Regenexx: Experts in Working with Self-Funded Health Plans
Employer – Health Plan
Employers with self-funded health plans can choose what they wish to cover including Regenexx procedures. Adding coverage for Regenexx procedures involves changing to your Summary Plan Description. Regenexx will work directly with you and your Insurance Broker to make this process easy. Contact us to learn more about how you can add coverage for Regenexx procedures.
It is entirely up to you to determine any additional coverages you would like to provide that are currently outside of your summary plan description. Having the freedom to amend the Summary Plan Description is one of the great benefits of having a self-funded plan and allows you to take advantage of medical advancements.
Our physicians start by reviewing any records related to the injury from previous providers. If there are no records, our initial evaluation will determine candidacy for our procedures. All patients receive an candidacy rating projecting their likely benefit from a Regenexx procedure and are advised about whether Regenexx is a solution for their particular injury.
You can add what is referred to as steering language into your Summary Plan Description; e.g. prior to undergoing a total joint replacement patients need to have a consultation at Regenexx. This kind of steering language is very common and allows you to ensure your employees have the opportunity to utilize the least invasive procedures available to treat their condition.
No, you are referring employees for a Regenexx consult. We evaluate patients to determine the best individualized treatment plan. Treatment recommendations can range from physical therapy, to surgery, or to one of the Regenexx procedures. Anyone who undergoes a Regenexx procedure signs and reviews a disclose before they elect to complete the procedure. Our process includes informing the patient about alternative options. In our experience people are thrilled to have the option to undergo our procedures once they understand the difference; however it is their choice. In addition, Regenexx carries professional liability coverage for these procedures.
The Regenexx team can assist in amending your summary plan description. We will work with your Third Party Administrator and/or your Insurance Broker to add the appropriate language to cover the procedure for your employees. If you choose to cover the procedure you’ll want to consider applicable regulations; e.g. ERISA, ACA, ADA, and HIPAA. Due to these concerns in most cases it is advantageous to offer these procedures inside of your plan.
Employer – Workers Comp
Yes, Regenexx is experienced in managing Workers Compensation cases.
How you refer a case depends on how and if you direct care. If you use a Third Party Administrator (TPA) to manage your workers compensation cases then we can work with them to ensure musculoskeletal cases are directed to us. We’ll work with nurse case managers, primary care physicians, and your e-insurer on procedures and processes to make referrals. Typically, the primary care occupational medicine physician will see the patient first. Once they determine there is a musculoskeletal issue they will refer directly to Regenexx.
Regenexx cutting edge procedures can achieve superior results to surgery at a fraction of the risk and a fraction of the cost. A more detailed review of outcomes is available in this document by procedure type. Less than 20% of cases are referred to surgery.
We are able to close orthopedic cases and give a final impairment rating post procedure. We achieve this because patients will start to feel the impact of the results quickly, and because there is minimal recovery patients will be able to return to work many times weeks or months earlier than surgery. In many cases we are able to achieve a 0% impairment rating. The reason is with our procedure, the patient is generally moving the injured joint within hours of the procedure therefore maintaining range of motion. In addition, our post procedure compliance is 80-100%, which increases the range of motion during the recovery phase and therefore lowers the potential impairment rating. This is not possible with surgical alternatives. This is what we would consider a successful case.
Regenexx offers substantial costs saving when compared to traditional surgical procedures. Our procedures start at $1000 and our top-end procedures intended to replace costly arthroplasty procedures cost $7,500. When you compare that to your average expense for total joint replacement you can recognize savings from $50,000 up to $100,000 and more. On top of the procedure expense, this revolutionary needle-based approach can give patients a 0 impairment rating. This can more than double the savings opportunity since surgery always creates some impairment while our procedures do not.