Mercury Health Travel works exclusively with group health benefit plan sponsors and insurers.
How we can help you save money:
- We'll coach you on what to ask for from your TPA or ASO.
- We'll provide confidential, second-opinion assessment on trends in current, past and projected utilization of high-cost surgeries and medications.
- If they cannot or will not help, we'll step in to help you build your own narrow network, negotiate with providers and fill your case management and logistics coordination through the entire episode of care. This includes preliminary program development, assuring quality and safety with robust documentation from the facility & physicians, coordination of travel and treatment (i.e. via 360°evidence-based medical case management), discharge planning, all the way through post-operative care, travel management and aftercare and/or medications required upon arrival back home.
You Decide What Makes Sense. No Pressure Whatsoever!
- Plan administrators worry about fiduciary duty, ERISA compliance, HIPAA compliance, and saving money. But in the case of medical travel development, many don't know where to begin and how to move forward. We fill in the gaps in your knowledge with confidential training. The best way is to come to your office and speak with you and your decision-makers. Let them ask any questions in person. Once we've answered your questions, we'll fill in your knowledge gaps if any with very specific information you may not have realized you'll need to know.
- If a medical travel pilot program makes sense to you, we'll help you design and develop your unique pilot program - no pre-designed programs that fail to drive real savings
- We'll introduce you to experts who can help with plan document creation for a very low cost. After all, there's not a lot to change.
Narrow Network Creation
- We'll introduce you to inpatient and outpatient providers we've already worked with. But you can ask us to help you explore any provider you choose. We don't work for commissions. Our client fiduciary duty is to you and your company.
- We'll teach you what questions to ask, what to look for on site visits, and how to ask for transparent, predictable, bundled case rates for each procedure. We'll accompany you if you like.
- Want to ask your local providers to sharpen their pencils and provide better pricing on select surgeries in exchange for preferred steerage? We can help with that too. Just ask!
- We'll conduct the due diligence review of provider credentials, training and experience for you and provide contracting support, including template contract agreements and pre-formatted, bundled case rate examples. That way, providers need only fill in their numbers so that you can compare offers and costs against your criteria, not theirs.
- We'll prepare a bolt-on medical travel benefits portal that's easy to use and quick to take action. You won't need to pay for costly price comparison tools that participants don't use and find confusing.
- We'll explain finalized program benefits to employees and executives, board members, benefits council and finance stakeholders. They'll know what to do if a need arises.
- We'll supply specialized case management and participant assistance at arm's length so you can remain HIPAA compliant. Pay only for the time we work. No expensive monthly fees.
- We'll review each bill that comes it to ensure it matches the contract, covered services and audit any extra unanticipated charges.
- We'll explain to your TPA and ASO all they need to know in order to pay claims as extra-contractual payments from your claim fund. Alternatively, we can help you pay the claim internally. Remember, in the first years, there won't be many claims for medical travel procedures. Employers with fewer than 1000 employees usually encounter 15 or fewer medical travel cases in a year. It may be less expensive to manage provider settlement in-house than to have your TPA get involved.
- When it's time to expand, we'll support you every step of the way to include more locations, additional procedures and greater savings.
- We coordinate discharge management, and care continuity with local hometown providers upon return from medical travel.
Measurement and Evaluation
- When you pay money out of your claim's fund, you probably want to know how it was spent and what value you derived. We help you understand your spend and how to improve or lower future costs.
- We remain on-duty for months after the patient's return to continue to monitor clinical outcomes over time. We periodically check in with the patient to obtain feedback on pain, activity, improvement, benefit satisfaction, provider satisfaction, aftercare satisfaction and more. End of the year roll up reports provide summarized information and our best recommendations for any changes or improvements.
- If we notice a problem in any monitored category of discover a new trend, we notify you and look at it together to determine root cause and impact.
- Any post-operative infection or quality concern is addressed immediately. We investigate any hospital-acquired or preventable "never events" immediately to determine what happened, how, and why and if you should pay for the rehabilitation or treatments associated with the incidence. If it means a temporary suspension of future referrals to that provider until the matter is sorted out, we manage it aggressively.
- We also measure and monitor ancillary vendor performance such as on-time, hassle-free air travel and hotel and ground support services reliability, service and quality. Most TPAs that offer a high-value network and medical travel only focus attention on the facility and provider costs, and nothing else. You may save $2000 on the "price" of the tonsillectomy or a hernia surgery and incur $3500 in ancillary travel and destination costs that they don't account for in their program. That makes no sense to us and it shouldn't make sense to you, either. Let's make your custom-tailored program based on "real" savings for all concerned.
How patients and plan sponsors benefit from our services
Your plan participants benefit from our services. However, we contract with the plan sponsor, a self-funded employer, an insurance company, or a government entity when it comes to case management and travel coordination. We follow your plan rules, coverage limitations, and protocols and serve as your arm's length service provider for HIPAA compliance. We only bill you for the time required to provide required services. The rates you pay are negotiated directly with the providers, so there's never a risk you'll pay embedded referral commissions or undisclosed percentages. Everything is out in the open and fully-transparent.
Many of the cases we manage involve patients who leave their hometown seeking care. Often they lack the surgical and diagnostic services available locally, or a medical second opinion that validates the diagnosis or treatment plan identified in their hometown or the employer prefers to shift elective care to higher-value, better equipped Centers of Excellence and other qualified providers.
What about expatriates and foreign nationals who need care?
Mercury Health Travel has pre-inspected, pre-qualified providers in 20 states and 26 foreign countries willing to contract directly with employers, government health schemes and insurers and reward volume with higher discounts. We coordinate both planned elective medical travel or emergency medical evacuation, and telehealth consultations both pre-and post-destination treatment. But we only manage cases of patients who have insurance or group health plan benefits, whether the coverage is privately insured, employer- or government-funded. We don’t facilitate services directly to consumers who self-pay as that is outside our business model.
Whether the need to travel arises due to scarcity of services, treatment failures at a local or regional level, plan-paid clinical trial participation, cancer treatments, organ and tissue transplants, orthopedic procedures, cardiac services, rehabilitation and recovery services, highly specialized pediatric care, specialty pharmacy and rare medications that are difficult to access because they are new on the market, or prices are high or the medication is unavailable elsewhere, or to access remote medical second opinions, we can help.