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
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
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.
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.