Access to a Worldwide “Cashless” Provider Network
Our providers network allows us to offer you 24-hour access to outpatient and inpatient medical services in 95% of the world’s customary travel and expatriate locations. We also specialize in carve-out and specialty networks in order to accommodate specific local, expat and or traveler portfolios.
Our USA network provides our clients and their insureds with access to more than 5,000 hospitals, over 90,000 ancillary facilities, and over 1 million healthcare professional service locations in the United States, including Puerto Rico. 98% of the U.S. population is within 10 miles of a participating network physician and within 20 miles of a participating network hospital.
Urgent Care Clinics and House Call Doctors
Access to urgent and medical care clinics and house call doctors across the U.S., Latin America, the Caribbean, Europe, Middle East, Asia and numerous African countries.
Our affiliated healthcare providers in the United States are located in key population centers across the country. They provide high-priority, individual medical attention in a comfortable setting. Prices for each service are prominently displayed in patient waiting rooms for a wide range of services, including:
- Blood work, including full blood analyses
- Diagnostic & extensive laboratory services
- Electrocardiograms (EKG’s)
- Employer physicals
- Pre-operative evaluations
- Immigration medical exams by a civil surgeon approved by the Bureau of Citizenship and Immigration Services
- In-house pharmaceutical services
- School physicals
- Vehicle and personal accident-related injury care
- Weight loss programs, including personalized meal plans
We adjudicate claims on the payer’s behalf at any point in an episode of care that is convenient for you. We can process medical requests worldwide coming directly from the insured, the provider, and/or our client’s operational plateaus. In the case of a real time claim, we can determine eligibility based on our client’s Table of Benefits and GTC (general terms and conditions) and adjudicate benefits through the real time auditing of our in-house medical department, operational 24/7.
WMMS can also operate on an after-the fact basis, auditing claims through our medical department, who will review each episode of care directly with the provider(s) to gather the necessary medical information and coding in order to (a) ensure that the claim is clean and (b) ensure the reasonability of charges. This is how we identify soft savings. We can deny charges for care that do not follow U.S. and/or foreign protocols and for which there is no medical necessity.
Once the claim is clean, we negotiate hard savings on the payer’s behalf, using Medicare rates as our benchmark. Our repricing process is carried out through our own in-house arbitrators or through partner PPO companies, depending on which is more cost effective.
Through our in-house arbitrators, who work in tandem with our physicians, and alternatively through our partnering PPO companies, we are able to deliver the most competitive results in current, concurrent, and retrospective claim negotiations.
Our recovery and subrogation services allow our clients to recoup medical costs, from third party insurances that may have had liability in the episode that generated the claims expenses. Our service encompasses an initial investigation and assessment process, leading to determine the feasibility of a recovery/subrogation, which is later followed through until the actual collection of the recovered amounts, which include claims paid upfront by the insurer, as well as copays and deductibles paid by the member.
Medical Case Management
When we manage an entire episode of care, we are able to maximize results for payers and their insureds. We start by providing convenient care alternatives (see urgent care clinics and concierge healthcare services) to insureds that help avoid medical situations from escalation to hospitalization in 95 – 97% of cases.
When hospitalization is required, we direct insureds to in-network facilities that optimize the best outcomes (e.g. the highest survivor rates and the lowest infection and mortality rates) and cost, ensuring the best possible patient treatment at a fair price.
Concierge healthcare services
Are available 24/7 in key population centers throughout the U.S. World Medical Care’s board-certified doctors will come to the insureds home, hotel or place of work. To aid in a fast recovery, these doctors are able to provide on-site medications, IV fluid hydration, sutures and stitches. They are equipped with advanced technologies to provide instant results, including lab tests, x-rays and ultrasounds. For employer groups, we can arrange immigration medical exams at low cost by a certified civil surgeon approved by the Bureau of Citizenship and Immigration Services (USCIS) at the insured’s office or home, with rapid processing.
Are available 24/7/365 to facilitate client, patient and family communication during and after an episode of care.
We offer translation in the following languages: