Your HIPnation Primary Care Physician is truly a concierge service.

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1 Patient Education How to Use HIPnation + New Era Indemnity Plan* HIPnation is a membership program that provides 24/7 access to your personal HIPnation Primary Care Physician. Your HIPnation Primary Care Physician is your advocate and first-stop for all your health-related questions. Whether this is for care within their office or assistance in navigating the rest of the healthcare system, let them work with you to manage every aspect of your healthcare needs. Your HIPnation Primary Care Physician is truly a concierge service. *The material presented in this packet is intended to help you navigate the healthcare system using New Era with HIPnation. The materials do not replace nor supersede in any way the material provided by New Era. Always refer to your New Era contract for the most accurate and up-to-date information. Patient Physician Relationship We want you to think about this as a relationship and nurture it as you do other relationships in your life. We want to engage regularly, however, if you have a question late Thursday night and it doesn t require an immediate answer, wait and call during normal business hours the next day or send a secure . If your medications are running low, please help your physician and let them know before the 11 th hour whenever possible. 1. You can contact your HIPnation Primary Care Physician or their office by: Phone the office and physician s mobile number are on the back of your membership card. For best results, please use the office number during office hours and your physician s mobile after hours. For medical emergencies, please call 911. Use the Telemedicine app. Your physician can assist you in setting this up. 2. The first step is getting to know your HIPnation Primary Care Physician. Please schedule an appointment to begin to develop this relationship. We want you to experience healthcare as it should be. (We hear that many members feel awkward about calling their physician. But once they get to know their physician, it becomes much easier to call them when issues or problems suddenly arise.) 3. There are NO copays and NO deductibles in the HIPnation Primary Care office. There is no cost associated with contacting or communicating with your Primary Care Physician. 4. Whenever you make an appointment with your HIPnation Primary Care Physician, communicate the purpose of your visit so time can be scheduled appropriately. 5. We encourage you to write down all questions or problems and bring them to the appointment. HIPnation Operations & Solutions, LLC 2500 Old Milton Pkwy Suite 210 Alpharetta GA USA PEHIPNE Page 1

2 Labs and Tests Performed in the Primary Care Office 1. Any test, lab, or procedure performed within your HIPnation Primary Care office will require payment at the point of service. During your annual wellness exam, HIPnation does provide a free one-time, yearly fixed set of labs: a Complete Blood Count (CBC), a Comprehensive Metabolic Panel (CMP), a Thyroid Stimulating Hormone (TSH), and a Lipid panel (cholesterol test). 2. Your physician will have the costs of any additional testing available upon making their recommendation. If they do not tell you the cost, then ask! We do this to create price transparency and keep costs down for you. 3. When you leave the HIPnation Primary Care office, please ensure you have a receipt along with a completed New Era claim form. Your Primary Care Physician s office will have this form. New Era will then pay a fixed, pre-determined amount to help offset costs incurred in the Primary Care office as per their contract with you. Remember: We negotiated for low pricing for any procedure or lab performed in the Primary Care office. In the traditional insurance model, you would pay your copay and then be charged the inflated insurance-based rates for these extra procedures days later. Since most deductibles are not met within a year, those costs would be MUCH higher than our HIPnation pricing. Plus, New Era potentially reimburses you a portion of the cost! Specialty Offices Before making a specialty appointment, please contact your personal HIPnation Primary Care Physician. Your Physician may help you avoid a trip through their direct communication with the specialist on your behalf. If a visit is necessary, your Physician should be aware in order to fully participate in and be knowledgeable of every aspect of your care. In addition, your Physician may be able to obtain a specialist appointment more quickly. 1. When you call or enter the specialty office, mention you are a member of HIPnation. While some specialists provide cash-pricing, some specialists have further reduced their cash rates for our HIPnation patients. 2. When the office asks if you have insurance, let them know that you have New Era as an indemnity plan. Let them know that you will be paying the HIPnation rates in the office. 3. If there are any issues that arise with either scheduling or pricing, please contact your HIPnation Primary Care Physician s office. 4. You will know the cost of the specialist office visit before you arrive if you have worked with your HIPnation Primary Care Physician prior to the appointment. However, if you don t have that information, you may ask for the cost when you call. HIPnation Operations & Solutions, LLC 2500 Old Milton Pkwy Suite 210 Alpharetta GA USA PEHIPNE Page 2

3 5. If there are additional procedures or testing done during the office visit, you will be charged for these items, but again, they will be at the reduced HIPnation negotiated rates. You will need to pay at the point of service. 6. When you check out of the specialist office, you will be given a receipt and superbill that includes the necessary information for you to submit to New Era along with the claim form. Note: If the specialist recommends a lab or test, then we recommend you: 1. Have the specialist write down the name of the lab (or provide a lab requisition form). 2. Call your HIPnation Primary Care Physician office, as they will work with you to get those labs or tests at the HIPnation negotiated rates with one of our HIPnation-affiliated labs. 3. The results can then be sent to the specialist. If you choose to have the labs done in the specialist office, you will likely be charged at a much higher rate than HIPnation s negotiated rates within your Primary Care Physician s office. You are certainly free to do as you like. Ambulatory / Outpatient Surgery HIPnation has negotiated rates for outpatient procedures and surgeries in physician offices and Ambulatory Surgical Centers within our community. When applicable, these rates will include a surgeon s fee, a facility fee (the place where the surgery occurs), and an anesthesia fee. Each has been negotiated on your behalf. 1. These rates are based upon full payment at the point of service. 2. Rates may change if payment plans are arranged it is up to the discretion of the parties involved. 3. You will pay at the time of service and receive a receipt and superbill to submit to New Era along with the claim form. Important Note: Instead of paying at the point of service, you do have the option of using your New Era card. If you are planning on using this, please let the medical center know when the procedure is being scheduled. Similar to the traditional insurance model, the procedure or surgery will be billed to New Era. However, the much higher insurance-based rates must be applied. This means that the reimbursement you receive from New Era is much less likely to cover the costs and you will have to pay the difference when you receive the bill. HIPnation Operations & Solutions, LLC 2500 Old Milton Pkwy Suite 210 Alpharetta GA USA PEHIPNE Page 3

4 Medications HIPnation s goal is to utilize our Academy of Independent Pharmacists to again provide you with holistic healthcare. How? Your HIPnation Primary Care Physician and the local Pharmacists are aligned they have each other s cell phones to share information and coordinate medications to minimize cost, avoid medication interactions, improve medication adherence all with the goal of benefitting you. Our Pharmacists are an integral part of our community working together to help you be well. As for payment, simply let the pharmacist know you are a HIPnation member and you will be paying the cash rate for the prescription. Sometimes this cash rate will be lower than your previous copay; sometimes it may be more. If it is more, it may feel like you ve gotten a bad deal. But remember, it is your total healthcare costs that you need to calculate and evaluate. Certain larger pharmacies offer to fill some prescriptions for free as promotions you are certainly welcome to take advantage of those. You will be operating outside of the HIPnation community, so communicate that decision to your HIPnation Primary Care Physician. 1. If you use one of our affiliated Pharmacists, let them know you are a HIPnation member. They will provide you the HIPnation rates, and you will pay cash. 2. If you use any other pharmacy, ask for their cash rate for the prescription. 3. When you purchase a medication, obtain a receipt to submit to New Era along with the claim form. Note: Because we use independent pharmacies, the days and hours of operation vary. We encourage you to find your preferred pharmacy and be aware of the days and hours of operation prior to needing a prescription filled so there will be no issues or disruption in your medication schedule. There are, however, shipping options for a nominal fee. Check the pharmacy website or call the pharmacy for more details. Imaging Your HIPnation Primary Care Physician may suggest a location or you can visit our website for a list of locations that will provide you HIPnation-negotiated rates for imaging. You will know the price beforehand and will pay at the time of imaging. You will be given a receipt and superbill to submit to New Era along with the claim form. Urgent Care Since HIPnation is not insurance, we do not cover these events. If possible, notify you HIPnation Primary Care Physician before going to Urgent Care. You may find that your Primary Care Physician may be able to avert an unnecessary Urgent Care visit. HIPnation Operations & Solutions, LLC 2500 Old Milton Pkwy Suite 210 Alpharetta GA USA PEHIPNE Page 4

5 If you do need to be seen in Urgent Care, then if possible utilize the Urgent Cares within our HIPnation community. 1. When you call or enter the Urgent Care, mention you are a member of HIPnation. They have specific, negotiated HIPnation rates. 2. When the Urgent Care asks if you have insurance, let them know that you have New Era as an indemnity plan. Let them know that you will be paying the HIPnation rates. 3. If there are additional procedures or testing done during the office visit, you will be charged for these items, but again, they will be at the reduced HIPnation negotiated rates. You will need to pay at the point of service. When you check out of Urgent Care, you will be given a receipt and superbill that includes the necessary information for you to submit to New Era along with the claim form. Emergency Room If you are experiencing a medical emergency, then go immediately to the Emergency Room. Since HIPnation is not insurance, we do not cover these events. Notify your HIPnation Primary Care Physician when either you or a family member is able. If you are not sure whether you are experiencing a medical emergency, then notify your HIPnation Primary Care Physician. You may find that your Primary Care Physician may be able to avert an unnecessary Emergency Room visit. If you do need to be treated in the Emergency Room, then present your New Era card. Hospital Care or High Cost Healthcare Events Since HIPnation is not insurance, we do not cover these events. If you need hospital care, you will present your New Era card upon admission. If possible, make sure that the hospital is in the insurance network PHCS. This is the insurance plan associated with New Era. You can find this out by contacting the hospital or New Era. The hospital will bill New Era directly (as with any other type of traditional commercial insurance plan). New Era will then pay the pre-determined amounts for the hospital stay, including any procedures or surgeries performed. This entire process is dependent upon your insurance contract with New Era. After New Era pays out the defined amounts, the hospital will bill you if there is an outstanding balance. If the New Era payment exceeds the hospital charges, then New Era will send you a check for the balance. As part of New Era s plan, you have access to Karis360. This is a group that will help negotiate hospital pricing on your behalf. If you have a planned hospital-based surgery, then you can call Karis360 and they will negotiate on your behalf in advance. If you are hospitalized as an emergency, then this group can work on your behalf after you have been discharged home. Please make sure your HIPnation Primary Care Physician is aware that you are in the hospital so they can be involved in your care. HIPnation Operations & Solutions, LLC 2500 Old Milton Pkwy Suite 210 Alpharetta GA USA PEHIPNE Page 5