Frequently Asked Questions

General

What is HIPnation?

HIPnation is a new healthcare delivery model that provides concierge-level style of care with costs at 60% less than using the old, broken healthcare system.

HIPnation is not insurance. HIPnation has removed the insurance burden and costs from primary care so there are no insurance forms, no pre-qualifications, and no cost uncertainties. This allows our providers to give you more time and resources to devote to you, the patient

When you do need to access care outside of primary care, we have low, HIPnation-negotiated True Cost rates for labs, imaging, and specialty services.

Your total monthly costs include all access to HIPnation primary care (with no copays) and our low, HIPnation-negotiated True Cost rates, as well as a sharing product or indemnity product, either of which provides safeguards for life’s medical uncertainties.

Solutions start at $248/month for individuals, $650/month for families, and $219/month for employees.

What makes HIPnation different from healthcare insurance?

HIPnation is not insurance and HIPnation is not an insurance company. The biggest difference is that HIPnation removes insurance, its restrictions, and complexities from primary care.

Why?

Paying with an insurance card actually increases the cost of healthcare because you are paying for your healthcare and coding, billing, claims denial processing, pre-certification, prior authorization, lawyers, accounts, consultants—everyone who works within the insurance model.

If you purchase healthcare services without an insurance card, you pay for healthcare. That’s it. And this makes the cost of healthcare significantly less. Same product, less cost.

How does this model make me healthier?

Most traditional primary care physicians have 1000’s of patients. We limit our HIPnation physicians to 700. Why? This allows them to have more face time with YOU. When a physician has time to get to know the whole you, this means a healthier you!

Primary care is designed to help prevent health problems and treat new issues as early as possible. When Primary Care Physicians have the flexibility and support, they are able to handle 60-80% of your healthcare needs.

Studies show that patients with access to a personal 24/7 Primary Care Physician experience:

  • 66% fewer specialist visits
  • 65% fewer emergency department visits
  • 82% fewer surgeries
  • 35% fewer hospitalizations

Who started HIPnation?

HIPnation was started by a group of concerned, practicing physicians who believed they had found the answer to the U.S. healthcare problems that politicians have been trying to solve for 30 years. Members of the team have testified before Congress, as well as spoken across the U.S. for the last decade. The Physicians take care of patients every day and know the burden of the broken U.S. healthcare system on an individual in the actual treatment room.

How can I learn more about HIPnation?

If you are unsure about how to use HIPnation so it best works for you, we can help. Please contact us at 888-676-6007 or email us at info@HIPnation.com.

for Businesses

What are the HIPnation options for my company?

You can choose to use HIPnation with a sharing product (which starts at $219/month per employee) or you can choose HIPnation with a level-funded plan, which is a more traditional approach (prices start at $335/month per employee). If you choose a level-funded plan, insurance premiums, if unused, will be returned to you each year.

How do I know which HIPnation solution is right for my company?

Every company is unique. We will partner with you to evaluate cost saving opportunities and how you want to approach your healthcare solution. A short call is needed to determine your best course of action. Please contact us at 888-676-6007 or email us at info@HIPnation.com.

As a small business, what cost savings can I expect using one of the HIPnation solutions?

The small group market is severely affected by the lack of cost-effective choices. One small technology group in Alpharetta saved $56,000 this year switching to HIPnation while a small, private preschool in Atlanta saved $55,000. Additionally, the cost went down for employee contributions, as well, thus producing in some cases a 10% decrease for employee’s costs.

How do you help me explain the change in thinking to my employees?

We provide HIPnation Patient Education to all new members, which help guide your employees to use their new healthcare solution in the most effective way possible. Additionally, a HIPnation Project Manager will be assigned to your group and is available to answer specific questions. Your new HIPnation Provider is also an excellent source in providing guidance in navigating the healthcare system.

Additionally, we offer on-site training or video conferencing Q&A sessions. We also have a dedicated Membership Services line available for all our members Monday – Friday 9am – 4pm.

What if one of my employees has a catastrophic event under the HIPnation model?

Your paired sharing product or your level-funded insurance plan will be used for any high-cost healthcare event.

Do I need to wait until my open enrollment period to switch to the HIPnation model for my business?

No. You can start today saving thousands of dollars per month while giving better healthcare to your employees by enrolling at any time.

What can you do for my 1099 independent contractors?

The HIPnation solution fits well with 1099 independent contractors. The sharing solution starts at $248/month while the indemnity solution starts at $335. Both can be offered – your 1099’s do not all have to pick the same solution.

I have more than 50 FTEs and I am required to provide insurance coverage under the ACA (Obamacare). How does the HIPnation solution help me with that?

The HIPnation solution was built specifically to partner with employers to provide an ACA-compliant plan, with products offered by our partners, that will give employees better healthcare, better access, and less costs.

What is the tax treatment for the HIPnation membership fee if an employer pays the fee as an employee benefit?

The employer should consider including the HIPnation membership payment in the employees’ W2 as a taxable fringe benefit. This payment is treated similarly to a payment that an employer would make for an offsite gym membership on behalf of an employee. HIPnation membership does not fall into the health insurance exclusion since HIPnation is not insurance.

Note: The above information is from our HIPnation CPA but we encourage you to consult your tax advisor. We are not giving tax advice. Members are encouraged to speak with their personal tax advisor.

for Children

What is my monthly membership cost for children?

You have 2 options from which to choose:

  1. You can choose to have 24/7 access to one of our Primary Care Providers for your children for $60/month with no copays; OR
  2. You can choose from one of our HIPnation partnered Pediatricians for your children for the individual membership fee of $60/month and a $40 copay per visit.

    Note:
    There must be at least one adult HIPnation member for dependent children on the pediatric option.

*Please review the profiles of each individual Primary Care Provider as each provider has different age requirements.

How are costs handled inside the Pediatrician's office?

HIPnation has worked closely with our Pediatric partners to produce a cash pay list for all procedures in their office. This will be a “pay as you go” system in partnership with your Pediatrician. You will receive this detailed information from the pediatric office after signing up with HIPnation.

How will vaccines be handled for my children?

If you select the HIPnation solution with a sharing product (Sedera), all vaccinations are covered by Sedera.

For use with our indemnity product, HIPnation has worked with our Pediatric partners to provide you with two options for vaccines:

  1. In the office, you will pay for all vaccines at a pre-negotiated cash rate; OR
  2. For our members who do not have insurance, there is a state program that can provide vaccines at reduced rates at local health departments. There are state and insurance guidelines that apply. Our Pediatric partners will help you with the paperwork as you navigate the system. There is a fee for the paperwork completion.

 

What if my child is sick in the middle of the night?

All of our Pediatric practices have on-call schedules and numbers that you can call. You may not speak with your personal doctor but will be cared for by one of their partners. This is standard pediatric practice.

Cost

Is the specialty care covered in my monthly fee?

No. It is, however, billed at a rate far below the individual rate, which has been negotiated by HIPnation. For most office visits, the rate will be $130.00 for initial Specialist office visits vs. $350.00 to $400.00 billed through insurance.

The great news is that 60-80% of your health care can be managed by your personal Primary Care Provider. And your HIPnation Primary Care Provider has access to HIPnation-affiliated specialists to answer specialized questions, which means you may not even need to take time out of your schedule to actually visit a specialist. Your Primary Care Provider may be able to manage that care for you.

How much does HIPnation cost?

Using HIPnation with our paired sharing product, Sedera, the cost starts at $248/month. Using HIPnation with our indemnity product is about $300. (Age and plan design determine whether that cost increases or decreases.)

It’s best to talk with us as some people prefer one product over another for managing their high-cost healthcare events. Please call us at 888-676-6007 to discuss these options.

What if I am hospitalized or have a high-cost healthcare event?

Your sharing product (Sedera) or your indemnity product help you manage hospitalizations and high-cost healthcare events.

Why do I have to join for at least 6 months?

The relationship between the personal primary care physician and patient is the foundation of HIPnation. While we provide acute “urgent sick care” needs, our focus is engaging intimately with you as a member. Because of the care we provide and our affordable rates, some had started to utilize our services as an urgent care center. To avoid this, we have a minimum 6-month membership requirement.

What about minor healthcare needs such as imaging, urgent care, or even specialty care?

When you pay cash for healthcare events it is always less expensive than using an insurance card. Why? Everyone takes cash—even in medicine. When you pay in cash you pay 30-60% less. HIPnation has negotiated many of these rates for you.

Why do I pay two different vendors for my healthcare solution?

Being intentionally different means thinking differently. HIPnation operates in the primary care and outpatient (non-hospital) space, removing the burdens of insurance and replacing insurance with a cash-based model. We do this best. Our partners do the managing of high-cost healthcare events best. Instead of paying exorbitant amounts of money to one entity for a lesser healthcare system, you have two excellent solutions and therefore two payments to two entities for a greater, high-quality, low-cost healthcare solution.

Doctor's Service

Is the HIPnation access to my personal doctor similar to telemedicine?

Telemedicine is an offering in many insurance-based plans where you can contact a doctor via telephone. With HIPnation, however, you will contact your personal HIPnation Primary Care Provider on their personal cell phone. You will speak to a doctor with whom you have a relationship. Your doctor will already know you and will understand your medical history.

Can I still see my personal OB/GYN?

Yes. You can continue to see any specialist physician you choose; however, you will not receive the prices we have arranged with our specialists to see HIPnation patients. At HIPnation, we have built a team of specialists who are specifically partnering with our providers in the care of our members and who have agreed to care for you at low rates, in most cases, available only for our members.

Can I keep my primary care physician?

Our unique, membership model with HIPnation does not work in the current volume-based, insurance-driven system. Our HIPnation Primary Care Providers care for approximately 75% fewer patients than would be considered normal in today’s insurance-based system. The HIPnation model allows you to have your physician’s cell phone, same day or next day access for appointments, as well as full care coordination with our specialist teams. This experience is just not available in most offices that accept insurance.

But if you do want to keep your primary care physician, you may. Simply pay your doctor a cash-rate to see them. You will want to get any labs needed done in our HIPnation offices so you can take advantage of our 90% less cost rates.

How does the HIPnation solution work for specialists in areas where HIPnation does not currently have a provider?

If you need to see a specialist who is not currently a HIPnation specialist, your Primary Care Provider can still initiate the referral. Depending on your insurance options, the visit could be cash pay, partially reimbursable through the indemnity plan, or a copay depending on your company’s insurance or the HIPnation self-insured plan.

How do HIPnation Primary Care Physicians reduce specialist visits?

In today’s high volume, insurance-based system, many primary care physicians are overloaded with visits and administrative tasks that do not allow them to adequately spend time with patients and fully care for them. The average doctor visit in the U.S. is less than 8 minutes which results in many unnecessary specialist visits. This increases your costs, time away from work, etc.

Our HIPnation Specialists are excited to partner with our HIPnation Primary Care Providers to limit these unneeded appointments, which allows the Specialists to see the patients who truly need their expertise.

Insurance Coverage

I have Medicare as my insurance. How does the HIPnation solution work with Medicare?

The reality? Health declines as we age and our healthcare management becomes more complex. Our HIPnation Primary Care Providers provide the invaluable foundation of a personal relationship over time that is one of the greatest determining factors of your health.

With HIPnation, your personal Primary Care Provider:

  • sees 60-75% fewer patients than a normal primary care provider
  • spends more time to get to know you
  • understands that wellbeing goes beyond just your physical health and extends into other areas of life that can impact your health — your relationships, job, finances, or changes in your lifestyle
  • learns your personal goals and desires for your own life, which may impact treatment

If you are discharged from the hospital, undergo a procedure, or have your medications changed, your HIPnation Primary Care Provider is available to help manage your care every step along the way. This personal engagement decreases the risk of hospital readmissions and minimizes other potential complications.

I have health insurance through my employer. How does the HIPnation solution work with this?

Our HIPnation Primary Care Providers see 60-75% fewer patients than the average primary care physician. This provides more time to get to know you, partner with you, and advocate for you as you navigate the healthcare system. Our HIPnation Primary Care Providers provide the invaluable foundation of a personal relationship over time, which is one of the greatest positive impacts of your health.

Additionally, our HIPnation Primary Care Providers are empowered with a communication of HIPnation-affiliated specialists to communicate with to receive specialty advice, which may even keep you from needing to go and see a specialist.

Inside our HIPnation primary care space, we have negotiated for lower costs for labs, EKGs, flu testing, strep testing — anything that can be managed inside of this space is less costly. Remember, there is no copay and there are no deductibles for primary care. This means less out of pocket expenses for you. (Remember, you must meet your deductible before your commercial insurance kicks in.)

What if I have already enrolled in an open enrollment insurance plan? Can I switch?

Individuals may switch to HIPnation at any time. You can also purchase our paired sharing product (Sedera) and indemnity product at any time. Call us at 888-676-6007 to help you find the product and solution that is best for you.

What if there isn’t a HIPnation office that is close to my home?

With our unique membership model, after your initial visit to your primary care provider, you have 24/7 access to your primary care provider via phone, secure message text, email, or video. When you have a relationship, your Primary Care Provider can handle much of your care over the phone or by video, thus reducing your overall time in the car (and in traffic) to have to visit the office for care.

Additionally, consider this – while your current provider may be closer in proximity to you, how long do you sit in the wait room? In the exam room? Because our providers see 8-10 people a day, there is little to no wait.

Locations

What if there isn’t a HIPnation office that is close to my home?

With our unique membership model, after your initial visit to your primary care provider, you have 24/7 access to your primary care provider via phone, secure message text, email, or video. When you have a relationship, your Primary Care Provider can handle much of your care over the phone or by video, thus reducing your overall time in the car (and in traffic) to have to visit the office for care.

Additionally, consider this – while your current provider may be closer in proximity to you, how long do you sit in the wait room? In the exam room? Because our providers see 8-10 people a day, there is little to no wait.

Can I change my Primary Care Provider?

The physician-patient relationship is the foundation of our healthcare model. But we do understand that sometimes relationships do not work out or you move and want a provider that is closer to you.

Yes, you may change your provider. Provider changes must be requested at least five (5) days prior to the end of the month. Officially, the provider change can only occur on the 1st of a month. If you request a change, you will continue to have access to your old provider until the next 1st of the following month. At that time, the change will be made and your new provider will be notified.

Can my child who is in college in another state be a HIPnation member?

Yes. Our HIPnation Primary Care Physicians will need to see them for an initial wellness visit to initiate the relationship and fully understand their medical history. In the HIPnation model there is no cost for the wellness visit.

After the initial visit, your child can contact their physician via phone, secure message text, or video at any time.

Telemedicine

What type of care can I expect via a phone call with my personal HIPnation doctor?

With the HIPnation model, your provider can care for you in a way that is best for you in your particular circumstance.  Most care at the primary care level can be done remotely using our telemedicine app. If the provider feels that is best for you to have an in-office visit, that will be arranged quickly.  Please remember that you must see your provider in person at least once every year for your annual wellness visits.