Medical Provider Networks

U.S. Medical Provider Network - First Health

When you call a doctor’s office for an appointment or present your ID card to a provider, it is important for you to say:
“My healthcare coverage utilizes the First Health Network - are you a First Health provider?”

For assistance in locating a First Health provider, please visit their website or call 1.800.226.5116. First Health will assist you in locating the provider type or specialist in your area.


ASPE health care benefit plan contains a Medical Provider Network inside the U.S. A Medical Provider Network is a network, or group, of doctors and hospitals that have entered into an agreement with Seven Corners to accept discounted fees for medical services. The Medical Provider Network is a Preferred Provider Network (PPO). Claims for services provided by a Preferred Provider are mailed directly to Seven Corners at the address on the back of your identification card.

If you receive your medical services from one of the doctors and hospitals in the Medical Provider Network your benefits will be paid at the negotiated provider contracted rate if they are a covered benefit. Also, if you use a provider in the Medical Provider Network the provider can not bill you for any covered benefits except the $25.00 co-pay for office visits, $75.00 co-pay for ER, urgent care or hospitalizations.

Usual, Customary & Reasonable Charges (UCR)
If you do not receive care from a provider in the Medical Provider Network, benefits will be paid at standard Usual, Customary and Reasonable Charges (UCR) for the area in which care was delivered if they are a covered benefit. If the provider bills more than UCR, you will be responsible for any charges over and above the UCR, as non-preferred providers are not under negotiated contracted rates.

35 Mile Exemption
If your home address is over 35 miles from the nearest Medical Network Provider, you are exempt from the provider network guideline. You are free to see any provider of your choice. You will need to call Seven Corners to coordinate this exemption.

Out of Network Charges
If you pay for your medical services out-of-pocket or are billed at the time of service you will need to submit a claim for payment or reimbursement.

Additional Information
If you want to discuss your provider choice with Customer Services, you can call customer service toll free in the U.S. at 1.800.461.0430.

Do not wait to find a provider for emergency care - go straight to the nearest ER. Emergency care is defined by Seven Corners as a need for hospitalization, trauma (ie: broken bones, accidents), acute and spontaneous non-controllable pain, blurry vision, intense headache, chest pain, shortness of breath, unmanageable high fever, open wounds, or any life-threatening situation.

If you have a life-threatening emergency, please call your local emergency service or go to the nearest hospital. If you are unsure where the nearest hospital is located, the Seven Corners staff can assist.

International Medical Provider Network

To locate a provider or hospital in the USDOS Non-U.S. Medical Network, call toll free: 1.800.461.0430 or collect: +01.317.818.2867 outside the U.S. Or visit www.wellabroad.com to search through a network of health care providers outside the United States. To access this site, sign-in by using your ASPE ID card # (certificate #) and your date of birth. Under “Search Providers,” select your country of choice.


Exchange participants on grants outside the U.S. may go to any provider they want. Seven Corners offers a Medical Network outside of the U.S. but the non-US Medical Network work slightly different than the U.S. Medical Networks.

Non-U.S. doctors and hospitals are contracted to provide access to USDOS participants based on payment of Usual and Customary Rates for Local Nationals. Seven Corners has built Usual and Customary Rate tables for specific regions outside of the United States. There are two types of Non-U.S. Medical Network Providers which are defined below:

Direct Pay Providers
Direct Pay Contracted Providers are defined as providers that Seven Corners has reviewed and determined that the provider meets all the necessary requirements for quality care based on their country licensing authority. Additionally, these providers have agreed to a payment fee schedule which is not more than the rates local nationals pay and they have agreed to accept payment directly from Seven Corners without billing the participant first. Participants may not be required to pay out of pocket when accessing these providers for covered services. Seven Corners wire transfers payment to provider’s bank account in the currency of the providers’ choice or can mail the provider a check.

Referral Providers
Referral Providers are defined as providers that Seven Corners has reviewed and has determined the provider meets all the necessary requirements for quality care based on their country licensing authority. Seven Corners has loaded these providers in a database, and has sent them information on joining the Seven Corners Direct Pay Network, but they have not yet agreed to join the Direct Pay usually due to lack of large numbers of participants in their area. As participant numbers in the area grow or providers are accessed, Seven Corners continues negotiations with those providers in an attempt to move them into our Direct Pay Contracted Provider list. If a provider has not agreed to participate in the Seven Corners network, Seven Corners will still attempt to negotiate a direct pay or guarantee of payment agreement with the provider so you will not have to incur all of the out-of-pocket expenses at the time care is received.

Emergency
In the case of an emergency during which the member is outside the United States, our Assistance Department should be contacted immediately. We ask that you gather as many details as possible for our Assistance staff during this call. Our office can be reached 24/7/365 days a year by calling 1.800.461.0430 or collect +01.317.818.2867. You may dial this number direct or you may contact your local operator and request to make a collect call to this line. The caller may also visit the AT&T Travel site to determine the toll-free access code for your specific country. This code should be dialed followed by our toll-free number: 1.800.461.0430.

Emergency care overseas is defined by Seven Corners as a need for hospitalization, trauma (ie: broken bones, accidents), acute and spontaneous non-controllable pain, blurry vision, intense headache, chest pain, shortness of breath, unmanageable high fever, open wounds, or any life-threatening situation.

Seven Corners is available to support you with an emergency number and guide you to a Direct Pay or Referral Provider, but clearly we want you to seek immediate care at the nearest facility.

In emergency situations where care is needed immediately, you are not required to call Seven Corners. If you have a life-threatening emergency, please call your local emergency service or go to the nearest hospital.