Your plan participants may require travel to receive care at an acute rehabilitation hospital. Plan participants may be admitted with a traumatic injury, debilitating disease or following certain types of surgery. Acute rehabilitation is appropriate for patients who will benefit from an intensive, multidisciplinary rehabilitation program. The Approved Providers we have in our network all offer physical, occupational and speech therapy, and are medically supervised by physiatrists and other specially-trained physicians and neuropsychologists to determine if the plan participant needs additional psychological or psychiatric treatment. Our criteria for Approved Providers is that there must be an attending physician onsite 24 hours a day to manage the medical aspects of each patient’s care.
In this setting, the patient is expected to make significant functional gains and medical improvement within a reasonable time frame. Patients receive a minimum of three hours of therapy per day, up to six days a week. Therapy is provided on both a one to one and group basis, depending on the needs of the individual patient. Additional services such as respiratory therapy, aquatic therapy, and therapeutic recreation programs are also available for patients during their rehabilitation.
When a plan participant faces a long rehabilitation program by a multidisciplinary team, the costs can skyrocket well above the cost of any surgical procedure. We have identified and approved rehabilitation programs for:
- New amputees
- Brain injury patients
- Cardiopulmonary rehab
- Spinal cord injuries
- Orthopedics rehab
- Stroke rehabilitation
- and more
Some of the most amazing programs that offer considerable rehabilitation program savings are located at destinations outside the USA, in close proximity to thermal springs and aquatic rehabilitation centers in Spain, Greece, Ukraine, Germany, and Hungary.
Our CEO, Dr Maria Todd, has been recognized as one of the most knowledgeable non-physicians in the world in this domain area of expertise, and has been recognized by the Ukrainian Academy of Rehabilitation and Human Health as an "Academician". Only three people in the world have been awarded this designation, an honorific title used to denote a full member of an academy that has a strong influence on national scientific life. Dr Todd is the only non-physician Academician to be recognized in this way.
- Laparoscopic Roux-En-Y Gastric Bypass
- Laparoscopic Sleeve Gastrectomy
- Gastric Banding (Lap band)
- Mastectomy - Male Subcutaneuos
- Cancer Staging Consultations
- Treatment Option Consultations / Second Opinion
- Solid Organ Transplants (familial donor)
- Pain Management
- Tumor Excisions
- Bone Marrow Transplants
- Stem Cell Transplants
- Clinical Trials
- Last Chance Therapies Unavailable Near the Patient's Usual Residence
- Coronary Artery Bypass Graft
- Heart Valve Procedures
- Pacemaker Installation and Maintenance
- Cardiac Transplants
- Angioplasty (Balloon & Stent)
- Coronary Artery Bypass Graft (CABG) Open Heart Surgery
- Radio Frequency Ablation
- Valve Replacement Surgery
- Dental Implants
- Wisdom tooth extractions
- Oromaxilofacial surgery
- Orthognathic (jaw) reconstruction and revision
- Lefort Procedures (adults and children)
- TMJ procedures
*Subject to coverage and reimbursement limits based on plan terms and conditions
- 24 hour holter (EKG) monitoring
- Carotid Angiography
- CT Scan
- Diagnostic Cardiac Catheterization (Coronary Angiogram)
- Electrocardiogram (EKG)
- Electrophysiology Testing (Arrythmia)
- Exercise Echocardigraphy
- Exercise Stress Testing
- Myocardial Biopsy
Physical Exams / Checkups
- Basic Physical Exam
- Comprehensive Physical Exam
- Executive Physical Exam
- FAA physical
- CDL physical
When an employee requires drug and alcohol rehabilitation, everybody tends to panic, at first. Where to send them, for how long, what will it cost, and how to measure outcomes are the most frequently encountered concerns for a Plan Administrator. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.
The Mental Health Parity Act (MHPA), signed into law on September 26, 1996, requires that annual or lifetime dollar limits on mental health benefits be no lower than any such dollar limits for medical and surgical benefits offered by a group health plan or health insurance issuer offering coverage in connection with a group health plan.
MHPA applies to group health plans for plan years beginning on or after January 1, 1998. The original sunset provision (providing that the parity requirements would not apply to benefits for services furnished on or after September 30, 2001) has been extended several times. If you have questions about the sunset provision, contact the EBSA office nearest you.
Generally requires parity of mental health benefits with medical/surgical benefits with respect to the application of aggregate lifetime and annual dollar limits under a group health plan
Provides that employers retain discretion regarding the extent and scope of mental health benefits offered to workers and their families (including cost sharing, limits on numbers of visits or days of coverage, and requirements relating to medical necessity)
The law, however, does not apply to benefits for substance abuse or chemical dependency.
The law also contains the following two exemptions:
Small employer exemption. MHPA does not apply to any group health plan or coverage of any employer who employed an average of between 2 and 50 employees on business days during the preceding calendar year, and who employs at least 2 employees on the first day of the plan year
Increased cost exemption. MHPA does not apply to a group health plan or group health insurance coverage if the application of the parity provisions results in an increase in the cost under the plan or coverage of at least one percent. If your organization is at risk for these costs, we help you to reign in expenses for MH/SUD, maintain the fiduciary duty of loyalty to plan participants and find you high-value and performance rehabilitation centers to treat addictions to:
- illicit drugs
- prescription drugs
- eating disorders and behavioral addictions, such as sex, love, gambling, work, shopping, and the Internet
Settings include detoxification, 30-day and 90-day inpatient or residential treatment, partial hospitalization programs and outpatient rehab. Centers are located throughout the USA, the Caribbean and on 5 continents. Addiction rehabilitation programs can vary greatly in price. The basis of this differentiation includes, among other things:
- location - facilities in luxurious surroundings throughout the USA and some foreign destinations can cost more than traditional treatment centers. Travel to the facility must also be factored into the cost, especially if it is far from home.
- length of the program
- activities and extra services available
- staff to patient ratio
- amenities such as gourmet food, private rooms, animal-assisted therapy, acupuncture, massage, and yoga
There are also other costs associated with MH/SUD.
While the cost of rehab may be a deterrent for some people, it is important to remember the many “costs” of addiction. Addiction can be costly due to:
- The cost of the drugs.
- Loss of productivity at work.
- Legal fines.
- Medical bills for physical or mental health issues associated with addiction.
Addiction “costs” users in other ways too, ranging from the deterioration of relationships at home and interpersonal interactions with co-workers, to overall unhappiness and poor health. If you decide that your ASO or PPO network offers a MH/SUD provider that is less than what you want or need for your plan participants, talk with us. We may find you an alternative within the same price range, but with higher value and amenities at an alternate location.
- Nasal Polyp Removal
- Tonsillectomy (Adult)
- Turbinates of Nose - Excision
- UPPP (Snoring /Sleep Apnea Treatment)
- Hysterectomy - Abdominal
- Hysterectomy - Vaginal
- Microwave Endometrial Ablation
- Uterine Artery Embolism / Ablation
- Cataract Surgery
- LASIK Laser Refraction
- Macular Degeneration
- Retinal Surgery / Vitrectomy
- Bowel Resection
- Cholecystectomy - Gall Bladder Removal
- Hernia Repairs
- Hernia Repair - Epigastric
- Hernia Repair - Femoral
- Hernia Repair - Inguinal
- Liver Surgery
Assisted reproductive technology (ART) is the technology used to achieve pregnancy in procedures such as fertility medication, artificial insemination, in vitro fertilization and surrogacy. It is reproductive technology used primarily for infertility treatments, and is also known as fertility treatment. It mainly belongs to the field of reproductive endocrinology and infertility, and may also include intracytoplasmic sperm injection (ICSI) and cryopreservation. Some forms of ART are also used with regard to fertile couples for genetic reasons (preimplantation genetic diagnosis). ART is also used for couples who are discordant for certain communicable diseases; for example, HIV to reduce the risk of infection when a pregnancy is desired.
The following procedures are available through our Network of Approved Providers:
- Assisted Hatching (AH)
- In Vitro Fertilization Treatment (IVF)
- Intracytoplasmatic Sperm Injection (ICSI)
- Intrauterine Insemination (IUI)
We have identified Approved Providers in Texas, Mexico, Spain, Greece, Ukraine and other destinations that offer high value, rapid access, telehealth support in between destination treatments, and are willing to negotiate on price based on steerage and outcomes. In our reviews, we not only evaluate the providers success rates for establishing a pregnancy (which is the basis of most marketing and advertising messages) but also the ratio of full term delivery of a healthy baby. Miscarriages, birth defects and stillborn deliveries are not always reflected in advertised statistics. Miscarriages occurs in at least 15-20% of all recognized pregnancies and usually takes place before the 13th week of pregnancy. So the goal of infertility treatment and reproductive technologies is not simply the establishment of the pregnancy itself. It is the delivery of a healthy full term baby.
- Joint Replacements (shoulder, wrist, hip, knee, ankle)
- Joint Replacement Revisions
- Complex Fracture Treatments
- ACL Repair
- Ankle Fusion Operation - Arthodesis
- Carpal Tunnel Decompression
- Discectomy - Slipped Disc
- Hip Replacement
- Hip Resurfacing
- Knee Arthroscopy
- Knee Replacement
- Shoulder Arthroscopy
- Shoulder Tendon Repair - Rotator Cuff
- Spinal Fusion
- Spinal Stenosis Operation
- Spine - Total Disc Replacement (TDR)
- Cervical (Neck) Fusions
- Spinal Disc Replacements (single and multi-level)
- Lumbar Fusions (low back)
- Stem Cell Collection
- Stem Cell Banking
- Stem Cell Injections (autologous, tissue specific, pluripotent)
- Clinical Trial Participation
- Colectomy - Total - and Ileostomy
- Colon Polyp Removal
- Gastrectomy - Vertical
- Hemi-Colectomy - Left
- Hemi-Colectomy - Right
- Prostate Surgery
- Robotic Surgery
- Seed Implanation
- Partial Nephrectomy (removal of the kidney)
- Bladder Cancer Surgery
- Vasectomy Reversal
- Abdominal Aortic Aneurysm (AAA) Surgeries
- Angioplasty Surgeries
- Endarterectomy Surgeries
- Embolectomy Surgeries
- Endovascular Aneurysm Repair (TEVAR) Surgeries
- Stenting Procedures
- Vascular Bypass Graft Surgeries
- Phlebectomy Surgeries
- Endovenous Laser Treatments
- Carotid Procedures
- Varicose Vein Removal
- Varicose Vein Laser Removal (ELVeS)
Typically, corporate clients supply de-identified past claims data and predictive modeling reports for our review. Upon receipt, we determine which procedures might produce quick savings based on epidemiological projections. We focus on procedures that will save >$15,000 per case, net, after travel. We also review any past or eminent lasered claims the organization may face to determine if we can save the client money.
Medical Tourism Cosmetic Procedures
We realize that corporate medical travel procedures rarely include cosmetic surgery and dentistry. Plan beneficiaries may call on us to help coordinate all medical travel whether the services are covered or non-covered. We'll leverage our connections to obtain discounts and plan a memorable destination health experience with any Approved Provider in our network.
- Breast Augmentation (Augmentation Mammoplasty)
- Breast Lift (Mastopexy)
- Breast Reduction (Reduction Mammaplasty)
- Buttocks Augmentation
- Buttocks Lift
- Chemical Peel (Skin Refinishing - May require mulitple sessions)
- Chin Surgery (Mentoplasty)
- Dermabrasion (Skin Refinishing - Often requires multiple sessions)
- Ear Surgery (Pinnaplasty)
- Eyelids (Blepharoplasty)
- Face / Neck Lift (Rhytidectomy)
- Facial Implants (Chin, Cheek & Jaw Surgery)
- Facial Line Filling
- Forehead / Brow Lift
- Injectable Fillers (Improving Skin Texture)
- Liposuction (Lipoplasty)
- Male Breast Reduction (Gynecomastia)
- Nose Surgery (Rhinoplasty)
- Spider Veins (Sclerotherapy)
- Thigh Lift
- Tummy Tuck (Abdominoplasty)
- Upper Arm Lift (Brachioplasty)
Procedures available across the USA and at international destinations.
Even though our clients may set up a pilot program, if the client requires a one-off urgent case outside the pilot program, we can help.
If your plan participants decide to travel for health and wellness services not covered by the plan, we'll provide assistance and help obtain discounts and guidance, network wide.