Frequently Asked Questions
The SurgeryPlus benefit is a supplemental benefit offered by your health benefit plan for non-emergency surgeries, which provides quality care and concierge-level member service at a lower cost.
No. This benefit does not replace your existing health plan. The SurgeryPlus benefit is an additional benefit for those enrolled in one of your employer’s health benefit plans.
SurgeryPlus manages the entire process for you, including the location of a surgeon. SurgeryPlus has already located and screened the area’s quality surgeons who have met a rigorous credentialing process, which includes a review of all applicable medical qualifications. SurgeryPlus only works with quality surgeons in the area.
The SurgeryPlus benefit provides access to hundreds of surgical procedures in specific categories, such as Spine, General Surgery, Genitourinary, Orthopedic, Bariatric, Ear, Nose & Throat, Cardiac, GI, and Pain Management. Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. Call a Care Advocate at 855.200.2099 for more information.
A Care Advocate will coordinate the episode of care for you, including locating a surgeon, scheduling appointments, transferring medical records, and arranging travel. You’ll work with a Care Advocate throughout the entire process that will know all the details of your case.
As part of your employer-sponsored benefits, SurgeryPlus offers quality care and concierge-level member service at a lower cost.
EDH is the only delivery model that can direct employees to quality providers for better outcomes. We offer transparency in a healthcare delivery system based on quality and cost.
Although we cannot anticipate patient volume, we know that as we grow our clients will drive adoption with their members, and that will give us the opportunity to direct more patients your way as one of our preferred providers.
As we continue to bring on new clients, we will monitor our network and ensure that we can provide the care they need while keeping our network to a select number of providers.
The EDH network is proprietary, confidential, and unpublished. Provider information and pricing is never shared with employers, third party administrators or carriers.
We take pride in going the extra mile to ensure our members receive the best possible care from quality providers with proven track records and a reputation for success in their area of expertise. With the SurgeryPlus benefit, plan members have access to our exclusive Surgeons of Excellence network, with providers who are located in or near most major metropolitan areas across the nation and have passed our strict credentialing standards. Our national network is made up of 100% board certified providers representing numerous specialties, including orthopedics, sports medicine, spine, general surgery, gastroenterology, women’s health/GYN, bariatrics, ear, nose and throat (ENT), cardiac and more.
We conduct a rigorous credentialing review on all of our providers, at both the physician and facility level. For physicians, we review a range of information, including licensure, board certification, education, specialty training, sanction activity and malpractice history. Where available, we also evaluate available research data or information discussing factors such as clinical outcomes, medical protocols or other issues. For facilities, we review available regulated data around readmissions, complications, hospital acquired conditions and more.
Our providers are committed to providing members with the highest quality of care, so they can return to work healthier, happier and sooner.
For companies with self-funded health insurance, surgeries and other medical care can be extremely costly. Here at Employer Direct Healthcare, we believe in affordable healthcare. That’s why, with SurgeryPlus, we offer pre-negotiated, bundled rates for thousands of the most common, highest volume medical procedures. Our bundled rates for an episode of care include:
– Physician fees
– Anesthesia fees
– Facility-related charges
Planning for surgery can be overwhelming. From locating a quality surgeon and scheduling multiple appointments, to dealing with unexpected medical bills and arranging travel – it’s complicated, we get it. The SurgeryPlus benefit takes care of it all for our members with our full-service healthcare concierge. Members are paired with a personal Care Advocate who handles the entire process for them and is dedicated to ensuring they receive the best care for their specific needs.
Utilization is the key to success. That’s why our clients receive a dedicated Account Executive and access to our marketing team to develop a custom-tailored, effective communications plan to ensure their employees are always keeping their Employer Direct Healthcare benefits at the top of mind. Not only do we partner with our clients to support all design, creation, execution, and management of their marketing plan, we also track performance on each piece of collateral to better understand what each client’s employees respond best to. This allows us to target pieces that drive the most utilization and return the highest ROI.