The Trust realizes that committing to S.T.O.P. is a big decision, and you likely have many questions concerning the program. This is why we have created a FAQ to help you get the answers to some of the most important and common questions asked concerning the program. Of course, if you do not find the answers you need here, you are welcome to call or e-mail the Trust with any questions or concerns you may have.
| Q: |
Why are some portions of my provider's program not covered by the Trust? |
| A: |
While developing the S.T.O.P. program, the Trust quickly came to find that the approaches and program structures currently utilized by our contracted providers varied greatly. It became evident that this wide array of methodologies allows our participants to select whichever program works best for them rather than be forced into a one-size-fits-all approach. However, this also means that some providers may utilize or implement components that fall outside of what is covered by the Trust, such as nutritional bars or shakes. The Trust has included detailed program overviews for each providers page so that you can determine exactly what your out-of-pocket expenses will be before selecting a program. |
| Q: |
What if I decide that the provider I enrolled with is not right for me? |
| A: |
You may simply select another contracted S.T.O.P. Program provider from the Trust’s selection list. |
| Q: |
What if I would prefer to use Weight Watchers or Jenny Craig? |
| A: |
The plan will pay up to $50 per calendar year for weight management support groups. Please review the Plan Document (p. 140) for additional information. |
| Q: |
Will I have a separate copay if I am referred to a dietician, nutritionist or counselor? |
| A: |
Yes, your original copays and plan benefits will apply. Make sure to review the current Plan Document for any special testing. |
| Q: |
Will my lab work be covered? |
| A: |
Yes, as long as you utilize one of our contracted providers (i.e. Quest Diagnostic or LabCorp.). Please remember that your out-of-pocket cost will be significantly higher if your lab work is completed by an out-of-network provider. |
| Q: |
Will my lab work be covered if it is drawn in the office and the specimen is being sent to a non-contracted lab? |
| A: |
Yes. However, if your lab work is sent to an out-of network provider (a lab other than Quest or LabCorp), you will have to meet a deductible of $1500.00 for Diamond medical plan participants and $2500.00 for Platinum medical plan participants. |
| Q: |
Is there a copay for lab testing draw if the services are performed in the S.T.O.P. provider's office? |
| A: |
Yes. If you are currently on the Diamond plan, your copay responsibility is $10 per test while a Platinum plan participant's copay is $15 per test. |
| Q: |
What if my S.T.O.P. provider refers me to an out-of-network provider? |
| A: |
We ask that our providers only refer you to other in-network providers. However, it is always, ultimately, your responsibility to verify that the provider you have been referred to is in-network. You can verify that either by checking online at www.teachershealthtrust.org or by calling the Service Department at (702) 794-0272. |
| Q: |
Will my medications be covered? |
| A: |
In most cases, yes. A $20.00 copayment for all weight loss medication will apply provided your weight loss medication is prescribed by one of the selected in-network S.T.O.P. providers and the prescription is filled at an in-network pharmacy or by Medco (for long-term medication). This will include generic medications as well. |
| Q: |
Is gastric bypass or LAP-BAND surgery covered? |
| A: |
No, the Trust does not cover gastric bypass or LAP-BAND surgery or any services related to this procedure. |
| Q: |
Can a S.T.O.P. provider charge me an appointment "no call/no show" fee? |
| A: |
Yes. The Trust does not dictate each provider's office policies and procedures or how they choose to administer them. Make sure you discuss all policies and procedures prior to your appointment and do not sign any agreements that you do not fully understand or acknowledge. |
| Q: |
What if I disagree with a S.T.O.P. provider's office policy or procedures and do not wish to sign required forms? |
| A: |
It is highly recommended that you always read what you are signing rather than signing off on any forms you are provided. If you disagree with what the provider is requiring, do not sign the form and choose another provider. |
| Q: |
Will the Trust cover testing to determine what percentage of my body is muscle, fat, water, etc.? |
| A: |
Yes, if the services are performed by a S.T.O.P. provider. However, BMI testing is considered a diagnostic test. The copay for the Diamond Plan is $10 while the copay for the Platinum plan is $20. Some of the S.T.O.P. providers will offer this test on a weekly basis. You may tell your provider that you would prefer to check your BMI on a monthly basis or at longer intervals to minimize your out-of-pocket expenses. |
| Q: |
May I see my S.T.O.P. provider for general medical issues also? |
| A: |
Yes, but keep in mind that this may warrant a separate visit with a separate copay responsibility. It is not recommended for your weight management claims to be combined with or incorporated into your general medical care. |
| Q: |
Will the Trust pay or reimburse for shakes, bars, vitamins and/or supplements given to me in the provider's office? |
| A: |
No, you will be solely responsible for the cost of any of these items as well as all over-the-counter medications. |
| Q: |
Will I be billed a copay for each office visit pertaining to the S.T.O.P. Program? |
| A: |
Each provider offers different programs. If the provider bills the Trust for an office visit, you will be charged the office visit copay. Not all office visits require a face-to-face visit with your provider. Some visits may only consist of a visit with office staff for the purpose of recording your weight, and medication dispensing. Ask the provider before scheduling an appointment if they will be billing an office visit at each appointment. |
| Q: |
Who may I contact if I have any questions or concerns about the program or my provider? |
| A: |
You may contact the Trust Wellness Division via phone at 702-866-6192 or e-mail at wellness@teachershealthtrust.org. |
| Q: |
I have two health plans from separate carriers. The Trust is secondary and my primary does not cover weight management. May I participate in the S.T.O.P. Program. |
| A: |
Yes. If the Trust is the secondary insurance carrier, you or your provider should submit your claims to both your primary carrier and the Trust. After the primary carrier has processed the claim, you or your provider should submit a copy of the primary carrier's Explanation of Benefits (EOB) to the Trust. Please review page 71 in your Plan Document for detailed information on how to file a claim. |
| Q: |
Will B-12 or fat burner injections be covered? |
| A: |
Yes, but only if administered by a S.T.O.P. provider. |
| Q: |
What will not be applied to my $600 S.T.O.P. benefit maximum? |
| A: |
Your weight loss medications, registered dietician services and therapy for weight loss will not be applied towards your $600 benefit maximum. |