Employers FAQ

Why is ClearChain Health a network-free insurance company?

ClearChain Health is network-free because we want to have the ability to audit the providers that participate in our program. Traditional insurance companies typically don’t audit the procedure codes provided by healthcare facilities. As a result, employers pay higher rates that can significantly impact the company’s bottom line. At ClearChain Health, we operate on the belief that the audit we implement catches errors and saves money at every level of the claims process. We work for you, the employer to save you money.  

Transparency

+ What is transparency in health care?

Transparency in health care means that every entity involved in a patient’s health care clearly and openly communicates the actual cost of that treatment or medication. Over the years, there has been a push for transparency in healthcare pricing, with little success. Currently, medical billing is confusing, convoluted, and filled with hidden fees and rebates designed to benefit insurance companies. This lack of transparency and the benefits to insurance companies is often blamed for the rising cost of health care in our country.  

In October 2020 the Centers for Medicare & Medicaid Services announced a plan to increase transparency over the next several years. 

At ClearChain Health, we believe in 100% transparency and operate our health insurance plan on this foundation. 

+ Are out-of-pocket costs higher with a direct relationship between you, your medical providers and your health insurance plan?.

+ What is ClearChain Health’s transparent pricing policy?

ClearChain Health operates on a transparent pricing model. In fact, this is the foundation of our health plan. We outline where every $1 goes upfront so the employer knows and understands how our plan works. 

+ How does ClearChain Health make money?

ClearChain charges per enrolled employee per month, retains 2% of savings generated through audit and repricing, and receives an administrative fee per prescription fill.

Dedicated to transparent health care, we have eliminated the conflicts of interest associated with traditional carrier and broker models by setting this fee model.

+ Does ClearChain Health benefit from spread pricing? 

No. A pharmacy benefits manager (PBM) is a company that manages or administers an employer’s pharmacy benefits plan. Most PBM’s utilize a concept called spread pricing where they keep a portion of the total paid for prescription drugs by a health plan rather than passing the complete payment on to pharmacies. 

ClearChain Health contracts with a transparent PBM that passes along the actual cost of the drug. Additionally, we charge a transparent flat transaction fee of $6. While the employee – or member – won’t notice a difference, you will because we are saving you money.

+ Does ClearChain Health benefit from prescription rebates?

No. Any time an employee fills a brand-name prescription drug, a rebate for that drug is generated. Because the rebate is not owned by an employer’s plan, the plan benefits manager, broker, or carrier has the right to distribute the rebate as they choose. Typically, rebates are distributed in their favor. 

At ClearChain Health, our transparent rebate protocols mean that the employer gets the rebate instead of the broker, administrator, or insurance company. And, we are paid an administrative fee per prescription fill. That’s it!

Brokers

+ How do brokers connect with ClearChain Health?

Currently, ClearChain Health is brokered through WayPoints Benefit Solutions. Please contact the Waypoint Benefits team directly at (insert email and phone).

Employees

+ What is the biggest concern our employees will have if we transition to ClearChain Health?

Your employees, our members, will ask if their provider is in-network. Traditionally, insurance companies have conditioned members to ask if our provider is in-network. So, this is the most common question we get from members when they transition to ClearChain Health. 

Our member advocate team is available to answer any questions members have and help guide them through every step of the onboarding process. And, we make it easy for employees to nominate their providers to participate in ClearChain Health’s program.

Learn more about how we take care of our members. (link to Members overview page)

+ Why do our employees have to nominate their provider to be covered?

Because ClearChain Health is network-free, we do not have a traditional “network” of providers that members are required to choose from for treatment. Our plan allows members to choose their own provider or facility. Our provider nomination process is what connects a provider to a member’s benefits plan. This nomination process is what establishes the provider relationship with ClearChain Health so they agree to submit claims to us and receive payment from us.

Learn more about the provider nomination process here. (link to the provider nomination form page)

+ Will our employees see a difference in ClearChain Health if we change plans?

In most cases, employees will benefit from better benefits and reduced fees through ClearChain Health. While the employee – or member – won’t notice a difference in the actual benefits services provided, you will because we are saving you money.

Providers

+ Do providers participate in ClearChain Health Care Plan?

Yes. More than 90% of providers and facilities will participate with ClearChain Health. This means they will bill and accept payment from ClearChain. Learn more about our provider outreach by reviewing How We Work with Providers. (insert link to this page)

+ Do providers understand what ClearChain Health is? 

Employer Resources