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Resource Center

FAQs

[1] How do members access different health services throughout Pennsylvania if they live in one county and work in another and need care in both places?
The PPHN network allows its members to access their health care when and where they need it most in a convenient and efficient manner. One identification card covers all the member networks statewide and all networks utilize a uniform operational approach. Our broad range of coverage for our members, combined with single signature contracting and a single point of claims submission for providers, allows us to provide the highest level of customer service for employer groups, members and providers.

[2] How can I find out what providers and hospitals are in the PPHN Network?
By visiting our website: www.pphn.com, you can easily conduct a provider search, locate our geographic coverage map that lists all of the counties we cover and the hospital and ancillary facilities included in those counties and learn more about our Provider-owned network partners.

[3] What if a member wants to visit a provider or facility that is not in-network?
With PPHN, you may choose any provider for your health care needs without any referral requirements. The benefit to utilizing our in-network providers and facilities is the negotiated discounts that are applied to the fees charged. In some cases, a discount can be negotiated for special procedures and it is recommended that you consult with our medical management department.

[4] What is PPHN's relationship with insurance companies and Third Party Administrators?
PPHN works collaboratively with our Payor partners to provide our clients the coverage they need. While they administer the benefit plan and claims payment, PPHN ensures our clients are receiving the highest level of quality care at the best facilities with a wide geographic coverage area.

[5] How can PPHN help to contain and better manage our health care costs?
First and foremost, PPHN is dedicated to offering the highest level of quality health care through our Provider-owned networks. We accomplish this by providing a wide geographic coverage area so no matter where your employees live they are never too far from coverage when they need it most. We also achieve many cost efficiencies through a strong medical management program, continuous review of local health care trends and practice patterns, negotiating the most competitive provider contract reimbursements, as well as procuring competitive access and administration fees. Finally, we offer self- funding plan options that are very viable alternatives to traditional insurance company managed plans that can allow you to be more in control of how you manage your health care plan costs.