait more than half hour, let the office staff know that your are still there.

103. Access to Healthcare Network Disenrollment from AHN You will be disenrolled for the following reasons: Two late payments to AHN providers. One non-payment to AHN providers. Inappropriate behavior with a provider or AHN staff. Not giving adequate notice for appointment cancellations more than once.

105. Access to Healthcare Network Disenrollment Process – Two late payments You will receive a Certified Return Receipt Requested letter disenrolling you from AHN. All providers associated with your care will be notified you are no longer an AHN member. You will not be allowed to join AHN again. AHN providers can send you to collections. AHN providers can dismiss you from their practice.

106. Access to Healthcare Network Disenrollment Process – Non-Payment You will receive a Certified Return Receipt Requested letter disenrolling you from AHN. All providers associated with your care will be notified you are no longer an AHN member. You will not be allowed to join AHN again. AHN providers can send you to collections. AHN providers can dismiss you from their practice.

107. Access to Healthcare Network Disenrollment Process – Inappropriate Behavior If the provider claims that the member is inappropriate any of the following measures may be followed: Member will be issued a Warning Letter. Member will be transferred to a new provider. Member will be disenrolled immediately.

108. Access to Healthcare Network Chapter 8 Member Rights and Responsibilities

109. Access to Healthcare Network Member Rights As a Member of AHN you have the right to: Be treated with respect. Be referred to healthcare providers regardless of race, color, sex, national origin, handicap, religion or sexual orientation. Change your primary care provider (PCP) Discuss your health concerns with your providers.

110. Access to Healthcare Network Member Rights Continued Ask questions about and get information on diagnosis and treatments. Be involved in decisions about your health care. Contact AHN to obtain information and to get answers regarding questions and complaints.

111. Access to Healthcare Network Member Responsibilities As a member of AHN you have the responsibility to: Ensure that your membership fee is paid. Take charge of your own health and your own health care. Follow the plan of treatment prescribed by your health care providers.

112. Access to Healthcare Network Member Responsibilities Continued Treat all health care providers with respect and dignity Protect your AHN ID Card. Show your AHN ID Card before accessing services. Inform your health car providers if you are no longer an AHN member.

113. Access to Healthcare Network Member Responsibilities Continued Make full payments to AHN health care providers at the time of service. Inform AHN staff of any changes in your health care coverage, income, employment status, address and/or telephone number. Inform AHN providers of any changes in your health care coverage, income, employment status, address and/or telephone number.

114. Access to Healthcare Network Member Responsibilities Continued Show up on time for your appointments. Cancel appointments at least 24 hours in advance. Notify AHN if you change your PCP. Arrange for transportation to and from your scheduled appointments. File grievances and complaints in accordance with the Member Agreement.

115. Access to Healthcare Network Member Agreements Upon enrollment, you are required to sign several agreements. Check the back of your Member Manual for a copy of all the Member Agreements and Waivers.

116. WELCOME TO AHN!