What type of insurance is MedCost?

MedCost specializes exclusively in self-funded corporate health benefits and group insurance plans with a level of expertise and focus most other carriers do not have. But that’s the financial piece of the plan.

Is MedCost a TPA?

As a third party administrator (TPA), MedCost is here to provide you with accurate, cost-effective and timely administrative services. Not only are we committed to service excellence, we are nationally recognized for best-in-class claims operations and health care administration.

Is MedCost a PPO?

MedCost is a PPO used by many individual payor groups; therefore, benefits will vary by employer group. The member should present a MedCost card to identify members of this PPO.

Does MedCost require referral?

No referral form is necessary for specialty care. With MedCost PPOnetwork you also have the option to choose specialty care without going to your primary care physician. For non-participating physicians, benefits are paid at out-of-network rates.

Is self-funded the same as self insured?

Self-insurance is also called a self-funded plan. This is a type of plan in which an employer takes on most or all of the cost of benefit claims. The insurance company manages the payments, but the employer is the one who pays the claims.

What is the timely filing limit for MedCost?

within 90 days
MedCost advises that claims should be submitted to MedCost within 90 days from the date of service; however North Carolina General Statute 58-3-225, “Prompt Payment Under Health Benefit Plans,” allows 180 days for claims filing for fully-insured plans.

Does MedCost cover breast pump?

Breastfeeding Benefits and Breast Pumps Breast pumps are covered under your plan. All benefit plans must provide breastfeeding support, counseling and equipment for the duration of breastfeeding. Coverage of breast pumps may include a rental unit or a new pump you keep, but a pump is covered.

Does MedCost cover acupuncture?

MEDCOST®, Wake Forest Baptist Health’s primary insurer, reimburses for acupuncture, including services by licensed acupuncturists (not just MDs). Health Savings or Flexible Medical Spending Accounts nearly always reimburse for acupuncture.

What are the cons of a self-funded health insurance plan?

Disadvantages of a Self-Funded Health Plan The employer is exposed to risk of high losses due to extraordinary claims. Current year expenses will be unpredictable. There is a possibility of financial loss due to operational inefficiencies.