We all know that the cost of healthcare has gotten out of hand. Your employer has chosen TrueCost to ensure that what you pay for healthcare services is consistent and reasonable. TrueCost reimburses providers 40% more than the amount paid by Medicare. Many physicians and hospitals consider this Medicare plus 40% rate to be fair and are pleased to accept patients who are covered by TrueCost.
Just as fully-insured health plans have providers who are “out-of-network,” there are some providers who are reluctant to accept the TrueCost reimbursement rate.
• They will treat patients with TrueCost as “self-pay” patients
• They intend to charge patients the amount they would charge an individual who does not have health insurance
• This may be more or less than the amount covered by TrueCost
We do not recommend utilizing providers who will not accept TrueCost. You may incur additional costs to utilize their services. They may also request that you pay an amount at the time of service that exceeds your co-pay and/or deductible.
Providers have contacted Custom Design
Benefits directly to let us know they are happy to take patients under this plan.
Contact your Patient Advocate through
Custom Design Benefits to:
• Request information about providers who accept the plan
• Request information about the
TrueCost reimbursement rates for specific procedures

Before utilizing a hospital’s services, ask how they intend to treat TrueCost coverage. If they identify you as a self-pay patient, ask about any up-front costs you may incur and what will be due at the time of service.
1. Request a completed claim form from your provider. The form may be called a UB Form at a hospital or outpatient facility or an HCFA at a doctor’s office. Health care providers are required to provide you with a completed form at your request.
2. Mail, email or fax the form to Custom Design Benefits:
• Mail: 5589 Cheviot Road, Cincinnati, OH 45247
• Fax: 513.389.2998
• Email: Claims@CustomDesignBenefits.com
3. Custom Design Benefits will send you a check for the TrueCost amount for the procedure or treatment. You can then pay your medical bill using these funds.
If the amount of reimbursement is less than the amount you are balance billed by the provider, we encourage you to contact your Patient Advocate through Custom
Design Benefits. We will be able to give you advice on whether or not to pay the difference or if an alternative rate can be negotiated with the provider.
You are required to pay the appropriate co-pays and/or deductibles called for in your plan. But do not automatically pay additional funds out-of-pocket without consulting Custom Design Benefits.
Most healthcare providers observe basic rights related to your care and the cost of your care. Among those rights:
• To be treated in a considerate and respectful manner, even and especially when discussing billing
• To receive complete and current information about your diagnosis and prognosis, both in terms you understand and using the medical terminology and codes used in billing and reimbursement
• To receive a full explanation of any procedure or treatment you receive, including an itemized bill
• To have access to the information in your medial record within the limitations of hospital policy
In the event of an emergency, go to the nearest hospital, regardless of their status and acceptance of TrueCost.
Healthcare facilities are required to treat emergency patients with no regard to their ability to pay or discrimination against any type of healthcare coverage.
Following your visit, if the facility does not accept TrueCost, follow the self-pay process and Custom Design Benefits will assist you in processing your claim.
In many cases, especially at non-profit hospitals and surgery centers, self-pay patients are invited to apply for financial assistance. For example, a family of four with a household income between
$46,000 and $69,000 could be eligible for a 60% discount or other financing options from the healthcare facility.
These discounts will lower your selfpay bill, bringing it closer in alignment with the reimbursement rate offered by TrueCost. If your bill is less than the
TrueCost reimbursement you may keep the difference.
5589 Cheviot Road Cincinnati, Ohio 45247
800.598.2929 513.598.2929 www.CustomDesignBenefits.com