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Administrators and Payers

Administrator/Broker FAQs

What is the difference between the SuperMed Plus and Traditional network?

The SuperMed Plus network contains both institutional, e.g., hospitals, critical care and skilled nursing facilities, and professional providers, e.g., physicians, suppliers, that hold a SuperMed contract with Medical Mutual.

The SuperMed PPO product has two contracting levels – network and participating. Members receive the highest level of benefits when using a network provider. If a member receives services from an out-of-network provider, but the provider is considered a participating provider, benefits may be reduced to the non- networking level. However, both network and participating providers are to accept our allowable amount as payment in full for covered services, and the member will not be balance billed for any amount above the negotiated reimbursement amount. For non-contracted providers, the member may be balance billed and held responsible for charges up to billed charges.

The Traditional network includes institutional and professional providers that hold a participating contract with Medical Mutual. Please note, all SuperMed Plus providers are also part of the Traditional network.

Which network product generates the most savings for a group?

The SuperMed Plus product will generate the most savings as this network is comprised of both institutional and professional providers.

What types of questions does Medical Mutual answer for payers?

Payers can call Medical Mutual if there are questions regarding the pricing of a claim. Payers can also call Medical Mutual if they need to know the provider’s network status.