Independent Health’s iDirect® FAQs

What is Independent Health’s iDirect®?

iDirect is Independent Health’s High-Deductible Health Plan (HDHP). Members pay out-of-pocket for their health care services until they reach their plan deductible. Once the deductible has been met, a regular health plan takes over with copays and/or coinsurance, which protects members from serious health care related expenses (note: member liability varies by plan).

What is my deductible amount?

Your deductible amount is set according to your specific group plan design. Please refer to the Benefit Summary or Contract (Certificate of Coverage) for your plan deductible amount.

How is the deductible calculated?

Medical services that count toward your deductible are applied based on the date the claim is received and posted by Independent Health, not by the date you received care. Most health care providers bill Independent Health shortly after you receive care; however, it is important to note that providers have up to 120 days to do so.

Do all of my medical services go toward my deductible?

No. The deductible does not apply to in-network preventive care services, routine vision and dental (if applicable).

If I need surgery, would that be subject to my deductible?

Yes, surgery services would be subject to your plan deductible. Only in-network preventive, routine vision and dental services (if applicable) are not subject to the deductible.

Do I show my Independent Health ID card when visiting a doctor or filling a prescription even before my deductible is met?

Yes. Showing your ID card allows Independent Health to track your deductible and out-of-pocket maximum and gives you access to Independent Health’s negotiated rates when seeking services from an in-network provider.

Before reaching my deductible, will I be billed for my medical services or will I have to pay for them up front?

For plans with deductibles, some participating providers request payment at the time of service. If your provider requests payment up front, he/she will be required to reimburse you any overpayment received once the claim is processed. Otherwise the claim will be processed first, and you will then be billed by the provider for the remaining balance due.

How am I notified when a service is processed against my deductible?

Independent Health tracks your deductible and sends you an Explanation of Benefits (EOB) when you owe part of the cost of the service. As you use services, you will receive an EOB showing the amount processed against your deductible. You may contact Member Services at (716) 631-8701 or 1-800-501-3439 to obtain your current deductible and out-of-pocket totals. In addition, we encourage you to keep a record of all your health care expenses.

I received a bill from my provider. How do I know how much and/or when to pay?

All participating providers are required to submit claims to Independent Health, even if you haven’t met your deductible. Independent Health will review and process the claim, and your physician will bill you any balance due. You may keep track of what you owe by reviewing your Explanation of Benefits (EOB). If you owe your provider, it will be indicated under “Total Member Responsibility." Please feel free to call us with questions about your claims submission or payment at (716) 631-8701 or 1-800-501-3439.

How are my pharmacy claims processed?

Pharmacy claims are processed “real time.” If you have a “shared” deductible (i.e., both medical and pharmacy claims contribute to your deductible), you will pay the negotiated full price of the medication until you reach your deductible. Once you meet your deductible, your applicable member liability will apply.

How are specialist office visits covered?

You must meet your deductible before in-network specialist services are covered. Once you meet your deductible, you will pay any applicable member liability.

How do I know when my deductible has been met?

You can track your claims and/or get your deductible balance by:

  • Referring to the Explanation of Benefits (EOB) you receive
  • Calling Member Services at (716) 631-8701 or 1-800-501-3439
  • Having your provider’s office check online if they have access to WNYHealtheNet 
If my family deductible is $3,000, at what point in coverage will my liability change to copay/coinsurance?

You or any combination of members of your family must reach the family deductible before copay or coinsurance applies. In-network preventive, routine vision and dental services (if applicable) are not subject to the deductible.

Do I have the option of seeing any doctor I want?

Independent Health offers an extensive network of providers. You may have the flexibility of using non-participating providers based on your plan option.  If your plan includes out-of-network benefits you can minimize your out-of-pocket costs by using a participating physician, which in turn allows you to take advantage of Independent Health’s negotiated rates. Our negotiated rates are generally lower than what the provider may normally charge.

Are referrals required under the iDirect plan?

No. You have the freedom to see in-network specialists with Independent Health’s iDirect® plan, without obtaining a referral.

Do I need to get approval for services?

Certain services under your iDirect plan will require you to call for approval or “precertification.” A detailed list of services requiring precertification is included in your Contract (“Certificate of Coverage”). Failure to obtain precertification when necessary will result in a penalty and reduction of benefit. Call Member Services at (716) 631-8701 or 1-800-501-3439 to obtain written approval for services requiring precertification.

What preventive care services are covered in full?

We offer a number of preventive services for $0 copay. View a complete listing of $0 copay in-network preventive services on our site or by logging in to your online Independent Health account.

What happens if I’m overcharged incorrectly for a medical service?

Your physician or provider will be responsible for promptly refunding the difference. If you pay the physician out of your HSA funds and are overcharged, your physician must return the overpayment amount to you so that you can put it back into your HSA. If you don’t redeposit the money you’ve taken out of the HSA, you may be responsible for tax penalties. Consult with your HSA custodian/bank for guidance in re-depositing funds to your HSA.

How do I open an HSA?

The HSA administrator/bank your employer selected will issue a welcome kit. You must complete the bank application or signature card and return it to the bank to establish your HSA. Once your account is funded, your bank will issue a debit card for your convenience.

How are contributions made to my HSA?

You, your employer, or a family member can contribute to the account. These contributions can be made by payroll deduction or directly deposited to your account. Remember, you may only access funds that have been deposited in the account.

How much can I contribute to my HSA?

Your annual HSA deposit cannot exceed the maximum allowed contribution in accordance with IRS guidelines. Individuals 55 and older can make additional catch-up contributions in accordance with IRS guidelines until they enroll in Medicare. At that point, contributions are no longer allowed. Visit the IRS website at www.irs.gov  to check the current HSA maximum contribution amounts.

What is the Mental Health Parity and Addiction Equity Act?

Congress passed the Mental Health Parity and Addiction Equity Act that requires large group health plans (51 employees or more across the United States) to provide the same treatment limits and financial requirements for mental health and substance use disorder services as they do for medical and surgical services.

As a result, beginning on your group's renewal date, on or after July 1, 2010, the following mental health and substance abuse disorder benefits will have the same member liability (copayments, coinsurance and deductibles) as your medical and surgical benefits:

  • Inpatient coverage for mental health diagnoses
  • Outpatient coverage for mental health diagnoses
  • Partial hospitalization coverage for mental health diagnoses
  • Pharmacological management coverage for mental health diagnoses
  • Inpatient detoxification coverage
  • Outpatient substance abuse rehabilitation
  • Inpatient substance abuse rehabilitation