FREQUENTLY ASKED QUESTIONS:

PriceMDs Outpatient Surgical Solution

What is PriceMDs’ (PMDs) Outpatient Surgery Solution?

PMDs is an established database of facilities, surgeons and medical specialists 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 and their employees to identify qualified physicians throughout the United States who have already agreed to offer all-inclusive, low-cost bundled prices for more than 400 outpatient elective surgical procedures.

What is the cost to a client to have access to PMDs?

A client pays either a PEPM capitated rate or a minimun capitation that is applied to PMDs‘ fee schedule per procedure based on accessing the database.

How does a Plan Sponsor Nurse Navigator coordinate with PMDs?

A Plan Sponsor Nurse Navigator is a patient advocacy program designed to help members define and understand how to maximize their healthcare benefits and quality of care.

Any Plan Sponsor’s Nurse Navigator can choose to either work and coordinate for a patient directly through the PMDs online platform or directly with the PMDs staff by phone or by email.

What is the PMDs service area?

PMDs covers more than 400 all-inclusive bundled outpatient surgical procedures. These are available through PMDs’ national network of doctors and facilities that spans in 46 states with over 1,400-plus facilities, and 14,000-plus healthcare professionals.

What medical treatments are available with PMDs?

PMDs has a master list of services that encompasses all-elective-surgery that maybe performed at any Ambulatory Surgery Center that is part of the network.

What are the benefit requirements and what has to be changed in the Plan Document?

The Plan must be able to waive all or part of the deductible for patients. PMDs is a “bolt-on” solution so it works in parallel with other treatment options. It is always encouraged that the Plan is reviewed by the Phia Group (health care cost containment experts) in the event that there are any additional Plan Document concerns.

When can PMDs be added to a client’s Plan?

Since PMDs is a “bolt-on” solution, it can be added to a patient’s Plan at any time.

What are the options for a patient that already has a provider preference?

Usually the patient preference can be accommodated since the requested provider is most likely listed in PMDs’ network (provider should be operating from a facility that bundles procedures). If a specific provider is not available, the ability to waive all or almost all of the patient’s out of pocket cost (usually $2,000 to $5,000) is an incentive for the patient to choose the PMDs high quality and more cost effective alternative solution.

What is included in bundled pricing?

MDs bundled pricing includes all costs that are required to perform that elective procedure. Included in the bundle are the facility fee, the surgeon’s fee (inclusive of initial consult and post-op care and pre-op lab work), the anesthesiologist’s fee including implants & pathology.

What is the claim flow process?

Once a procedure is performed the facilty sends a UB04 form that has the same invoicing as the pre-op authorization price on listed bundle pricing listed on PMDs site. The provider receives payment from payor in about one week. PMDs is also working on a tool to enable same-day direct deposit if both payor and provider are willing to participate.

How the Treatment/Drug program works

 

What is PriceMDs Treatment Cost Containment Prime Plus™ Program (TCC Prime Plus™)?

A program that significantly reduces expensive specialty drug costs for patients and employers. Approximately 175 specialty drugs are available through the program.

Patients will have live tele-consultations with U.S. Board Certified, U.S. educated, and U.S. trained physicians who will prescribe the same medications for which you are already receiving treatment. A 90-day supply of your medication will be delivered to your home or office after completion of telemedicine consultations and all other necessary steps.  All 50 states are covered! 

Who is eligible for the TCC Prime PLUS™ Program?

Members who are on specialty medications are eligible for the TCC Prime Plus™ shipping refill program. Members must possess a valid U.S. passport as per U.S. Customs shipping requirements. Your employer will decide which specialty medications are included in the TCC Prime Plus™ program.

Are the specialty drugs that I will receive the same as the specialty drugs I receive through my local pharmacy or facility?

Yes, these are the same brand name drugs from the same manufacturers that supply drugs to U.S. pharmacies and healthcare facilities.

Do I have to change doctors to use the program?

No, the patient’s treatment plan and care will continue to be handled by his/her U.S. based doctor(s). 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 his/her U.S. based physician(s).

Am I required to participate in TCC Prime PLUS™ Program for my specialty drug treatment?

The program can be voluntary, opt-out or even mandatory. Your employer selects what is best for the company. Your dedicated Registered Nurse will explain how using the program benefits you.

Do I need a passport to use the program?

Yes, a passport is required.  Although there is no travel in TCC Prime Plus, a copy of your passport is required for personal importation of medication. TCC Prime Plus™ follows current CBP, FDA & USDA self-importation guidelines. A PriceMDs dedicated Registered Nurse Navigator will provide details.

What is required for the TCC Prime Plus™ program refill?

Patients must have up to date medical records and prescription for their specialty medication. A Nurse Navigator will organize a 30-minute video teleconference with our U.S. trained, U.S. Board Certified non-U.S.-based physician to confirm medical regimen. Once that’s complete, a second teleconference with a U.S.-based Board-Certified specialist, licensed in your state will write you the prescription.

How much medication will I receive per fill and when?

Usually, you will receive a 90-day supply of your medication with each shipment in about 30 days or less from your telemedicine appointment.

How will I know it is time to schedule my next fill?

A dedicated Registered Nurse Navigator tracks each fill and contacts patients approximately 60 days before it is time for their next treatment. Just like the initial fill, a dedicated nurse navigator will assist the patient every step of the way. So, expect to be contacted by your dedicated Registered Nurse Navigator ahead of time.

Do you offer temperature sensitive specialty medication through your program?

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 in facilities and shipping hubs that provide temperature control. All pharmaceutical packages ship via World Courier, YourWay or DHL Global Express and are tracked and monitored to ensure the least amount of time in transit, while allowing for clearances by Customs & Border Patrol, FDA, and USDA.

Are there state licensing issues related to telehealth?

States require providers using telehealth technology across state lines to have a valid state license in the state where the patient is located. We have physicians licensed to practice in all 50 states!

Do I need to have access to the internet for telemedicine?

A secure broadband internet connection is crucial to having a successful telehealth visit. Members without internet access may find it easier to connect   through their cellular phone carrier. 

How does a video visit work? Do I need special equipment?

For a video visit, you can use any of these devices:

  • An Android phone or tablet
  • An iPhone or iPad
  • A desktop or laptop computer (Mac or PC)

We recommend headphones or earbuds that have a microphone, but you can also use the speakers and microphone on your device.

How is the telemedicine video consultation scheduled?

Your telemedicine consultations are all scheduled for you by your Registered Nurse Navigator after coordinating and confirming a suitable time and date between you and the physician.

Do I need to download any special apps or programs?

No, that is not necessary. At all times you will be in direct contact with your dedicated Registered Nurse Navigator and prior to your telemedicine consultation your RNN will email you a link to join.

How long should I expect the telemedicine consultation to last?

Your telemedicine consultation is scheduled for a 30-minute time slot however in most cases, expect to be done sooner than that.

How do I get started with PriceMDs Treatment Cost Containment Prime Plus Program?

To learn more, please discuss with your employer and contact one of our Registered Nurse Navigators.