Our top priority at AmeriHealth New Jersey and AmeriHealth Pennsylvania is making sure that members have equitable access to quality care and affordable health coverage. We believe that all our members should be able to access the doctors and hospitals in our network without having to pay more than their health benefits require to receive medically necessary care.
Hence this reminder: Participating Providers who require patients, including our members, to pay a designated fee (e.g., annual membership fees and/or other surcharges) for Covered Services to remain in their care are in violation of their AmeriHealth Professional Provider Agreement (Agreement) and are subject to termination from the AmeriHealth network.
This is typically referred to as concierge medical care, or retainer medicine, and is in violation of the terms of your agreement.
Participating Providers are required to comply with the terms and conditions of their Agreement, which requires them to accept payment from AmeriHealth as payment in full for all Covered Services.
Covered Services include:
- well-patient visits
- emergency telephone consultation available 24 hours a day, seven days a week
- treatment of acute conditions
- coordination of medically necessary care
- referrals to appropriate specialists for treatment
Under your Agreement, it's mandatory that you provide Covered Services during normal business hours, in addition to 24/7 telephone access for consultation on medical concerns and emergencies.
This policy was updated in the Provider Manual for Participating Professional Providers – AmeriHealth New Jersey and the Provider Manual for Participating Professional Providers – AmeriHealth Pennsylvania in November 2022.
If you have any questions, review your contract or contact your Network Coordinator or Provider Partnership Associate.