Spectrum Health Lakeland Plan Member Co-Pays

May 1, 2019

UPDATE ON COPAYS:

The co-pay for Spectrum Health Lakeland plan members is $30.00 for Tier 1 (in-network) PCP and Specialist office visits. All Lakeland Care Network credentialed providers are in-network/Tier 1 for Lakeland plan members.  Unfortunately, the Real Time Eligibility (RTE) software that offices use to determine a patient's co-pay, indicates a $55 copay for Tier 1/in-network visits.  This information comes from Priority Health and it is incorrect.  The only co-pays that are $55 are for Tier 2 (out-of-network) PCP and Specialty visits. Priority has informed Lakeland that this will not be changed in 2019. Therefore, please discuss this with your staff and make sure the office reception teams are aware to collect $30 for PCP and Specialty office visits for Lakeland Care credentialed (Tier 1) providers.

Attached is some helpful information for your office to know for your patients who are Lakeland plan members.  This update reviews correct co-pay amounts for Primary and Specialty Care, Patient Costs, Covered Preventative Services, Referrals and Prior Authorizations.