Before you visit the doctor, be sure to check the tier of the provider. This determines your copay costs. Then advise the office staff of the correct copay so you won’t need to be billed or credited later. If it turns out the physician is Tier 3 (highest copay), you may want to consider changing providers.
As outlined in the Benefit Decision Guide, all GIC employee/non-Medicare plans will continue to tier specialists based on quality and cost efficiency. Harvard Pilgrim and Tufts Health Plan are implementing Primary Care Provider (PCP) tiering and changing their tiering methodology based on provider group value instead of individual performance effective July 1, 2017. This change may affect your copays.
Finding Your Physician’s Tier
To find out your physician’s tier, contact your health plan by visiting their website or calling their customer service department. Provider tiering does not apply to GIC Medicare plans. Don’t forget to also view on your phone or download and print the abbreviated prescription drug formulary. This will help you discuss whether medications are covered, which tier they’re in, and to find out if there are lower cost alternatives. See the plan pages for contact information.
This information provided by the Group Insurance Commission .