1. Does MedCost sell individual insurance?
MedCost is not an insurance company, so we do not offer individual policies. For more information about our payer partners who offer individual insurance, please send an e-mail to firstname.lastname@example.org.
2. What online tools are available to me?
For information specific to your health plan and members, you should visit your claims payer’s web site for the resources and online tools available to you. If your claims payer is MedCost Benefit Services, log in to view Explanation of Benefits (EOBs), check Flex spending account balances (if available through your health plan), track the total claims dollars applied year-to-date to your deductible and/or out-of-pocket limit, access the Summary Plan Description for your health plan, and much more.
3. How do I find an in-network provider?
Use our online provider directory. Select your primary network from the list, and follow the onscreen prompts to locate a provider. If you’re not sure what your primary network is, check your health plan ID card or contact your Human Resources department.
To search for in-network providers, select your network from the list:
Locate A Provider
4. How do I find a participating provider when I’m traveling?
Click here to use our online provider directory. Select your travel network from the list, and follow the onscreen prompts to locate a provider. If you’re not sure what your travel network is, check your health plan ID card or contact your Human Resources department.
5. Why was I contacted to participate in your Personal Care Management program?
Personal Care Management (PCM) is a unique nurse health coaching program designed to help individuals who show early symptoms of or are at risk for developing a serious health issue. You were contacted because you have been identified as someone who may benefit from participating in the program. PCM is available through your health plan at no cost to you and can help you improve your overall health and wellbeing. If you’d like to know more about PCM, please call the number listed on the letter or e-mail you received, or click here to view a short video showing real-life participants talking about their experience with the program. You also can call our Customer Service Contact Center at 1-800-795-1023 for more information.
6. Why was I contacted to participate in your Complex Case Management program?
Complex Case Management offers guidance from a registered nurse with specialized training whenever a member experiences certain cancers, strokes, or serious injuries or illnesses. You were contacted because you have been identified as someone who has experienced a life-altering medical event and may benefit from participating in the program. Complex Case Management is available through your health plan at no cost to you and can help you make the most efficient use of health care resources over the course of long-term treatment. Our board-certified Case Managers work with you and/or your caregiver, your physician(s), and your health benefits administrator to coordinate medical care, assist in finding and obtaining community services, and provide education to promote quality of life outcomes. If you’d like to know more about Complex Case Management, please call the number listed on the letter or e-mail you received, or call our Customer Service Contact Center at 1-800-824-7406.
7. How can I find out more about the SmartStarts Maternity Management program?
SmartStarts is a maternity education program that can help any expectant mother and is free to you, if available under your health plan. If you (or a covered spouse or dependent) become pregnant and enroll in the program, you’ll work with a personal prenatal nurse.The nurse will make scheduled phone calls to check on you during your pregnancy and provide educational information that corresponds with the needs of each trimester. You also may call or e-mail the nurse whenever you have a question or concern. If you are identified as having a high risk pregnancy, you will be monitored very closely to minimize the health risks to you and your baby. Call our Customer Service Contact Center to learn more or enroll at 1-800-824-7406.
8. What is precertification, and what has to be precertified?
Precertification is the process of obtaining authorization for a medical procedure or hospital stay before the procedure or stay occurs. Many health plans require precertification, and your benefits may be reduced if it is not obtained. Please check your Summary Plan Description document to determine what should be precertified under your health plan. (If MedCost Benefit Services is your health plan’s claims payer, you can login to the secure member portal to view your plan document(s) for a list of medical or surgical services that require precertification.) Information regarding precertification, including a contact number, also may be found on your health plan ID card.
In many cases, your doctor may call to initiate precertification of a stay or procedure. In other instances, however, you may need to call to start the precertification process. You should discuss precertification with your doctor to ensure that it is done.
Please note that precertification does not guarantee payment; it only confirms your plan coverage for a particular treatment or procedure and the patient’s eligibility for coverage. Many other factors are considered by your health plan’s claims payer when determining payment.