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Will we be able to keep not only our PCP but specialist providers, like dermatology, OB/GYN etc?

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What if our current PCP doesn't accept this kind of insurance? What is the name of this new insurance?

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I visited the website and could not find my PCP listed as one of recognized members of the group. What is the process for QUICKLY adding my PCP to the roster?

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The document submitted to the board for approval of this plan, very clearly states things not covered or included with this proposed plan.

Critical illness

Organ transplant

Dialysis

Ivf/ fertility support

Specialty care

For those who would potentially need these significant coverages, what then?

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I am unfamiliar with an HRA, so I have several questions: Do we have to pay out of pocket for all medical costs and then get reimbursed by Monument Academy? How much money is allocated for each employee in the HRA? What qualifies for reimbursement, will we get to see a specific list? Will our HR department see our medical information since they will be the ones reimbursing us?? What is the timeline for getting reimbursed? Is there a lot of paperwork involved?

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Is Redirect Health actually health insurance? Their website states they have Healthcare Plans. On the BBB website, Redirect Health states they are a Program management.

Also, is there another Pinnacle location or is the only one available in Southern Colorado Springs?

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Some of RX costs with even just the 'Everyday' plan are $50-$100. I've never paid that much for these. Is there a mail in RX company we can use to save on these costs? Thanks!

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What are the monthly premiums for employees? All I'm seeing on the paperwork for the board is the cost for employers.

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I don't understand what is happening with Pinnacle Primary Care. Is this the only place we can receive primary care? What do they have to do with our health insurance?

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When I put in my age, it tells me that the EveryDay care is $145 per month, but if you want basic hospitalization coverage, too, it is $419 per month. If I were to end up in the hospital, then I would be responsible for the first $2000, then there's a 20% co-share. What does this mean? $419/month for an individual can't be right, right??

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I called Redirect health today. They do not have my primary care physician listed in network for primary care, nor do they have my dermatology providers. They did have Penrad imaging for my scheduled mammogram this summer. When asked how this all works, I understand that we will need 2 days to get pre authorization before any visit (except urgent care). And “if your doctor is willing to make a claim,” which really put a red flag up for me- leads me to wonder: doctors may not be willing to make claims? And if they do, our costs will be much larger bc they are not in network?. Our relationships with our doctors and providers that we currently have appears to be at a huge risk.

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When reviewing the charts of coverage for cancer specifically, I saw the comment that once a deductible was met, there was a 20% co-insurance for additional services... at least, that is how I understood it.  If that is the case, does that mean that I would have to pay out of pocket 20% of all other services connected?

FROM LANCE:

The plans are set up with a yearly $2000 deductible and $4000 out of pocket maximum ($4000/$6000 for family coverage).  Once the deductible has been met, then the member pays 20% of expenses until the $4000 out of pocket maximum has been met.  After the out of pocket max has been met, then the plan pays 100% of eligible expenses.

Your max out of pocket is $4000, but remember that the Health Reimbursement Agreement is in place so you will be able to submit expenses under the deductible and out of pocket maximum for reimbursement.

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Pinnacle Health Care is run by an MA parent and is married to a possible/most likely new board member. Isn't this a conflict of interest?

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The board notes mentioned that specialty care is not included. What exactly does that mean? Dermatologist? Cardio? Neurologist? Rheumatologist? Oncologist? All those doctors will not be covered?

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Can we have the option to choose between Cigna and Redirect?

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The video did not pick up some of the sound bites from last night; here is an overview of some of the pieces of information:

1. Redirect Health and Pinnacle health are part of a subscription setup. This means that Pinnacle is not contracting with MA directly. Think of it as if Redirect had a subscription with 24 hour fitness. The access and cost is more direct and the fees are easier to process, but the people under Redirect could choose to go to Anytime. There is simply a request put in prior stating that their membership will also be part of the plan, and it will be paid for. The request just has to be submitted prior to the first workout.

2. You most certainly can go to any other PCP. You will need to use the app (more direction on that today and 17th), and then the request is handled on Redirect's end. The reason PCPs accept this health plan is because it doesn't interfere with their compensation. The idea of "out-of-network" isn't applicable in this case in the traditional sense where large insurance companies will not budge. The prevention of care is because the insurance company refuses to foot the bill. That isn't the case with Redirect. They aren't the ones putting the stop on the payment to the provider.

3. The majority of care being done in a doctor's office prevents the outsourcing of care to larger organizations. It isn't that the care you receive from larger hospitals is subpar; it is that it might not be necessary and the cost could be far lower to you and the school. If you go to your doctor, your doctor runs all the necessary tests and decides you need an MRI. He/she then sends you to a freestanding imaging center for that MRI, the cost to the patient is substantially lower. The cost that the patient incurs can be submitted to the HRA for reimbursement. Since the initial cost is lower, it allows the HRA to cover more for enrollees.

4. HRA or Health Reimbursement Account is established by MA. Employees and not contributing to this account. The money in that account is to serve as a safety net and a monetary coverage option for the patient if they experience costs outside of the coverage. For instance, if you meet your deductible but not your out of pocket max, the HRA acts as the bridge between the two for that 20% co-insurance until you hit the OOP max. From there, you are 100% covered under the plan. Another example would be if you needed emergency surgery, but it isn't fully covered under the plan. You could submit that reimbursement request to the school, and we are able to help you out on a more ground-level support system. Right now, if you need emergency surgery, and Cigna says they won't cover anymore, there is no way to help the employee on our end with those costs. The fight ensues between the employee and Cigna.

5. The monthly premiums are lower which is naturally more cash flow for employees a month. However, this isn't just about lower monthly costs. This is about quality care. This type of healthcare plan raises the level of care because the power of choice is in the patients' hands. This model mirrors the way school of choice raises the quality of education and places the power of choice for their child's education in the parents' hands. Parents choose MA because of the quality of education! Opening up the market lowers costs to the enrollees, lowers cost to the organizations or schools that provide benefits, and requires the providers to compete for the patient which increases the quality of care. Taking back the control over your medical needs is returning healthcare to what it was intended to do: maintain good health, provide intimate-quality care, and serve people in their time of illness or need.

6. To sum things up, you can go to whomever you choose for your PCP; Pinnacle is an option that adheres to the plan's model so it simplifies things with great quality care (not required); the monthly premiums are drastically lower; the HRA is your safety net in times of need; by lowering the amount of outsourced care, the HRA will maintain more monetary reserves to help people who have more critical needs; you will have direct contact to an actual person who can find the answers: Lance Vitt, Peak Benefits.