ABC COMPANY CARE CONNEX EMPLOYEE GUIDE

Transcription

1 ABC COMPANY CARE CONNEX EMPLOYEE GUIDE

2 Ineffective healthcare breaks the bank - we re here to help.

3 Healthcare Costs at a Glance ABC Company knows this and wants you and your family to save money, time, and receive the best possible healthcare experience and outcome! We have customized a healthcare plan that will help to reach those goals. Standard health insurance is likely to pay 250% more for hospital charges for you than for a person on Medicare. Most non-emergency illnesses (flu, sore throat, urinary tract infection, cough, etc.) can be treated at home, by a physician via video doctor visit. A lab test or MRI done at a hospital costs 400% more than a local, independent lab or radiologist where the quality is often better. Up to 30% of surgeries performed in the U.S. are unnecessary.* Additionally, most surgeries performed in a hospital can be done in a freestanding surgery center at a lower cost. *Based on a study by the National Library of Medicine

4 WELCOME Welcome to your Care Connex medical benefit program! Your employer is concerned about the rising cost of health benefits for the Company and it s employees. Instead of increased (and often costly) payroll contributions, Care Connex changes the way health benefits are delivered to you or your family: 01 Access to a Care Navigator: Assistance in connecting with a medical provider (and in some cases scheduling appointments). 02 Preferred Providers: Experience enhanced member benefits by using a Preferred Provider. 03 No Restrictive Provider Network: Ability to select the doctor of your choice. No In-Network or Out-of-Network. 04 Video Medicine: Reach a physician for less severe conditions 24 hours per day and 7 days per week.

5 Your Personal Care Navigator Health care and health benefits can be confusing. It is important for you to make the right decisions for you and your family when it comes to treatment, location and cost. Our Care Navigator is here to assist you and can be reached by phone at (888) , or by at HOW IT WORKS After verifying your identity (for privacy purposes), we will listen to your needs. The experience and information at our fingertips will help us provide necessary assistance, from finding a doctor in your area to arranging an appointment for a MRI, lab test or even a surgery. We will never rush to a solution that will jeopardize your care or financial liability. In some cases, it may take a few days to find a suitable solution that meets your needs. We will notify and update you through the entire process. Our Care Navigator is here to assist you! (888) carenavigator@advancedpricing.com.

6 FREEDOM TO USE ANY PROVIDER, + recommendations you can trust. SAME DAY SURGERY CENTER Access for a wide range of surgical procedures that can be done safely without hospital admission. HOSPITAL Access to Connex provider hospitals, including centers for specialized care, oncology and transplants. RADIOLOGY FACILITY Access to over 3,000 independent radiology centers for quality MRIs, CT Scans and more.

7 One of the biggest changes to your Plan is the ability to use any provider you want. You are no longer bound by the restrictions of In-Network or Out-of-Network providers. That said, Care Connex offers access to Preferred Providers. A Preferred Provider is an entity contracted by the Care Connex program and has agreed to accept fair and reasonable payment while also agreeing to not balance bill. This added benefit is completely optional. We continue to recruit and contract providers. If you would like to nominate a provider for consideration, please contact a Care Navigator with the provider name, specialty, address and phone number. We will contact the providers and determine if they agree to the terms of the contract. LAB WORK Access for lab work ordered by a physician. In most situations, your MD can take and submit samples directly to the lab. PHYSICIAN Access to local physicians as well as over 675,000 preferred physician locations nationally. To locate a Preferred Provider, simply contact a Care Navigator: (888)

8 Video Medicine Service With MDLIVE, you have unlimited access to board-certified doctors via secure online video, phone or the MDLIVE App 24 hours a day, 7 days a week, 365 days a year. Designed as an alternative to expensive urgent care visits or to waiting extensively to get an appointment with your primary care doctor, MDLIVE grants you access to a physician for diagnosis and treatment of non-emergency medical conditions, such as cough, allergies, pink eye, sinus issues or flu. If necessary, these doctors may prescribe non-narcotic medication. An added bonus of the service is its cost to you. In most cases, expect to pay little to nothing. With an MDLIVE account, you can browse doctor profiles, view available appointment times and schedule appointments with the doctor of your choice. MDLIVE offers free sign up and account activation. Any applicable fees are collected once an appointment is scheduled. Review the Summary of Benefit and Coverage to learn more about your responsibility as a patient. Sign up and activate your account by using any of the following methods: Visit mdlive.com and click Get Started. Call MDLIVE at +1 (800) 400 MDLIVE (6354) and choose Option #1. Download the MDLIVE App, available for iphone, Android, and Windows smartphones.

9 Your Financial Responsibility It is your responsibility to review the Summary of Benefits and Coverage (SBC) and the Summary Plan Description (SPD) for your Plan. This information is provided upon enrollment but is also accessible through the web portal or by calling the customer service number listed on your ID card. Contact customer service or log into the portal to see how much of your deductible remains and whether outof-pocket limits have been satisfied. Please note that these amounts are updated regularly, so be sure to monitor your account accordingly. Patient responsibility is a critical component of the Care Connex program. Be sure to pay the provider directly for any amounts due (copayments, deductible and coinsurance). If you can t pay the entire bill, setup a payment arrangement. Failure to make timely payments will result in loss of protection against balance billing and may expose you to additional financial liability.

10 Fair & Reasonable Payment to Providers Think about going to a grocery store with a 50% off coupon in-hand. Sounds great, until you learn the cost for a gallon of milk is a whopping $20! Coupon or not, most people wouldn t buy the milk, especially when they know the average cost is around $3. However, those unaware of the actual cost may in fact purchase the overpriced milk as they think they are getting a great bargain. The above analogy is helpful when considering how healthcare bills are usually paid. When a PPO discount is applied, we don t necessarily know if the final cost is unreasonable. To ensure fair and reasonable payment is made, Connex benchmarks Cost and Medicare data. As such, your Plan is based upon a Fair and Reasonable Payment methodology. There may be instances when a non-preferred medical provider disregards fair payment, and bills the patient for the difference. This is known as Balance Billing, which will be explained in greater detail on the next page. A discount doesn t always translate to a good deal.

11 Balance Billing If you do not use a provider contracted for the Connex program (Preferred Providers), you may receive a statement from the provider showing an amount due which exceeds the copayments, deductible and coinsurance reflected on your Explanation of Benefits (EOB). That is called balance billing and is a tactic used by the provider for additional collections. Unlike most purchases or services that have clear pricing, doctors and hospitals rarely list prices. Other than the co-pay, you may not even know what a visit or procedure costs. Would you ever agree to pay $30 for a disposable razor when you know the fair price is $3? No! Receiving a balance bill from a doctor or hospital is the equivalent of a razor company billing you $27 extra for a $3 razor. Approximately 95 % of balance bills aren t disputed because patients don t know their rights with regard to fair and reasonable billing. We recognize our responsibility to support you if you are balance billed based on our determination of fair and reasonable. This support includes everything from handling provider appeals to providing legal protection against aggressive collection efforts. (866) If you receive a balance bill, immediately contact us at (866) to initiate our Advocacy program. We will work with you to dispute the balance bill and terminate future collection activity.

12 More Information HOURS Monday - Friday: 8 am - 7 pm EST Saturday - Sunday: CLOSED CONTACT (888) carenavigator@advancedpricing.com