Interview with CJ Gueldner with RiseMed Health Network

Interviews, Uncategorized

RiseMed Health

I would like to thank CJ Gueldner with RiseMed Health for the information provided in this interview. They offer benefit plans to individuals, companies and associations.

Anita: I understand there are many benefit plans in the marketplace – What’s different about your plans?

CJ: Good questions. Yes, it is true that there are many benefit and insurance plans in the marketplace. What makes our plans different is that they are designed with the end user in mind.

 You see individuals had been mandated to have enrolled into benefit insurance plans. However, all plans never took the end user into mind when it came to price, usage or access to care – but our plans do.

As agents we come across many plan designs which range in cost. However, we’ve taken the time to research plans that benefit our consumer.

Our plans range from:

Just Telemedicine which include behavior and mental health

A Telemedicine plan which includes Formulary Tier 1 or Tier 2 drugs at an affordable price.

Minimum Essential Coverage (MEC) Plans which are ACA compliant to cover preventative health services, Telemedicine, Formulary Drug Coverage, and some hospitalization for in-network and additional plans which include out-of-network.

We also have Limited Benefit Plans (LBP) which include everything a MEC Plans covers, plus more coverage and benefits for the member. These plans cost a little bit more, however, they cover more services which include more formulary drug coverage (Tier 1, Tier 2 and some Tier 3) and more hospitalization and urgent care. These LBP plans are designed for individuals that fall into disease management or prenatal. They are unique plans that address health coverage enrollment for individuals who are in limbo and/or missed the open enrollment process. The plans are also designed for individuals who don’t need a major medical plan but need access to care and general formulary drug coverage. Also, you can enroll into these plans at any given time throughout the year.

We also have major medical plans too.

Anita: So, what network are you with?

CJ: Well, the plans I just mentioned are under the Aetna, First Health and USA PPO Network. Yes, that is correct a national PPO network that follows you wherever you go in the U.S.

The network is so easy to search for a PPO provider, Urgent Care Center, and Lab. What’s great about this network is that you can easy within seconds create a personalized directory no matter where you’re at in the U.S. …. And the plans are affordable!

Anita: You mentioned Telemedicine? Can you tell me about it and how it works?

CJ:  Yeah. Definitely! Our Telemedicine by Remedy.me is amazing! We provide it as a stand-a-alone product, and/or it is automatically included into each of our plan designs. The service is available 365/24/7 days a year (English & Spanish), is available for resident and non-resident, and includes the standard services offered by every other Telemedicine company in the market. However, our plans include more services like:

  • Behavior health
  • Mental health
  • Domestic Violence and family counseling
  • Diet and Nutrition counseling
  • And so, so much more.

Anita: The Telemedicine sounds incredible – Can you tell me about the Drug Coverage?

CJ: Yes. Our formulary drug coverage is by Integrated Prescription Management (IPM) who also created E-Script. By having them manage the formulary drug coverage for the plans – provides more Rx Prescription coverage under Tier1, Tier 2 and Tier 3.

When a member is enrolled into a plan which includes formulary drug coverage. They will be prompted to create a user profile with IPM, update their current Rx coverage within their IPM profile to receive helpful notification pertaining to their prescription coverage. Also, this way IPM can validate their Rx with Retailers. And remember, our PPO plans and formulary drug coverage follow you within the U.S

Anita: Well, your plans sound amazing? Is there anything else we should know about the plans?

CJ: Yes, well the plans are offered under RiseMed by Medical Access Network. The network is an association which offers plans at an affordable price point with year-round enrollment options. The plans also include Identity Theft Protection. Isn’t that amazing. Now, can you name a plan that also include that for its member other than ours? No, I can’t!

Anita: Can you tell me how your claims are handled?

CJ: This makes access to care, pre-authorization and the adjudication of the claim simple in providing the member a summary of benefits (SOB).

Anita: How long have these plans been available? Why haven’t I heard about them before?

CJ: Good question! These plans have been available for several years. They’re even available during open enrollment under the healthcare exchange. Like I mentioned earlier, we took time to do our research to partner with Medical Access Network in providing these plans to the consumer as RiseMed and RiseMed Health.

Anita: So, where can someone go to enroll or find additional information

CJ: They can call (833) 203-2210 Or (775) 241-8508 go to www.risemedhealth.com.

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