Other Medical Solutions
Other Medical Solutions 101
Key Takeaways
- MedCareComplete (MCC) has carefully selected and packaged non-insurance products and services that are designed to drive high utilization and high employee satisfaction.
- When insurance-based strategies have reached the maximum effectiveness, smart employers begin using non-risk-based strategies outside the insurance realm.
- Benefits that reward high utilization and shift costs away from the employer can add real value to employer benefit plans.
Telemedicine
Telemedicine offers 24/7 access to U.S. Board-certified physicians who can consult, diagnose, and prescribe medication for common and acute illnesses by phone or video. This can redirect medical costs from group health plans by handling up to 70% of all doctor visits.*
*Average costs for level 1 non-emergency visits. healthcarebluebook.com.
Frequently Asked Questions
Telemedicine is a national network of Board-certified licensed Internal Medicine and Emergency Room physicians who diagnose illnesses, recommend treatment, and prescribe medications when appropriate for its members over the telephone, through secure bi-directional video and email.
Immediate access to medical attention can often resolve problems that if left untreated, could eventually result in hospitalization. Telemedicine provides convenient, affordable access to healthcare at anytime and anywhere! Telemedicine provides 24/7/365 access to a physician without ever having to leave your home or office. No waiting for office visits! Prescriptions (if needed and appropriate) are sent to the local pharmacy of your choice.
Telemedicine’s programs reduce unnecessary doctor’s office and emergency room visits and allow members alternatives to visiting their primary care physician for purely informational and other basic reasons. Data shows up to 70% of all doctor visits may be superfluous, costing billions of dollars and can be handled with a telemedicine telephone or video consultation.
Telemedicine uses a third party credentialing agency to ensure that only the best providers are servicing clients. The credentialing process is comprehensive and includes license verification, reference checks, and background checks. In fact, the process is fully in accordance with the American Association of Preferred Provider Organization (AAPPO) standards and is the same criteria used by hospitals to grant privileges.
We recommend that for infants under two years of age an actual visit to the doctor is in order. However, there is no minimum age to consult with a telemedicine physician regarding your medical concern. However, the physician’s ability to provide information or diagnose and treat is dependent on the nature of the symptoms and the patient’s ability to communicate his/her condition to the doctor.
Absolutely! Telemedicine is not insurance. We do not deny access to quality care because of pre-existing conditions.
Yes. Telemedicine services are available 24/7/365 throughout the United States. Generally the physician will call the patient on the number that was provided within 15 minutes and guaranteed within a couple of hours.
No. As a member, you have access to unlimited telephone consults anywhere, anytime. You only pay the nominal consult fee if applicable for each instance.
A telemedicine physician has the ability (if medically appropriate) to prescribe a wide range of products. These include, but are not limited to, medications such as antibiotics and antihistamines. Our physicians do not prescribe medications regulated by the Drug Enforcement Agency or those that pose a potential for abuse or addiction. Also, telemedicine physicians do not prescribe lifestyle drugs.
The most common prescriptions given are antibiotics and antihistamines. Our physicians follow strict protocol when diagnosing conditions.
Medication Management
Medication Management is for members and their families who suffer from chronic or poly-chronic conditions (a home delivery service for those who take more than four maintenance medications per day.) Members are paired with Patient Care Coordinators who improve the lives of chronically ill patients. As an added convenience, medications are often sorted, labeled, organized, and delivered to the member’s home at no additional cost.
Frequently Asked Questions
We work with patients who have chronic conditions including heart disease, IBD, HIV, diabetes and hepatitis. We also work with transplant patients.
We provide our services at no additional cost to the patient. The patient pays the copay for their medications just like any other pharmacy.
We accept most insurance. Our enrollment team will confirm the patient’s insurance coverage before any prescriptions are filled.
We have access to a number of copay assistance programs for many chronic conditions including COPD, high cholesterol, high blood pressure, IBD, HIV, diabetes, asthma, hepatitis, HIV, kidney disease and rheumatoid arthritis. An enrollment team member will identify all available copay assistance programs for which the patient qualifies.
Yes. We facilitate prior authorizations for all medication management patients. Please note that the prescriber may be asked for specific chart information and will need to provide signatures where required.
Prescriptions are filled and shipped from our pharmacies in Georgia and Florida directly to the patient’s home or other physical address. We cannot deliver to P.O. boxes.
Yes. We can ship 90-day supply medications if prescribed.
The patient can request to have all prescriptions transferred to us so that all of their medications come from a single pharmacy.
Any new prescriptions can be sent by the provider to us via ePrescribe, fax or phone. Written prescriptions given to the patient will need to be mailed to us. Your Patient Care Coordinator will assist you with this transition.
Each patient is assigned a PCC who will call the patient at least once a month to confirm that the patient is doing well, to discuss any challenges the patient may have with their medication regimen, to verify any changes to the medication regimen and to confirm the patient is ready for their prescription refill.
We do not automatically refill prescriptions because we want to speak with the patient before shipment. This way we can ensure there have been no changes in the prescriptions and that the patient is ready for a refill.
If a patient’s prescription changes mid-cycle, the patient’s PCC will confirm that change when notified by the provider or provider’s office and on an immediate follow-up call with the patient. If the patient is to start taking a new medication or to discontinue a current medication mid-cycle, the PCC will confirm the patient’s understanding of the provider’s instructions and will ship new medication as needed.
Delivery instructions are established between the patient and their PCC before each medication shipment. The patient will be notified during this conversation if signature is required upon delivery. They will also have the option to specify an alternate delivery location if necessary.
Medical Bill Negotiator
The cost and complexity of health care continue to grow. You don’t have the time or experience to become a health care expert. Now you have a partner to provide medical bill assistance. Reduce cost and realize more value from health care through the leader in medical bill negotiation and health care advocacy.
The first time you enter a bill you will create an account profile that can be used to identify you. This will save you time on future visits. You can use your personal login ID to check on the status of your medical bill negotiation and review your final savings summary report. To get started, you will be asked to provide some basic information about your medical bill and provider by entering it online or faxing it in. Experts will negotiate medical bills as long they exceed the $300 minimum.
Frequently Asked Questions
Medical Bill Negotiator (“MBN “) provides expert medical bill review and negotiation services to save employees money.
Members can access the MBN ‘s bill negotiation portal by visiting the link in their MedCareComplete account. Bills should be entered in the MBN portal only.
The MBN ‘s Negotiation Specialists are very respectful of patient/provider relationships. We work collaboratively with all medical providers. Providers benefit from the negotiation because the MBN corrects anomalies in billing, informs them about the”market” cost for procedures, gets them paid faster and reduces the risk of uncollectible bills.
The MBN recommends that participants review bills before they pay for services. If you pay for medical services at time of delivery, you lose the opportunity to reduce cost through negotiation. The MBN will not be able to negotiate a bill you have already paid. However, if you have pre-paid a portion of the bill, the balance is negotiable.
Medical Bill Negotiator typically works on a success based fee structure. As a MedCareComplete member there is no additional charge for the negotiation as long as your bill exceeds $400 and you can enter a charge card for payment to the provider.
The MBN will authorize the participant’s credit/debitcard to ensure sufficient funds are available to pay the bill, prior to commencing the negotiation. If the provider has agreed to reduce the bill, the MBN will enable the provider to charge the participant’s card for the reduced amount of the bill only. With the MBN successfully negotiating a bill, there are no additional efforts required of the participant to pay the provider.
If the MBN does not save money negotiating the bill, we do not pay the provider and we drop the authorization on the card.
Can I use a debit card? Participants can use a credit or debit card. The MBN accepts VISA, MasterCard and American Express. The MBN also accepts most debit cards from health savings accounts (HSAs) and personal checking.
Under ordinary circumstances the MBN will reach the provider and complete the negotiation within an average of 5 business days. The MBN provides personal service on every bill. As such, we contact the provider’s billing staff directly to negotiate the bill in every case.
Participants can log into their account to view personal account information by using their login and password, 24/7. To check the status of a case, select “Manage Account” after logging into review the latest details. Participants also receive email notifications.
Personal and healthcare related information on the MBN ‘s site is confidential and secure. Your information will be used only in our efforts to reduce the bill. The MBN does not provide any information to direct mail or telemarketing companies. The MBN ‘s privacy policy is posted on our website for review. The MBN ‘s privacy policy is certified by TRUSTe, a leader in web privacy certification and compliance.
While the MBN cannot guarantee savings, the results typically fall in the 20% to 50% range. The amount the MBN can save depends on the amount of the bill, type of provider, geography and the degree to which the provider is charging a reasonable fee.
The MBN believes personal service is the key to success. The MBN will negotiate directly with providers billing staff (hospitals, physicians, ambulatory surgical centers, labs, etc) on behalf of participants to reduce the bill. Personal, one-on-one negotiation increases the chances of saving participants money.
