Acute Care

Inpatient Care and Review

Care starts before you are a patient in the hospital. From precertification through the inpatient stay and transitioning to post-discharge care, MedCost proactively communicates with hospital staff to anticipate and facilitate member needs during their course of care. This includes ensuring evidence-based care practices are followed and recommending cost-efficient, in-network providers. It also includes coordinating post-discharge needs such as rehabilitation, home health services and equipment, or services that fall outside a member’s health plan.

Outpatient Care Review

All outpatient procedures involve some level of risk. Our Outpatient Review provides a safeguard by evaluating a member's medical history to ensure that other, more conservative measures have been exhausted. The goal is to reduce the number of unnecessary surgical procedures and tests while keeping your employee's health and safety a top priority.

Rx Clinical Program

MedCost’s dedicated team monitors and educates those in need of medications. Programs include injection training, proactive side effect management and adherence assessment. We also actively provide drug interaction assessments and notify members of any gaps in pharmacy care. Tools such as prior authorizations, step therapy and formulary management assist members in making the best use of their benefits while minimizing disruption to their current plans of care.

ER Utilization Management

This is a direct mail program that focuses on members who use the Emergency Room for non-urgent conditions. This program educates and provides alternatives to using the Emergency Room for treatment.

Behavioral Health

Millions of American adults suffer from mental health issues such as anxiety, depression, substance abuse, even loneliness. The Mental Health Parity Act was expanded under Health Care Reform to include coverage for behavioral health and substance abuse services as essential benefits. This reform means managing behavioral health costs for your health plan and providing better outcomes for your employees is more important than ever. Along with traditional care resources, MedCost provides convenient options to support members in successfully navigating the behavioral health continuum of care.

The Healthy Mind program addresses immediate and ongoing behavioral health needs with real-time telephone coaching and emphasizes the link between mental and physical health by connecting employees to a primary care physician.  Coaches provide navigation to other in-network and community resources, if needed. 

Through the Telehealth option, employees participate in traditional counseling/therapy via telephonic or online video consultations scheduled in advance with a psychologist/psychiatrist. 

Telehealth Services

Telehealth services, including consultations by phone, apps or videoconferencing, are on the rise as employers make medical care more accessible, affordable and convenient for their busy employees. Many acute health concerns can be treated without incurring the expense of an office visit, urgent care facility or emergency room visit. Conditions such as respiratory and urinary tract infections, allergies, anxiety, muscle and arthritic pain, and minor joint sprains and strains can all be treated via phone or mobile device. Employees have 24/7/365 access to doctors licensed to practice medicine in their respective states. A Caregiver Program also allows employees to add an elderly or sick relative to their account and arrange video or phone visits for a flat fee. Telehealth can be added to your health plan at any time.

Cost Comparison Tool

Powered by health plan data and claims information, the Cost Comparison Tool reveals the costs of hundreds of common medical services on a member-specific level and can help your employees make more informed, cost-effective care decisions. Patient reviews and quality ratings provide additional context and information about the providers. Shopping for care is easy for employees—the tool is available in their secure member account. The Cost Comparison Tool meets the requirements of both the Payer Transparency in Coverage rule’s self-service shopping tool and the No Surprises Act’s price comparison tool.