PriceMDs has a proprietary platform with an established database of facilities, surgeons and medical specialists throughout the U.S. that have listed all-inclusive bundled pricing for elective medical and surgical procedures.
It enables private and public sector entities, including employers with self-insured healthcare plans to receive an all-inclusive, low-cost bundled prices for more than 400 outpatient elective surgical procedures at 30% - 50% savings.
A client pays a per employee per month (PEPM) capitated rate. With 30% - 50% savings, one bundled surgery may cover the cost of the PEPM for 1 - 2 years.
PriceMDs' national directory of doctors and facilities spans across 46 states with over 1,100-plus facilities, and 14,000-plus healthcare professionals.
PriceMDs SCC bundled pricing includes all costs that are required to perform that elective procedure. That Includes the facility fee, the surgeon's fee (inclusive of initial consult and post-op care and pre-op lab work), the anesthesiologist's fee, also durable medical equipment, implants & pathology if needed.
PriceMDs' SCC program is a bolt on solution, it can be added to a self-insured plan at any time.
Clients will be provided with marketing material to share with their members. This information will direct the member to contact a PriceMDs Registered Nurse (RN) if a physician has recommended surgery and their dedicated RN will manage their care. PriceMDs RN can also coordinate imaging if needed (outside of the bundled pricing).
The patient is required to have a diagnosis and/or an initial plan of treatment from a physician and or specialist for an elective surgery/procedure. They must also be on the client's medical plan.
A procedure that is deemed necessary to the patient but does not need to be performed immediately (i.e., colonoscopy, knee or shoulder replacement, ENT procedures, etc.).
The members' out of pocket (OOP) cost is waived by the employer to encourage participation. They will also receive the guidance of an assigned PriceMDs RN to assist them through the process.
The patient preference can be accommodated if that provider is listed in PriceMDs' directory. If a specific provider is not available, the ability to waive by the employer patient's OOP cost (usually $2,000 to $5,000) is an incentive for the patient to choose the PriceMDs high quality and more cost-effective alternative solution.
Once a procedure is performed, the facility sends a UB04 claim for the authorized bundled price directly to the payor. The provider receives payment from the payor within 10 business days in receipt of the claim.
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TCC is a program that significantly reduces the cost of expensive specialty medications for employers and their members. Approximately 180 specialty medications are available through the program.
It is a second opinion program where patients will have live telehealth consultations with U.S. Board Certified, U.S. educated, and U.S. trained physicians who after consultation and medical records review to determine appropriatness of treatment will prescribe the same branded medications patient is already receiving. A 90-day supply of the medication will be delivered to their home or office after completion of telehealth consultations.
Yes, these are the same brand name medications from the same manufacturers that supply to U.S. pharmacies and healthcare facilities. PriceMDs directly sources these same medications from the lower established price in the European Union.
Zero cost, no sign-up fee, no PEPM, no cancelation fee. The client will only receive an invoice if their member is participating in the TCC program which will lower their cost by ~30%. PriceMDs will quote an all-inclusive price and lock it in for one year, subject to a possible increase each April 1st.
The typical savings are approximately $30,000.00 annually for each member that participates in the TCC program.
Members and/or their dependents who are on their employer's plan and are prescribed a specialty medication. The client/employer will decide which specialty medications are included in the TCC program.
This is a bolt on solution that can be added at any time!
PriceMDs follows all guidelines of the Federal Food, Drug & Cosmetic Act 2003 804j for self-importation. Only FDA approved medications are sourced. All shipments are subject to examination at the border by FDA, CBP, and USDA. It is a second opinion program that requires a consultation with an international, U.S. Boarded and Licensed MD and a U.S. boarded and licensed in the state of the patient's domicile. PriceMDs is fully insured for regulatory compliance and medical malpractice by the Beasley Group (a Lloyd's of London Co.).
No, the patient's treatment plan and care will continue by their physician. This program allows patients and employers to save on the high costs of specialty drug treatments. It does not replace the patient's relationship with their treating physician.
Members must possess a U.S. passport as per U.S. Customs shipping requirements. Although there is no travel in the TCC telehealth program, a passport is required to show citizenship for self-importation. A PriceMDs Registered Nurse (RN) will provide details.
Patients must have up to date medical records and prescription for their specialty medication. Their dedicated PriceMDs RN will organize a 30-minute video teleconference with our U.S. trained, U.S. Board Certified non-U.S.-based physician and also with a U.S.-based Board-Certified specialist, licensed in their state who will write the prescription.
The patient will receive a 90-day supply of their medication with each shipment in about 30 days or less after telehealth consultation. Their dedicated PriceMDs RN will monitor the shipment closely and follow up with the patient after the shipment arrives.
The PriceMDs RN tracks each fill and contacts patients approximately 60 days before it is time for their next treatment. Just like the initial fill, the dedicated PriceMDs RN will assist the patient every step of the way.
Yes, cold chain (refrigerated) shipping is our specialty. From ambient room temperatures, to controlled room temperatures (20°C to 25°C), to refrigerated (2°C to 8°C), all medication shipments arrive to facilities and shipping hubs that provide temperature control. All pharmaceutical packages ship via FedEx Express or DHL Global Express and are tracked and monitored to ensure the least amount of time in transit, while allowing for clearances by CBP, FDA, and USDA.
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