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Health Care Trust


The Montana Association of Counties Health Care Trust was established in 2005 to provide a cost-effective alternative for health insurance benefits for counties and county-related boards and districts. By pooling the risk of a severe financial loss over a larger population, premiums are generally more stable, limiting the broad fluctuations that an individual county or district might otherwise experience.

The Health Care Trust is able to combine the purchasing power of pool members when negotiating plan services, such as claim management, case management, preferred provider pricing, and reinsurance. The result is favorable coverage, terms, conditions, and plan limits that are tailored to the needs of the county, board, or district.

Plan services such as enrollment, risk control, and wellness programs are tailored to the needs of county members. Health Care Trust members have a significant voice in how the pool is operated and how claims are resolved, since the policy-making board is comprised of county commissioners. If claims controversies should arise, Health Care Trust members have the full support of MACo administration and the Health Care Trust board.

Staff        Telephone Numbers & Addresses

 


 

 

Reference Based Pricing Map

Reference Based Pricing Acute Care Facilities

Reference Based Pricing Critical Care Facilities

 

Reference Based Pricing is a method of paying hospitals and other medical facilities based on a standard reference point, in this case Medicare. Reference based pricing closes the gap in how much different hospitals in Montana charge for the same services and saves MACoHCT and our participants money.

 

Medicare is the largest healthcare payer in the country. It gives us a relatively consistent way to compare facilities because all facilities accepting Medicare are measured in the same manner. Medicare’s calculation process is also publicly available.

 

The cost of medical services continue to rise at a rate far faster than inflation of other goods/services and faster than employees’ pay. Reference based pricing is the most effective tool we have to bend that cost curve. This change will mean less money going to health care expenses and more going into employees’ pockets. It also creates a system that is more fair, transparent, comparable and predictable than how hospitals charge us now.

 

If you have a service at a Participating hospital, your benefits will function exactly as they do now. You pay your deductible and coinsurance and the Plan pays a fair amount based on a market analysis on your behalf. 

If your service is at a non-Participating hospital, you pay the same deductible and coinsurance you pay now and the Plan pays the same fair, pre-determined amount. This amount is being accepted by other comparable facilities, but a Non-Participating hospital reserves the right to send you a bill for more. This is called a balance bill. It is completely your responsibility to pay and does not count toward your deductible or max out-of-pocket, thus providing you with an incentive to go to a Participating hospital.

 

Almost all professional providers in the State of Montana are contracted on a Medicare type (Reference Based Pricing) – Fee Schedule structure so they already accept this form of reimbursement.  There will be no change in processing the professional claims or in the Explanation of Benefits (EOB). 

If a professional provider is employed by a Non-Participating hospital, they will be paid the same way they always have, but the hospital does reserve the right to balance bill the patient.

 

Services outside the state of Montana will be subject to the Cigna network.  Visit www.askallegiance.com/ProviderSearch to see a list of Cigna in-network providers and facilities.

 

If you have an emergency medical need, go to the nearest emergency facility!
The reimbursement rate for emergencies has been set at a higher amount that will cover what facilities in Montana charge for emergency cases. If a Non-Participating facility tries to balance bill you for an emergency, please contact Allegiance. They can help you negotiate that bill.

If you are admitted to a Non-Participating facility, please contact Allegiance right away. A case management nurse will help you get transferred to a Participating facility as soon as you are stable.

 

Call 866-669-6428.