 MedCAT is a catastrophic medical management solution focused on select medical events most likely to impact stop loss claims. We have preferred contracts with a select group of top medical management service providers offering services aimed at improving patient health care experiences and managing cost. We believe these value-added services can be helpful to patients with complicated health problems as well as adding a differentiating feature for your clients with our insurance products.
The following services provided by MedCAT Service Providers are available at no additional cost to all Medical Excess underwritten Stop Loss Policyholders when referred through and approved by MedCAT. In addition, stop loss underwriting discounts are available when MedCAT suggested plan document language and service agreement are implemented:
Cancer Care Management
Biologics, Inc. carves out chemotherapy management from the health plan. Evidence-based cancer treatment criteria are used in collaborating with the attending physician and patient. An Oncology Certified Nurse reviews the treatment plan that helps in formulating the best possible treatment path for the individual. A clinical oncology pharmacist is also available for consultation. Requires plan document amendment.
Renal Dialysis Management
Dialysis Cost Containment (DCC) utilizes four approaches to decrease cost through U & C re-pricing, epogen carve-out management, network/negotiations and/or home hemodialysis. Potential savings are greater than conventional network discounts. (client pays per claim re-pricing fee, based on percent of savings). Requires plan document amendment.
Neonate Management
Paradigm Health Management Services performs concurrent review on premature babies that are at or below certain birth weights while in neonatal intensive care units (NICU). Paradigm Health Management Services uses evidence-based neonatology management criteria resulting in savings due to appropriate reduced length of stay. Referral needed within 5 days of birth. Requires plan document amendment.
Transplant Management
Specialty Care Center Network is Medical Excess's own proprietary national transplant network including top transplant centers. Medical Excess also accesses Strategic Health Development Corporation (SHDC) and LifeTrac Transplant Network as needed. MedCAT recommends that a nurse case manager be involved with coordinating the needs of the potential transplant patient. Requires plan document amendment.
Hemophilia Management
U & I, Inc. provides blood factor deliverable anywhere in the United States. U & I includes a disease management style program with the cost of blood factor. U & I impacts reduced costs associated with patients with hemophilia through individualized care planning resulting in reduced bleeding episodes and emergency room visits. (client pays for injectable factor product). Requires plan document amendment.
Early notification is the key in maximizing the opportunity to making a positive difference in an episode of care.
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