Critical illness

Organ transplant

Dialysis

Ivf/ fertility support

Specialty care

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

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?

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.

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.