My name is Carlos Garcia and I am a physician who practices a blend of both non-‐traditional and traditional medical therapies. I invite you to visit my website, UtopiaWellness.com to familiarize yourself with my practice. Interactive Medical Co-‐op is the new response to out-‐of-‐control healthcare insurance costs, which wreak havoc on America's corporate profitability and keep individual employees from enjoying better health and proactive wellness.
Our government and corporate America both acknowledge that our healthcare system is in need of revision,however, neither knows what to change. Interactive Medical Co-‐op is the first Co-‐op network to break the mold from the usual and customary conventional, symptom relief driven, traditional medical plans. Interactive Medical Co-‐op is America's first Co-‐0p network that embraces prevention, wellness and providing patients with a blend of both traditional and integrative treatments.
Why was IMC created? IMC resulted from the request of a fortune 500 corporation, which self-‐insures, seeking a blend of traditional and non-‐traditional medical services. The corporation tasked Utopia with the integration or blending of both realms of the medical world. The driving force for the corporation is to manage costs, while providing their associates with better healthcare options and treatments.
What is self-‐insurance and how does it differ from ordinary healthcare insurance? Traditional health insurance is Obama care insurance. Someone, God only knows, decides what is medicine by deciding what gets paid, i.e. pre-‐authorization. Now, one would think that the megaliths of the fortune 500 would understand health insurance. I thought so, however the shocking reality, at least to me, is that the majority hire or purchase insurance through a broker, who tells the corporation what insurance products will comply the government’s mandate.
Usually, fiscally savvy brokers will steer a corporation into accepting a premade plan from a huge healthcare insurer, i.e. Aetna, Blue Cross, etc. The corporation, as we, in this case is at the mercy of the traditional health insurance company, who also works along side with the traditional health insurance broker. One would think savings would be returned, or passed on, to the buyer, the self-‐insured corporation. This is a nice theory, but not the practice. In this case, which is the norm, the corporation is no better off than we are. The deals, or discounts, made to the large health insurance companies, i.e. Aetna, etc. is not normally disclosed to the self-‐insured corporation. I suspect the “logic” being, because we insure so many, this really is not because of you, corporation, it is because we risk so much more than you. Because corporations realize this, they are desirous of change. However, the corporations are not sure what to do. IMC is the physician arm of this change, the evolution of healthcare delivery.
Successful corporations adapt to situations. They analyze failures and learn from them. Thus IMC is the realization that self-‐insured corporations, those mandated to provide healthcare for their employees have requested. They want us to help them provide a better product and delivery for the healthcare for which they are willing to pay. Corporations function with profit in mind, they understand everyone expects to be reimbursed fairly for services rendered and they expect that a profit will be incorporated into the reimbursement schedule. By the same token if fair reimbursement is given, they expect service commensurate with that payment. For equitable reimbursement, corporations expect face-‐to-‐face time between practitioners and patients. This is perceived value.
In a self-‐insured health plan, the corporation designs its own health insurance plan, since the corporation funds and pays for all services, however in this case, practitioners are invited to make recommendations in order to diversify options. The theory being by diversifying, or increasing treatment options and instituting a wellness health maintenance plan everyone benefits.
The corporations will benefit by: Decreasing lost productivity due to illness.
Better productivity because the workers are in a better state of health and wellness. Decreasing interventional costs, i.e. number of E.R. visits will decrease.
Get to understand how their monies are being utilized.
Are able to propose healthcare delivery options from their perspective, i.e. what works. for that company and what does not in order to arrive at a mutually beneficial solution.
We, the practitioners, benefit by:
Doing what is in the patient’s best interest from a broader medical treatment palette. Ability to monetize our non-‐traditional educational investment, while keeping your current revenue streams and treatment options.
Timely reimbursement, i.e. less paper work.
We provide input to better cost effective healthcare delivery. We get to decide and influence medicine for today and its future.
The patients benefit by:
Being able to use natural treatments, which when administered correctly has few side effects.
Spending face time with their practitioners, i.e. bonding with us.
Learning it is time to start respecting and treating our bodies as we do our automobiles, and hopefully better.
Being able to do what my insurance will pay for…
By working synergistically, in a win-‐win environment, everyone begins to breakdown antagonistic barriers, which just add inefficiency to the equation. Actually self-‐insured companies have a fiduciary responsibility to manage their healthcare plans with cost savings in mind.
In very simplistic terms, an actuary, based on fiscal data, tells the corporation, the consumer and payer of services, what is its financial risk. The corporation usually wants a cap on its financial exposure for an illness per employee. The corporation hires a management corporation, known as a third party administrator, TPA, which deals with claims. The TPA evaluates claims and disperses reimbursement. They also keep and provide all sorts or statistics and reports on a periodic basis to the corporation. Some of the healthcare funds are also used to buy reinsurance to cover expenses above and beyond the actuarial employee cap. Since many of the fortune 1000 companies self-‐insure, they have the right to dictate terms and conditions with respect to services covered and reimbursement under ERISSA law. The management corporation then follows instructions.
For example: the average person diagnosed with cancer in America, spends about 1.250 million dollars. The corporation may be responsible for the first $250,000, while the reinsurer may cover the next $500,000 as stop loss insurance, and yet a second reinsurer covers the remainder. There are even additional, secondary insurers to cover transplant procedures and medications. Indeed, it is commonplace for insurance companies to buy reinsurance(s) to cap their own financial exposure as well.
Back to Interactive Medical Co-‐op:
The biggest issue most corporations face is that they do not practice medicine and need guidance from vetted medical sources. By the way of example, Interactive Medical Co-‐op asked me to present a list of services provided at Utopia Wellness. These include chelation therapy, intravenous hydrogen peroxide, colonic irrigations, hyperbaric oxygen treatment, high dose Vitamin C, etc. The approved services list to date is part of the IMC application documents. This list will grow from your input. Once the corporation and Utopia agreed on reimbursements, the corporation contacted its management corporation and instructed them to accept the additional medical codes, which I created and the associated fee schedule. Although the TPA initially baulked at accepting my codes, which are nothing like the traditional ones on purpose, the TPA’s employer demanded its incorporation. It is now part of this corporation’s approved and reimbursed healthcare insurance program.
How is this Co-‐Op any different than a PPO?
-‐ PPOs service members of traditional medical treatment plans. PPOs place very little, if any, emphasis on preventative, wellness-‐based treatments. There is no practitioner representation when it comes to major decisions in traditional PPOs. [You may speak with, or have access to a representative, but not with executive management.]
-‐ IMC services employees and family members covered by the self-‐insured corporations not traditional insurance healthcare programs, i.e. Obama care, HMOs, etc.
Our Co-‐op knows how to provide better healthcare than traditional health insurance companies. Members can approach the Co-‐Op executives with ideas providing better services while providing savings to the companies. In short our Co-‐Op is the first practitioner-‐based entity that is able to sit at the table with those executives seeking healthcare and that process our claims. Our Co-‐Op is an integrative forum. IMC values prevention over intervention, elucidation of the route cause of illness versus symptom treatment (Band-‐Aids). Our medical treatment palette is broader and better than the traditionally limited medical treatment palette.
Who is Interactive Medicines Co-‐operative’s target market?
IMC’s target market is that of the self-‐insured corporations, the fortune 1000 being the most prominent within this group. We are interested in corporations who invite us to the decision making process on the executive level, since it is we, the practitioners, who should be telling the health insurance companies what to reimburse. This is not a theory; I have done this. This is a reality; please look at the application documents.
How does IMC practitioner members get reimbursed?
IMC interacts directly with the end payers, and their third party administrators, TPAs, who represent the corporations that self-‐insure. IMC corporate participants acknowledge the value and efficacy of non-‐traditional therapeutic modalities and have instructed their TPAs to reimburse the services via a HCFA 1500 standard insurance form submission, with the codes provided to them by us.
Do you have to renounce or resign from any other revenue stream? NO!
Interactive Medical Co-‐Operative is another source of revenue for us. However, it is the first, which deliberately reimburses for non-‐traditional medical treatments, i.e. intravenous hydrogen peroxide, etc.
The corporation, which tasked me with advancing healthcare choices, has numerous locations throughout America, as well as various operations overseas. Thus, we need well-‐ qualified clinicians seeking alternative fee for service revenue sources to provide services across America. Additionally, the corporation that hired Utopia Wellness frequently associates with other fortune 1000 companies. Interactive Medical Co-‐op has also been promised introduction to other prominent and successful companies in America. To date, other self-‐insured companies, which have been told about the development of this evolutionary healthcare opportunity, have expressed great interest in joining the Interactive Medical Co-‐op healthcare system as payers. This is a work in progress but clearly one with great potential for us physicians who want to provide both traditional and integrative/alternative medicine to our patients and qualifies for fair and equitable reimbursement for our expertise and services.
IMC will be interacting with its members who wish to participate in the evolution of the Co-‐ operative on various levels. IMC seeks therapeutic treatment algorithms and protocols expertise from medical practitioners from versed medical palettes in traditional and non-‐ traditional medicine to provide the best blend of healthcare possibilities for its participants, our patients. This partnership between the payers, the self-‐insured corporations, and the broad based medically diverse practitioners is the evolution of medicine. Interactive Medical Co-‐op is the evolution of health services, which are currently limited and costly.
How often have
we heard verbiage such
as: I'll do whatever my health insurance plan will pay for... Interactive Medical Co-‐op
to practice and
advanced therapeutic efficacy
savings. However, self-‐insured corporations
Over the years many practitioners have diligently studied and pioneered non-‐traditional modalities to assist the healing of patients. These treatments are often effective and typically lack side effects, when done correctly. However, when traditional insurance healthcare plans are approached for acceptance and reimbursement, the clinical experience falls upon deaf ears. Whereas insurance companies are experts on mitigating financial risk and maximizing their own profits, they know little about healthcare and its delivery. They apparently never learned that medicine is an art and will never be just a science, mainly because each patient is his or her own unique environment, but the best clinicians know this well.
Interactive Medical Co-‐op is now asking physicians who desire to practice and provide both non-‐traditional and traditional therapies to join. With a large enough physician base, we will be able to service other self-‐insured companies nationwide, providing them with the savings that come from integrated medical interventions, while providing their employees with blended treatment options, pre-‐illness wellness interventions, and more efficacious treatments. Joining Interactive Medical Co-‐op offers highly qualified practitioners the opportunity to provide care with a broader therapeutic palette, with easy reimbursement.
Interactive Medical Co-‐op is today's reality of medicine's evolution. Please join us in this groundbreaking endeavor. We welcome you; your input is valuable and needed!
I thank you for your consideration,
Interactive Medical Co-Op, LLC.
110 State Street East
Oldsmar, FL 34677
VIEW IMC Colleague Package