Frequently Asked Questions (FAQs)

font size: Reduce font size Increase font size Print This Page

Your questions are important to us. Our Customer Service Representatives are available via phone and/or email.

Customer Service Center Hours: 7:30 am – 5:00 pm EST
AultCare Members: 330-438-6360
Toll free 800-344-8858

Email us your questions or comments.

However, we have compiled a few of the most frequently asked questions for your review.

1. Why did my employer choose AultCare to handle my health care plan?

With our long-standing relationship with the Aultman Health Foundation and Stark Quality Care Physicians, we are the largest hospital-based PPO in northeast Ohio offering the best doctors and hospitals in the area.

When you call or stop into AultCare, you are always greeted by friendly customer service representatives. You are never caught in an automated telephone system that only gives you menu choices. AultCare is highly committed to providing you with exceptional customer service and high quality care.

2. How do I find out what benefits are provided by my health care plan?

AultCare handles over 1,200 self-funded and fully insured plans. For this reason, we provide you with knowledgeable and friendly customer service representatives Monday through Friday between the hours of 7:30 a.m. and 5:00 p.m. EST

Many of your questions can be answered by looking at your employee health plan booklet. You should have received this when you enrolled in the plan, however, if you don’t have one or have a question, Contact Us.

3. How can I find out if my medical claim has been paid?

AultCare is very proud of our claims turnaround time. We process your medical claims within 10 days from the time we receive your completed claim information from your health care provider. We have also worked with many of our health care providers to allow them to send us this information electronically. This allows us to process your medical claims in even less time.

AultCare mails out an explanation of benefits on a monthly basis, just like your bank statement. This document explains which claims were processed for each covered member of your family, along with how the claims were paid, and what balance, if any, is owed to the provider.

4. How do I read my explanation of benefits that I receive in the mail?

AultCare knows how challenging medical paperwork can be to understand and we work at making our explanation of benefits easier for you to read. For your convenience, we have provided a sample explanation of benefits page with a detailed explanation of how to read it.

AultCare provides you with knowledgeable customer service representatives Monday through Friday between the hours of 7:30 a.m. and 5:00 p.m. EST. They are always willing to answer any questions you might have. Contact us.

5. What are COBRA benefits and how do I know if I am eligible for them?

COBRA is a continuation of employer-sponsored health care benefits when coverage is lost. Federal law requires employers who employ 20 or more employees (a special formula is used to calculate this) to offer COBRA coverage to employees (or former employees) and/or their dependents when employer-sponsored health care coverage is lost. If you and/or your dependents have lost employer-sponsored health care coverage, check with that employer to see if they offer COBRA.

6. What if I want/need to use a provider that is not listed in the Provider Directory?

If you see a provider (doctor or hospital) not in the AultCare network, your claim will be paid as out-of-network per your plan design. This usually means a higher deductible and a higher percentage of co-insurance for you to pay after the deductible is satisfied. You are also responsible for paying amounts billed that are over Usual, Reasonable and Customary (UCR).Click on the link below to see an example of claims payment both in- and out-of-network.
UCR SAMPLE

7. What is HIPAA and how does it affect me?

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996 which prohibits healthcare providers from sharing your personal and medical information without your express permission. AultCare prides itself on strict adherence to the regulations and will only share the information necessary for completing your claim and taking care of your medical needs. For more information, CLICK HERE.

Last updated: 5/1/2012 12:00:00 AM
Copyright Aultman Health Foundation
AultCare Information Systems
Manage Your Accounts
Forgot Password Create Login