AMPS FAQS

Who is AMPS?

Advanced Medical Pricing Solutions (AMPS) offers cost management solutions to self-insured healthcare plans, leading to reduced plan costs and lower member out-of-pocket expenses.

What if the provider has questions about my insurance?

Ask the provider to call the number on the back of your ID card to verify coverage and benefits. If the provider refuses, call the number on the back of your ID card and ask them to reach out to the provider. You will then be notified if they were able to resolve the issue. If not, they may provide you with alternate options.

What if the provider asks me to pay for my care in advance?

The healthcare provider may ask you to make a payment in advance. However, as the patient, you are only responsible for paying your out-of-pocket amount, which includes your co-pay, coinsurance, and deductible. You should only pay your co-pay in advance, as the coinsurance and deductible amounts are not calculated until your insurance claim is processed by the administrator.

What happens after my visit?

You will get an Explanation of Benefits (EOB) showing you your Patient Responsibility. It's important to compare your Patient Responsibility with what the provider says you owe. If the provider's bill indicates that you owe more than your Patient Responsibility on your EOB, this is called a balance bill.

What should I do if I receive a balance bill?

Remember that 95% of the time, there is no balance billing issue. If you receive a balance bill, please contact your Third Party Administrator (TPA) immediately using the number on the back of your insurance card. Your TPA will connect you with an AMPS member advocate who can help you file a dispute for an incorrect balance within 60 days from the date on the first statement you receive (not the date of service) under the Fair Credit Billing Act (FCBA). Disputes filed after 60 days are not protected under the FCBA.

Should I make any payments on the bill I receive or agree to a payment plan?

You should only pay your patient responsibility (co-pay/deductible) as stated on your Explanation of Benefits (EOB). If you cannot pay the entire patient responsibility at one time, you may make payment arrangements with the provider for your patient responsibility ONLY. However, if you choose to enter into a payment plan for the remaining balance, AMPS can no longer continue to defend the disputed charges.

Will the provider stop sending me bills once they are notified of the dispute?

Most providers will rectify errors and stop billing after the first balance bill, but it may take a few billing cycles to resolve. Providers usually bill on 30-day cycles and generate bills automatically. This means you might receive a duplicate bill while the provider is handling your dispute. If you do get another bill while your dispute is being processed, please contact AMPS at 800-425-9373.

If I have not received any additional billing in the past 30 days,
does this mean the process is complete?

It is highly probable that the provider has stopped all future billing. However, we want to make sure that you do not receive any additional bills for the next few months until we are confident that your dispute has been resolved. Therefore, please keep a lookout for any new bills, and if you receive any, kindly contact AMPS at 800-425-9373.

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