Frequently Asked Questions:

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 44 states with over 1,100-plus facilities, and 12,000-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.

What is PriceMDs’ (PMDs) International Drug program?

PMDs’ International Drug Program consists of an all-inclusive trip to Health City Cayman Islands (HCCI); a world class medical facility located in the beautiful Cayman Islands in the Caribbean. Patients will be seen at HCCI as an outpatient and they will receive diagnosis and treatment by a highly trained doctor. Upon completion they will return home with medication to treat their condition. HCCI has available medication to treat Hepatitis C, Psoriasis, Hemophilia Factor 8 & 9, Colitis, Crohn’s Disease and Rheumatoid Arthritis.Please click here for video...

During the entire stay the patient will enjoy quality, personalized concierge service and 4-star luxury hotel accommodations on the beach. Airfare can be arranged from anywhere in the U.S.

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

Abolutely zero! There is no cost for patients to access PMDs.

How does a Plan Sponsor coordinate with PMDs?

Plan Sponsors will work directly with HCCI Clinical Care Coordinator, Dr. Marjorie, to have the patient’s medical records sent as well as to ensure all pre-visit testing has been performed so that the patient is eligible for the proposed treatment. The patient will be given Dr. Marjorie’s contact information at HCCI to complete all details of the trip.

What is the procedure for accessing care?

The patient communicates with their Plan Sponsor directly by phone or by email. The Plan Sponsor searches throughout PMDs’ extensive database to find and locate the best treatment option available. This search is performed within the distance that the patient has requested based on their specified geographic location and other criteria.

What prescription drugs are available with PMDs?

Generic drugs for the medication and treatment of Hepatitis C, including other generic drugs that may be used for alternate, effective Hepatitis C treatments depending on each patient’s specific genotype. Additionally, a generic version  that treats spondylitis and arthritis is also available along with several other biologics and specialty pharmaceuticals.

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

Usually employee welfare benefit Plan Documents need to allow foreign travel for treatment and the waving of fees and deductibles. We always encourage review by the Phia Group (health care cost containment experts) if there are any additional Plan Document concerns.

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

PMDs International Drug Program is a”bolt on”solution and can be added at any time compatible with employee welfare benefit Plan Documents.

How is care coordinated with local U.S. provider?

The Plan Sponsor coordinates directly with the Clinical Coordinator Concierge at HCCI throughout the entire process. Please note that a non-invasive Fibroscan must be performed and reported within no less than 2 weeks prior to the patient’s arrival at HCCI. Fibroscan is a procedure that uses an ultrasound probe which emits a mechanical pulse at the surface of the skin, measuring the condition of the liver through sound waves. This is widely available and very commonly performed in the U.S.

How is travel coordinated?

Dr. Marjorie will assist the patient with all aspects of the travel plans. A valid passport is required. U.S. Passport holders do not require an entry Visa to visit Cayman. Some passport holders of other countries will require a Visa. If this is the case, Dr. Marjorie will make all proper arrangements.Please click here for video...

What is the claim flow process?

Claims are paid to PMDs by wire transfer at least 2 weeks prior to arrival at HCCI. PMDs will then remunerate the HCCI care bundle cost in its entirety.