The choice to enter the Carrum Health Procedure Program (“Program”) is voluntary, and the patient agrees to abide by all requirements of the program.
To be eligible for this program, the patient must have medical coverage from the Plan Sponsor’s health plan as their “primary” medical insurance coverage. If the patient is primary on another medical insurance policy (for example, a spouse’s plan or Medicare), then the patient is not eligible for this program.
Some patients who are eligible for participation in the Program may not be qualified for treatment through this Program. These decisions are at the sole discretion of Carrum Health working in conjunction with COEs, and may be based on criteria made known to the patient or on other discretionary judgment based on clinical characteristics, patient safety, and overall program appropriateness.
Carrum Health does not provide medical advice and does not provide medical care. You may be provided with reference information regarding alternative treatment options. This reference information may or may not fall within your given insurance guidelines, and is informative in nature, and does not constitute medical advice.
Individuals at COEs who may provide reference information or medical reviews are not acting in their capacity as treating physicians and thus do not formally establish a doctor-patient relationship. Their review and assessment are not a substitute for medical or professional care and patients are encouraged to consult with their own appropriate health care professional. Any subsequent questions or follow up care must be handled by the patient’s primary treating physician.
Billing for approved medical services under the program will be submitted to Carrum Health. The patient may receive billing from the hospital for any optional patient convenience items or non-covered health services unrelated to the approved procedure that the patient has chosen to have performed.
Patient Services Agreement
Obligation to follow instructions. The patient acknowledges and agrees that they will follow all care instructions from the Center of Excellence, including without limitation all pre-operative and post-operative instructions. The patient agrees that if they have any questions or confusion about care instructions that they will seek clarification from the Center of Excellence. The patient also agrees that they will take reasonable steps related to preparing for travel and surgery as they receive information and instructions from Carrum (e.g., it is the patient’s responsibility to act in a reasonable manner to ensure that they take time off for surgery, obtain an appropriate travel companion, arrive on-time to the airport, etc.). The patient understands that failure to follow instructions may result in the need for additional care or services that will be their financial responsibility and not covered by the Program.
Patient Eligibility. If the patient elects to change insurance plans prior to receiving a covered service and selects a plan that does not have access to Carrum Health through the health plan, the covered service(s) will be subject to cancellation or the patient will be billed through the normal plan guidelines without access to Carrum Health’s bundled rate, care concierge, and participation incentive. Patients are invited to speak to a Care Specialist for additional guidance on this topic.
Follow-up Care. The patient agrees to arrange follow-up care with a local physician for after their covered service. The patient will arrange this follow-up care before proceeding with travel to the COE and do so in conjunction with the advice provided by the clinical team and/or provider.The patient will detail these arrangements in written form submitted to Carrum Health as a condition of receiving treatment. Please see the attached “Post-Surgical Care Form”.
Patient Cost Responsibility. The patient may be responsible for paying all or part of their medical deductible if required by federal guidelines and/or contractual agreements with the health plan. In agreement with the patient’s health plan deductible and regular cost-sharing, the patient will be responsible for any services outside of this agreement, such as lab work, imaging, diagnostic testing, or any other costs not explicitly covered by this agreement.
Billing Practices. The patient may receive billing from the hospital/providers for any non-covered services or items. If the patient receives a bill they think should have been covered by the Program, please reach out to your Patient Care Specialist for further guidance.
Certain expenses are deemed to be tax-deductible under IRS rules, and some are considered taxable and will be reported as income to the patient. Carrum Health will tabulate the taxable portion and report amounts to the IRS by issuing the patient a year-end 1099 statement. The patient is responsible for filing the 1099 with their tax return. The patient should consult with a tax advisor for the possible tax deductibility of companion expenses or other “out-of-pocket” expenses on his or her tax return.