PHCS is the first and only national PPO to earn four endorsements of quality from two independent, nationally recognized quality assurance organizations, the National Committee for Quality Assurance (NCQA) and URAC.
NCQA certification for Credentialing and Re-credentialing (August 2001)
NCQA certification for Utilization Management (May 2001)
URAC accreditation for Health Network with Credentialing (October 2001)
URAC accreditation for Health Utilization Management (July 1993)
Key Features of PHCS:
PHCS is the largest proprietary PPO in the country with nationwide access
Member receives identification card and ‘Dear Doctor’ letter in their fulfillment kit with instructions to call CAREINGTON’S Physician Relations Department
CAREINGTON’S Physician Relations Department will provide the member with a list of providers after verifying which PHCS provider is participating in the discount card program.
CAREINGTON Physician Relations Specialist (PRS) will call the provider to confirm participation and make an appointment for the member
The live-operator feature ensures a positive member/provider experience
Providers must pass strict credentialing criteria
PHCS has relationships with providers associated with the majority of specialties.
Pre-Planned Services: members call 800-975-3322 to receive savings for pre-planned/non-emergency services; available only with the required pre-certification and referral number. The negotiated estimate payment portion amount needs to be secured prior to Member receiving any services. Network will confirm payment ability and provide a referral number
Emergency Visits: members must notify network and receive a referral number within forty-eight (48) hours of an Emergency Visit by calling 800-975-3322
How it works…
Members select a local participating provider by calling 800-975-3322 and asking for the “Medical Savings Card” department, or by accessing on line at www.galaxyhealth.net
Members must show ID card at the time of their visit in order to receive a discount.
Provider will follow instructions on the back of the card to “re-price” the bill by applying the predetermined savings according to the negotiated contract.
Member is responsible for paying remaining balance due to provider at the time of service. If member has any additional medical coverage, that amount will be applied to the bill according to the medical plan or policy in place.
CARE INGTON International is the largest independently owned dental network in the nation, and we currently serve about five million members with a nationwide provider panel consisting of more than 24,000 general dentists and specialists. In addition, we continue to lead the industry offering superb discount health care products including pharmacy, vision, chiropractic and wellness, and much more.
In addition to our flagship reduced-fee-for-service provider network, CARE INGTON International also offers PPO networks for traditional indemnity of self-funded programs. We are the only company that offers three levels of discounts within our provider panels. This combination allows us to meet the unique needs of each client, regardless of size or type. Our discounts are some of the deepest in the industry, and our set fee schedule is what makes it possible. Based on regional averages, our fees can amount to significant savings of 20% to 60%, substantially deeper than our competitors. Our members appreciate the savings.
CAREMARK is one of the largest pharmaceutical services companies in the United States. With more than 25 years experience the company’s goal is to enhance each participant’s health, doing everything from providing proactive health education to monitoring prescription history for potential drug interactions. CAREMARK provides the most convenient service, personal care and attention, and relevant, up-to-date information to participants and sponsors.
Cole Managed Vision (CMV) has the largest company-owned, company-operated core provider panel of any vision network in the nation. Company philosophy is to complement the best names in retail optical with a network of private practice optometrists and ophthalmologists. The discount program for laser vision correction includes the initial pre-screening, post-operative care and reimbursement for initial prescription on post-operative drops. A national network of surgeons participates in this program.
Managed care is the fastest growing market segment of the optical business, currently representing 30% of the industry. Over 80 million people receive vision benefits through Cole’s vision care program. Cole Managed Vision specializes in marketing to and partnering with employers, health plans, and associations to provide the highest quality vision benefits in the marketplace. The key to company success has always been a focus on forming mutually beneficial, long-term relationships with all plan sponsors and a commitment to the satisfaction of plan members.
American WholeHealth, Inc. is the leading online/offline provider of integrative health solutions for consumers, medical practitioners, health plans and employers. The company’s core business focuses on providing chiropractic and alternative medicine product management and risk-sharing arrangements to managed health care plans throughout the country. The company has a network of over 25,000 complementary and alternative medicine (CAM) providers including, but not limited to, chiropractors, physical and occupational therapists, acupuncturists, yoga instructors, nutritionists, and naturopathic practitioners. Products are designed to meet the needs of members and clients with managed alternative medicine, internet services, and health and wellness content for health plans and individuals.
HearPO is a network of credentialed audiologists who provide quality hearing care services and hearing aids throughout the United States. With over 1,600 credentialed affiliates, access to hearing care services and products is both convenient and affordable. All HearPO providers are audiologists with either a Master’s or Doctoral degree from an accredited university assuring the highest quality care possible and are licensed in the state in which they practice. HearPO realizes that patients who see our providers are our number one concern. Patient satisfaction is the most important variable we can monitor. To that end, HearPO surveys a significant number of our customers to assure our audiologists are providing only the highest quality care. HearPO is a nationwide healthcare company with convenient clinic locations. Our parent company, Sonus USA, is the largest provider of hearing healthcare services and products in North America. This advantage gives us the ability to negotiate substantial savings on products which are passed on to the consumer.
Optum delivers personal health management solutions designed to help individuals stay healthy, get healthy, and live with illness. Optum delivers an integrated, cohesive approach to managing the health of each individual, as an individual. With capabilities ranging from wellness promotion to self-care and triage to complex case management, Optum helps 27 million people take better control of their health and the health of their families.
Supporting the Entire Health Care Continuum: Optum's skilled nurses deliver satisfaction and peace of mind for nearly any health concern 24 hours a day, seven days a week. For example, NurseLine nurses help callers:
Learn self-care for minor illnesses and injuries
Understand diagnosed conditions
Manage chronic diseases
Discover and evaluate possible benefits and risks of various treatment options
Learn about specific medications
Prepare questions for doctor visits
Develop and maintain healthful living habits
Locate health care facilities and physicians
Connect with community support groups
Know how to choose the right care at the right time
Bilingual nurses are available to address the needs of Spanish-speaking callers, and through the Language Line translation service, we can support callers in more than 140 languages. Individuals also have access to more than 1,700 recorded messages, with nearly 600 available in Spanish, through the audio Health Information Library.
FREE and UNLIMITED telephone service from Registered Nurses
24/7 access 365 days a year
Access to audio tape library on over 450 health topics
Information about self care techniques for common symptoms
Decision support for high cost treatments, recently diagnosed medical conditions, home medical emergencies, diagnostic and surgical procedures, prescription and non-prescription information, expectation for medical testing
Diabetes Management with Liberty Medical
15% Discount on Diabetes supplies
Supplies and medications delivered to your home with no charge for mailing
*Dental Program savings are based on the 2003 National Dental Advisory Fee 80th percentile fee schedule. This is a discount program, not an insurance plan. Member is responsible for discounted fee at time of service. T he program and its administrators have no liability for providing or guaranteeing service and have no liability for the quality of service rendered. Note to Utah Residents: This contract is not protected by the Utah Life and Health Guaranty Association.
PLEASE NOTE THAT THIS IS NOT HEALTH INSURANCE AND WE DO NOT MAKE PAYMENTS DIRECTLY TO MEDICAL SERVICES PROVIDERS. YOU ARE OBLIGATED TO PAY FOR ALL HEALTH CARE SERVICES. YOU WILL RECEIVE DISCOUNTS AT CERTAIN HEALTH CARE PROVIDERS FOR MEDICAL SERVICES WHO HAVE CONTRACTED WITH THE PLAN. THIS PLAN IS ADMINISTERED BY CARE INGTON INTERNATIONAL CORPORATION, 7400 GAYLORD PARKWAY, FRISCO, TX 75034.