Frequently Asked Questions

General

What is HIPnation-PrimaryCarePlus?

In today’s healthcare system, you use insurance whether you have a cough or cancer. This is a problem.

Insurance is expensive and raises the cost of healthcare. Insurance should only be used for the worrisome events — not things like physicals, the management of chronic medical conditions, or the common cold.

HIPnation is a new model for the delivery of primary care, giving patients 24/7 access by phone, secure message text, or video to their personal HIPnation Primary Care Physician. Additionally, the doctor now has more time and resources to devote to the patient.

HIPnation is not insurance. HIPnation has removed the insurance burden and costs from the primary care area of healthcare so there are no insurance forms, no pre-qualifications, and no cost uncertainties.

This access to your personal Primary Care Physician is the foundation of our new healthcare ecosystem, redesigned to put insurance only where it is needed, thus reducing your total overall healthcare costs and refocusing healthcare on you.

The “Plus” in HIPnation-PrimaryCarePlusSM consists of removing insurance from most of the outpatient care space, which includes medications, labs and imaging, specialty physician office consultation, and specialty office-based procedures and outpatient ambulatory surgeries.

We then take our high-quality, low-cost, patient-centered healthcare ecosystem and pair it with insurance products to offset the cost of care and protect against those rare, high-cost catastrophic events that worry us all. Since most of healthcare can be managed in primary care and is no longer under the constraints of insurance, the cost of these insurance products decreases significantly as well.

HIPnation offers a comprehensive healthcare solution for less than $300 per month in many cases to most members.

What makes HIPnation-PrimaryCarePlus different from healthcare insurance?

HIPnation-PrimaryCarePlus is not insurance and HIPnation is not an insurance company. The biggest difference is that HIPnation-PrimaryCarePlus removes insurance, its restrictions, and complexities from primary care. With HIPnation-PrimaryCarePlus the relationship is between you and your primary care physician – the way it should be. Today, many physicians serve 3,000 or more patients – some see 35 or more patients a day! The current, insurance-driven healthcare model is so broken physicians are forced to increase patient load in order to make their practices work.

Because your HIPnation doctor has a much smaller patient load, the doctor has the time to give you the preventative services that will help keep you well. And if you need your doctor, you can get the care you need by making an appointment – usually for the same day – or access your physician by phone, secure message text, or even video.

Who is behind HIPnation-PrimaryCarePlus?

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 8 years. 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-PrimaryCarePlus?

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.

for Businesses

How does self-funding save me and my company money?

Self-funding is a way for employers to be able to gain control of the yearly double-digit insurance increases in the traditional insurance model. We have designed a system that allows for  self-funding with limited employer risk. This system also permits smaller companies to adopt a self-funded model. Contact us today for a free consultation.

How does HIPnation help a small business 2-25 employees?

The small group market is severely affected by the lack of cost effective choices for providing insurance coverage for employees. The HIPnation solution has been shown to be 30-50% less for employees, which translates to great employer savings. You can pair our HIPnation solution with several different insurance to give better healthcare at less costs.  Contact us today for a free consultation.

How can I calculate the savings for my business and employees?

There are many different hidden fees within a traditional insurance plan, both for employers and for employees. HIPnation can significantly limit specialist visits, eliminate primary care copays, and eliminate all deductibles in the primary care space. Contact us today for a free consultation.

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

For your employees, the enrollment will be very similar to what they have done in the past. The difference they will immediately see is that there will be no copays and no deductibles for primary care services. Your employees will appreciate that they will have the cell phone of their primary care physician.  60% of medicine can be done the primary care level so you, as an employer, have provided them with convenient access, better care, and less costs for the majority of their healthcare.

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

HIPnation partners with employers in two different ways depending on the size of the company. Both options provide for coverage for catastrophic events for employees in different ways. Contact us today for a free consultation.

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

With health insurance, you can actually switch at any time during the year. We have shown businesses how they can save thousands of dollars per month on their insurance costs while giving better healthcare to their employees. People can switch to HIPnation any time; however, you will only be able to purchase insurance products on the individual exchange during open enrollment.

What can you do for my 1099 independent contractors?

The HIPnation solution fits well with 1099 independent contractors. We take our high-quality, low-cost, patient-centered healthcare ecosystem and pair it with insurance products to offset the cost of care and protect against those rare, high-cost catastrophic events that worry us all. Since most of healthcare can be managed in primary care and is no longer under the constraints of insurance, the cost of these insurance products decreases significantly. Paired together, we can offer a comprehensive healthcare solution for less than $300 per month in many cases to most members.

I have more than 50 FTE’s, 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 our Primary Care Physicians for your children for $100/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

*Please review the profiles of each individual Primary Care Physician as each doctor 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?

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, at about the same rate as the Medicare schedule. For most office visits, the rate will be $120.00 for initial Specialist office visits vs. $350.00 to $400.00 billed through insurance.

The great news is that 80-90% of your health care can be managed by your personal Primary Care Physician. And your HIPnation Primary Care Physician 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 Physician may be able to manage that care for you.

Does the monthly fee cover my annual physical?

Yes, the annual physical is included plus a yearly one-time set of four labs (a complete blood count (CBC), a comprehensive metabolic panel (CMP), a thyroid-stimulating hormone test (TSH), and a Lipid panel, which is a cholesterol test).

How much does HIPnation-PrimaryCarePlus cost?

For participants using Primary Care Physicians (middle school aged and up) the cost is $100 per month. Children are $60 a month, with a $40 copay per office visit.

Is hospitalization or catastrophic care included in my membership?

No. HIPnation-PrimaryCarePlus membership provides primary care and access to low HIPnation-negotiated pricing for labs, imaging, medications, specialty consultations, and specialty surgical procedures. Individuals can purchase additional affordable supplemental health insurance products for those rare, high-cost catastrophic events that worry us all. Since most of the healthcare can be managed in primary care, the cost of these insurance products decreases significantly as well.

A HIPnation representative can help you determine what is best for you.

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.

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 Physician 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 primary care physicians 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 Physicians 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 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.

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 Physician 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.  Contact us for more details.

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 doctors to limit these unneeded appointments, which allows the Specialists to see the patients who truly need their expertise.  This is another key way we put you at the center of your care.

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 Physicians 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 Physician:

  • sees 60-75% fewer patients than a normal primary care physician
  • 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 treatement

If you are discharged from the hospital, undergo a procedure, or have your medications changed, your HIPnation Primary Care Physician 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.

If there were any time in life you needed a physician looking out for you, now is the time.

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

Our HIPnation Primary Care Physicians 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 Physicians 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 Physicians are empowered with a communication of HIPnation-affiliated specialists to communicate with to receive speciality 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 you commercial insurance kicks in.)

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

Individuals may switch to HIPnation-PrimaryCarePlus at any time; however, individuals will only be able to purchase insurance products on the individual exchanges during open enrollment periods.

How do I apply for the Catastrophic Indemnity plan mentioned on the HIPnation site?

Fill out a Contact Us form on our site, and we will introduce you to an insurance broker who can walk you through the process. The indemnity plans are underwritten so you will be required to provide answers to medical history questions regarding preexisting conditions. It takes about 2 weeks to know if you have been approved for an indemnity plan.

Locations

Where is HIPnation-PrimaryCarePlus available?

HIPnation-PrimaryCarePlus is currently available in several locations in the metro Atlanta area.

 

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 physician, you have 24/7 access to your primary care physician via phone, secure message text, email or video. When you have a relationship with your physician, your primary care doctor 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.

Can I switch physicians when an office closer to me opens?

As we expand our HIPnation offices and clinics, you are welcome to switch to a doctor closer to you at any time. This is easily done via a Contact Us form. Please remember, however, your new physician typically prefers or requires an office visit before using the 24/7 access via phone, secure message text, or video.

What if have the Catastrophic Indemnity coverage, and I have an accident outside of Atlanta? Am I covered?

New Era, our insurance partner, uses the largest physician network in the country, PHCS, so it is highly unlikely you will be in an area that doesn’t accept your insurance with New Era.

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 physician 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 available technology (phone, email, secure video). If they feel that is best for you to have an in-office visit, that will be arranged quickly.  Please remember that you must see your primary care physician in person at least once every year for your annual wellness visits.