How it Works
Emergency and Hospital Costs
A Community Risk Pool (CRP) is established for each community foundation. The function of the Risk Pool is to provide for the specialized and emergency care that the primary care physician cannot provide. It will also provide coverage for patients transferred to referral hospitals.
The catastrophic pool will cover all emergency room and hospitalization care. The catastrophic medical insurance will have a deductible for each service. A deductible of $200-500 will be required for ER visits and hospital care to insure that the patients try to use their primary care physician whenever possible.
- Fees for expensive out patient testing such as special lab testing and the catastrophic risk pool would pay CT and MRI scans
- Out patient services for such testing would subtract a $100 deductible fee from the patient’s savings through the card
- Service in the ER => $200 deductible
- Hospitalization => $500 deductible for each over night admission
- Hospital outpatient surgery => $300 deductible
Patients that come to the ER with minor problems will be referred back to their primary care MD for resolution of the problem. Physicians will be required to have a 24-hour availability through the physician’s nurse or physician’s Assistant. The physicians or a group of physician’s can cover each other.
The Foundation and hospital together, will both provide social service and a nurse supervisor for difficult cases. They will help patients deal with difficult circumstances, drug abuse, housing and any other problems that will effect compliance and therapeutic out-come. Most often this will be accomplished by referring in the appropriate government assistance and recovery programs.
Follow up is arranged with the primary care physician.
Anyone who is not enrolled will be enrolled at that time of the ER visit and a primary care physician assigned. Payment will be arranged based on patient circumstances.
If the patient comes from a different foundation, the nurse supervisor will arrange follow-up with the primary MD of that foundation. The ACHE Executive’s office of each foundation will work out costs in the next morning.
Patients with commercial insurance, No-fault Auto, and Workers compensation and Medicare and Medicaid will be handle by the hospital as they are now.
The risk pool will usually cover important outpatient procedures. CT, PETscans and other costly procedures will be handled as with any other system using the same criteria for necessity. If the patient meets appropriate diagnostic criteria the MD can arrange with the Required Mammograms and Pap tests for women will be part of the benefits for women and the primary care physicians arrange this.
Dental Plan will be available as an optional ad-on. A Drug Plan will be part of this offering. Medical Access Corporation will negotiate for the whole system to get the best prices for our patients. We will encourage use of generic medications and natural treatments whenever possible.