American Health Benefits - Hospitalization

Hospital Network

Galaxy Health Network Hospital (GHNH) program provides Members with access to over 2,500 acute-care hospitals nationwide. Members have the opportunity to save 10-30% or more. Remember, this program is not insurance and Members are responsible for paying the discounted bill in full. Members are able to utilize any in-network provider or facility as often as needed.

Important Notice: In case of an emergency, immediately contact your doctor directly or call 911.

Sample Case #1 A Member in California inadvertently put their hand through a window and went to the emergency room of a Participating Hospital. In addition to the hospital and radiology bills, the Network provided savings for the Member on their follow-up needs with a plastic surgeon. In this scenario below, the member was out only $100.

Procedure	Charges	Coverage	Percent Savings
Emergency Room Visit	$3,931	w/Accident Policy	N/A
Accident Policy $5,000 (Included with Freedom Plus Program)	$100 Deductible	up to $5,000	N/A
Total for this Visit	$3931	$3831	97.5%

Sample Case #2 A Member in Arizona went to the emergency room of a Participating Hospital and was diagnosed with appendicitis. The Member received an emergency appendectomy and was in the hospital for two days. Charges submitted from hospital, as well as the emergency room physician, surgeon, anesthesiologist, and pathologist.

Procedure	Charges	Savings	Percent Savings
Appendicitis	$16,157	$6,775	41.9%

Sample Case #3 A Member in New Jersey was in need of a preventative surgery. While the Member's selected surgeon was not a Participating Provider, the hospital was, and a Network Case Worker worked with the surgeon's office to find a participating lab and anesthesiologist recommended by the surgeon.

Procedure	Charges	Savings	Percent Savings
Preventative Surgery	$10,623	$3,853	36.3%

How To Access Your Discounts:

Step 1:
PRE-PLANNED SERVICES- Savings for Pre-planned/Non-Emergency services are only available with the required pre-certification and referral number. The negotiated estimated payment portion amount needs to be secured prior to the Member receiving any services by calling 800-975-3322. Once GHNH has confirmation of ability to pay a referral number will be provided.

EMERGENCY VISIT - Members must notify GHNH and receive a referral number within forty-eight (48) hours of an Emergency Visit by calling 800-975-3322 or GHNH is not responsible to negotiate discounts.

Step2:
NEGOTIATED SAVINGS - A Representative will coordinate all resources and negotiate with the provider and/or facility for contracted savings. Prior to the procedure, the Representative will obtain a good faith estimate of the cost involved for the treatment and inform the member of their estimated payment portion in writing. Note: Members must process their services through GHNH before submitting the claim to an insurance carrier. Members are not eligible for savings through GHNH if they ask a Provider/Facility to file an insurance claim for them.

Step 3:
ARRIVAL FOR SERVICES - Upon arrival for services, present your GHNH membership card to provide proof of the right to services to GHNH Providers/Facilities along with the precertification/ referral number obtained from the MSC representative in order to ensure proper billing of services rendered.

PAYMENT PROCESS

SECURE PAYMENT - Members will be responsible for any payment after either insurance and/or contracted discount is applied. All payments will be made directly to the facility and/or provider of services.

PAYMENT METHOD - Members have the option to secure payment using the following methods or any combination thereof as pre-approved by the facility and/or provider: Cash, Check, Credit Card, Insurance Payment, Medical Savings Account Funds, or other certified funds.

VERY IMPORTANT!!!
Members must call 1-800-975-3322 to pre-certify and receive a referral number. If a Member fails to obtain pre-certification or referral number and a bill is received, the bill will be returned to the Member as “Self-Pay” resulting in the Member being responsible for all billed services in full. Pre-certification documentation will be sent to the Provider/Facility upon request. Hospital discounts are not available in AK, HI, MD, RI, VT, WV and WY.

GALAXY HEALTH NETWORK MEDICAL SAVINGS CARD HOSPITAL TERMS AND CONDITIONS

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THIS PLAN IS NOT INSURANCE. THIS IS NOT A MEDICARE PRESCRIPTION DRUG PLAN.*
This plan does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. The plan provides discounts at certain health care providers for medical services. The range of discounts will vary depending on the type of provider and service. The plan does not make payments directly to the providers of medical services. Plan members are obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount medical plan organization. You may access a list of participating health care providers at this website. Upon request the plan will make available a written list of participating health care providers. You have the right to cancel within the first 30 days after receipt of membership materials and receive a full refund, less a nominal processing fee (nominal fee for MD residents is $5). Discount Medical Plan Organization and administrator: Careington International Corporation, 7400 Gaylord Parkway, Frisco, TX 75034; phone 800-441-0380.
The program and its administrators have no liability for providing or guaranteeing service by providers or the quality of service rendered by providers. This program is not available in Florida, Massachusetts, Montana and Vermont. *Medicare statement applies to MD residents when pharmacy discounts are part of program.