You can use the Provider Search tool on this website (www.OhioPPOConnect.com), accessed from links on our home page or from the “Member” dropdown on the main menu. You also can call the number for Ohio PPO Connect on the back of your health insurance ID card and speak to one of our customer service representatives who can assist in finding a physician or hospital that is in network with your benefit plan.
To keep your out of pocket expenses to a minimum, you should always try to use providers who are participating in the network. However, you always have the freedom to use a provider of your choice, whether inside or outside the network. Choosing a provider outside of the network may increase costs for both you and your employer.
A TPA is a company that processes and pays your health claims under the health plan that your employer has designed and chosen for its employees. You can find the phone number for your Third-Party Administrator on the back or front of your health insurance ID card.
Contact your Third-Party Administrator (TPA). They administer the health plan designed by your employer and will be able to tell you the specifics as to what is covered, how often you can see specialists, deductibles, and if a copayment or coinsurance is necessary for the service. Your TPA can also inform you if you will incur additional costs by using a provider who is not in the network. You can find the phone number for your Third-Party Administrator on the back or front of your health insurance ID card.
Your Third-Party Administrator (TPA) actually pays the providers for your medical claims. The TPA will issue the explanation of benefits (EOB) and the payment for the provider services directly to the provider. Your TPA can also explain any payments that are your responsibility, such as copayments, coinsurance, and deductibles. You can find the phone number for your Third-Party Administrator on the back or front of your health insurance ID card.
Please refer to the table below:
| Inquiring About: | Who to Call: |
|---|---|
| Find a doctor/hospital | Network Phone number on Insurance Card |
| Pre-Certification/Authorization | Third-Party Administrator or Phone Number on Ins Card |
| Claim on file/submitted | Third-Party Administrator or Network Affiliate |
| Non-payment on claim | Third-Party Administrator |
| Claim denial | Third-Party Administrator |
| Benefits & Eligibility | Third-Party Administrator |
| Accident detail information/Other insurance coverage information (COB) | Third-Party Administrator |