Medical Referral and Authorizations
Directing the insured to a medical provider can be performed by either the client or MedCare. In most cases this is only possible for insured that reside or are on an extended stay in the USA. The client can contact us whenever an insured is being treated in the USA on an inpatient or outpatient basis.
More often you will probably have cases in which persons become acutely ill and have health or travel health insurance coverage with you. They are admitted to a hospital or see a doctor on an emergency basis. As soon as MedCare is advised of the hospitalization of an insured, we are in touch with the hospital to provide them with a contact person in the US and a US billing address. The hospital and medical providers are then aware that services are being paid at reduced rates. This benefits your insured since he will not be required to make a payment or deposit against the expenses he is incurring.
Some of the expert services we provide include:
- Locating a medical provider in non-emergency situations.
- Confirming benefits with providers to eliminate payment requirements at the time of service.
- Assisting the insured by making appointments with medical providers.
- Acting as the liaison to obtain authorization for specialized treatment.
- Claims audit and review
Basically, the insured just needs to focus on getting healthy instead of worrying about the financial and approval processes.
Medical Bill Reduction
Our contract rates with hospitals and doctors achieve an average savings of 30-40% for the insurer. MedCare’s fees are based on a percent of the achieved savings. If the hospital or doctor is not participating in our network, we can generally achieve a reduction if the bill has not been paid. Our negotiations average a savings between 22-32%. If a reduction is not obtained, we will notify you and no costs are incurred.
MedCare has an affiliate relationship with a prominent international assistance company. If you are interested in 24/7 assistance services, we can put you in contact with the appropriate staff.
Routine case management begins on the first day of a hospital admission. This service helps avoid unnecessary treatments and exams which increase the medical costs for the insurer. Our staff receives regular updates regarding the diagnosis and current treatment of a patient as well as the current costs. This information is provided to the insurer every 48 hours. If a patient is in a non-PPO hospital and his condition permits, the insurer determines if he can be transferred to one of our contracted PPO hospitals or be repatriated to his home country. MedCare performs specialized case management services involving a physician upon request of the client.
Specialized Medical Programs
MedCare International has many of the country’s best hospitals under contract to provide specialized tertiary care such as bone marrow and organ transplants and cardiac procedures. Since these programs vary substantially in their quality and outcomes of care, MedCare only contracts with those hospitals with the best performance records. Pre-negotiated case rates might be of interest to you if one of your insured plans to have a procedure performed in the United States.
Bill Audit and Review
MedCare’s staff review hospital bills to identify questionable procedures and charges. If a bill seems unreasonable, we will perform a thorough audit of the patient’s medical record and treatment to validate the appropriateness of the billed services. After audit, we will contact the hospital and request removal of the questionable charges.
Customized Services – No Hidden or Additional Fees
One of MedCare’s strengths is the ability to tailor our services to each client’s needs. You decide which services you want us to perform and these services are customized to your requests and language preference. Based on your claims reporting criteria, MedCare will customize a comprehensive claims reporting package to your specifications in your language of choice. Whether the case involves suspected fraud against the insurer, subrogation clarification or research, MedCare can provide expert assistance for these requests. A thorough review of all claims is performed to ensure that the medical services performed and billed are warranted for the particular diagnosis. Verification of deposits or payments is performed to avoid duplicate payment or overpayment of the medical bills. We are in contact with the insured and the medical
providers to discuss eligibility for treatment. This information is expeditiously communicated to the insurance company for their decision and approval.
Banking and Provider Payment Services
MedCare offers its clients several options for banking services and medical provider payment. You may wire funds on an invoice basis or you may elect to establish a deposit account with us. If you select a deposit account, provider payment is made without delay and you save bank charges associated with multiple wire transactions. Either of these options will insure that the correct payment amount is made in US currency and the payment is accompanied by an Explanation of Benefits (EOB) to avoid balance-billing problems.