Frequently Asked Questions
Q. What is AIM and how does it work?
AIM is a national leader in specialty benefits management. If you determine your patient needs an advanced imaging or sleep management testing service, you contact AIM and have the service reviewed, to help ensure that it’s the safest and most appropriate treatment option based on evidence-based standards of care. You are then given the option to select a testing center to provide that care to the member. If a testing center is chosen that will cost the member more money out of pocket than other testing sites in the Horizon network, AIM will call the patient to let him or her know there are other options available that may be of equal or better quality that are more cost effective.
Q. Which groups are participating with the AIM program?
Horizon Blue Cross Blue Shield of New Jersey has entered into an agreement with AIM Specialty Health to help manage certain advanced imaging and sleep study related services for our members enrolled in certain National Account self-insured groups.
Review the groups enrolled with AIM
Q. Why was AIM developed?
AIM was developed to make sure your patient receives quality health care that is consistent with the latest medical research and to help your patient manage and lower his or her out-of-pocket health care expenses.
Q. What procedures are included in the program?
The program includes common advanced radiology and sleep medicine procedures:
- CT Scan
- MRI Scan
- PET Scan
- Nuclear Cardiology
- Sleep Test
- Treatment for a Sleep Disorder
Review the procedure codes reviewed by AIM.
Q. How much money would the patient save by using lower-cost provider?
Potential savings depends on the patient’s benefit plan, deductible status, coinsurance/co-pay status, etc. However, sleep testing can cost anywhere between $850 to $2,500 depending on where the patient lives, which provider he or she chooses and whether it is done in a facility or at home.
Q. If the patient decides to use a lower-cost service will AIM help schedule his or her new appointment?
Yes. AIM will try to reach the health care provider and schedule an appointment. If the provider isn’t available, we will give you the testing center’s phone number to schedule an appointment at a later time.
Q. What happens if the patient chooses NOT to use the lower-cost provider?
This is a voluntary program. The patient may receive services from whichever provider they wish to see.
Q. You recommended that the patient see a certain provider. Why is AIM trying to get the patient to visit a different one?
We want to provide the patient with the lowest out-of-pocket cost for this service while still maintaining the high quality.
Q. Is this information shared with you when a service is reviewed in advance and determined to meet clinical guidelines?
Yes. You receive this information to promote greater transparency, quality standards and cost effectiveness.
Q. How do I contact AIM for these services?
The toll-free number is 1-866-766-0250. This number is also on the back of the cards of those employer groups that opted into this program.
Q. What are AIM’s hours of operation?
AIM’s contact center will accept calls Monday through Friday between 7 a.m. and 7 p.m. Central Time. Member outreach (outbound calls) for the Specialty Care Shopper Program begins at 7:30 a.m. and ends at 8 p.m. Central Time.
Q. Is peer-to-peer review available for physicians?
Peer-to-peer reviews will be coordinated as the case advances. The toll-free number 1-866-766-0250 should be used for purposes of documentation.
Q. Why do the services you recommend need to be reviewed before your patient has them?
We recognize the value and expertise you provide in health care decisions. However, advances in care occur every day, and sometimes, a better or less expensive alternative to the care you initially recommended is available and medically appropriate. AIM physician reviewers support you in the decision making process by helping ensure your patient receives care that is based on the latest evidence-based medical research and practice standards. Together, we help reduce your patient’s need for repeat and multiple health care services, improving the health care experience and keeping out-of-pocket expenses at a minimum.
Q. How does AIM benefit the patient and his or her family?
AIM gives the patient and his or her family an opportunity to make informed choices about his or her health. They may be able to get the same quality procedure for less out-of-pocket expense by receiving their care from a different facility than the one initially recommended.