Frequently Asked Questions
for WHC Members & the Curious
This Page will answer many questions our Members have asked. If you have not viewed the “General FAQs”, we suggest you go there first.
For additional information go to other “FAQs” or select “WHC Plans“ then select your area of interest. There’s a lot of information in these two areas.
Next, if you have questions, need help with a medical claim, or want us to contact you, select the “Contact” Button.
Thank You for being a valued World Healthcare Member! The FAQs Follow.
Step 1: Whenever you have a Medical Service, always present your WHC ID and ask for a “No-Insurance, Self-Pay Discount”. You can also ask the receptionist for a copy of their Patient Discount Policy.
Step2: At checkout, make sure you receive the following documents.
Step3: At checkout, make sure you review your Billing Statement to see you received your discounts.
The Medical Documents You Need to Receive at Checkout:
✓ Intake Report: This document explains the doctor’s comments when you were first examined.
✓ Statement of Services: This document explains and lists the treatments you received.
✓ Billing Statement: This document shows the pricing and discounts for each Medical Service.
✓ Payment Receipt: This document shows the amount you paid on the day of your Medical Service.
Step4: Send your Medical Documents and your WHC Medical Claim Reimbursement Request to: ConciergeServices@WHCHealthcare.com
Please carefully read the following
Each of the following Documents are needed to process your Medical Cost Reimbursement Request.
✓ The WHC Medical Claim Form: The WHC Medical Claim Form describes the Medical Event causing the need for a Medical Service. A completed Medical Claim Form is required to process any Medical Claim. Failure to provide a Medical Claim Form will cause a delay or even a denial of your Medical Claim.
✓ Required Medical Service Documents: The Medical Services Documents should be given to you by the Medical Provider when you check-out. If not, please ask for them. Each of the following documents must be sent to WHC with your Medical Claim Form. Each document must in a legible, paper, PDF or .jpg format.
✓ A Statement of Services (SOS): The SOS describes each performed Medical Service. The SOS may have other names and may include multiple documents. For instance, it may be called the Intake Report or Initial Physician’s Report. The SOS must describe; (a) the initial medical analysis performed by each Medical Provider, (b) the description of the cause for the Medical Event, (c) the Medical Services performed, and (d) discharge notes.
For Routine Medical Services: Usually there is one Statement of Services and one bill from one Medical Provider. For an annual wellness there may be an additional Lab and Test bill.
For Non-Routine Medical Services: Usually there is more than one Medical Provider. Each Medical Provider’s Statement of Services and medical bill is treated separately when processing your entire Medical Claim.
Frequently the Medical Provider’s Medical Claim Documents will be received by you at different times. Send the Medical Claim Documents to WHC when received. WHC will process each when received, thereby speeding up your reimbursement.
✓ A Billing Statement: The Billing Statement shows the itemized cost for each medical treatment provided by the Medical Provider including CPT codes and any adjustment in the cost for Self-Pay and other discounts.
✓ Payment Receipt: A copy of your payment receipt (credit or debit card) or other evidence showing your payment at the time of the Medical Service or the amount owed to the Medical Provider.
Attach all your scanned (PDF) documents to an email and send to: ConciergeServices@WHCHealthcare.com
Medical Claim Deadline: Within 30 days after receiving any Medical Service of purchase of a covered Prescription Medication
Medical Treatment Deadline: Within 7 days of any illness or injury
Note: Any medical claim submitted beyond the Deadline will not be processed or reimbursed. Deadlines are necessary to give the WHC Concierge time to review your medical bills and to contact the Medical Provider.
Anywhere: You can receive any medical Service by any Medical Provider anywhere in the U.S. and World-Wide.
We do suggest you follow these guidelines:
✓ Primary Care Physicians (PCP): Use for annual wellness exams and general well-being Medical Services.
✓ Urgent Care Facilities: Use for any Non-Routine Medical Service.
X Free-Standing ER Facilities: Avoid a Free-Standing ER. Your cost can be 5 times greater than an Urgent Care. And you may be directed to a Hospital ER for treatment. In which case, you would likely incur two, expensive ER medical treatment costs.
X Hospital ER Facilities: Avoid an ER unless you have a major medical issue. Treatment costs at a Hospital ER are about 10 times more than an Urgent Care. Only receive Medical Services at a Hospital ER for a life-threatening Medical Event, or if directed by an Urgent Care Facility.
Yes: You are covered anywhere you travel.
Your Concierge Services is Your Personal Healthcare Advocate
✓ Helps you manage your entire healthcare program: So You don’t have to!
✓ Reviews your medical bills for billing errors: Most medical bills have Billing errors that must be discovered and addressed.
✓ Reviews Billing Statements to see if you are getting medical discounts: Lowers your Medical Service costs.
✓ Negotiates payment terms with Medical Providers. Another method to lower medical service costs.
✓ Sends You Cash Reimbursements: To reimburse your Out-of-Pocket medical service costs.
✓ Helps you locate cost effective Medical Providers: We have suggestions on which Medical Providers will give you good discounts.
✓ Helps you with general healthcare questions: We are your Healthcare Advocate.
Your Explanation of Benefits: Every time you submit a Medical Reimbursement Request you receive an EOB. Your EOB shows your CHSA and your Medical Account Balances.
Contact WHC: Contact WHC using an on-line request, or sending an email to WHC: ConciergeServices@WHCHealthcare.com
Included with your WHC Membership and Healthcare Plan Agreement: Your ID Cards are included with your WHC Membership and Healthcare Plan Agreement. Simply print them then cut out the ID Card. Be sure each family member has their ID Card with them at all times.
You can also contact WHC and request your ID Cards.
Remember! Always present your WHC ID Card each time you visit any Medical Provider and receive any Medical Service.
Yes – Anytime! Any person can be added; dependants (no age restrictions), friends, relatives, parents, grand parents, even your pets.
Yes – For Prescription Medications. The definition for a Prescription Medication is a medication requiring a Medical Provider’s authorization.
Prescription Medications are usually an Included Coverage if: (a) you selected the Prescription Medications coverage, and (b) the Prescription Medications currently being taking are disclosed in Addendum A of your CHC Healthcare Plan Agreement.
Otherwise, a Prescription Medication requires; (a) our prior written approval to be an Included Coverage unless the Prescription Medication is approved and is part of a Non-Routine Medical Service, or (b) is an Approved Cost and is less than the Prescription Medications Benefit Amount.
The WHC Meds Plus Program: The WHC Meds Plus Program is an optional benefit that reimburses you 100% of your Prescription Medications. No co-pays or deductibles. Contact us to learn more and to sign-up.
Note: Any medication prescribed by a Medical Provider for an illness or injury is covered like any Medical Service.
Refer to your WHC Healthcare Plan Agreement for a specific list.
Each of the following Medical Services is usually an Excluded Coverage and a Denied Cost unless WHC provides you with prior written approval before the Medical Service is performed.
✓ Any Medical Service not shown or checked in the Table on your WHC Healthcare Plan.
✓ Any Pre-Existing Medical Condition not disclosed on Addendum A of your WHC Healthcare Plan.
✓ Any Prescription Medication being taken not disclosed on Addendum A of your WHC Healthcare Plan.
✓ Any Elective Medical Service including vasectomy, pregnancy and maternity
✓ Any Medical Service or combination of Medical Services that exceeds or will exceed: (a) $250, (b) 130% of the Medicare reimbursement amount, (c) the respective Medical Services and Prescription Medications Medical Benefit Amount, (d) or in WHC’s sole opinion, exceeds the usual and customary frequency or cost for such Medical Service
✓ Any Medical Service whereby the same or similar Medical Service was performed at an interval or frequency deemed by WHC to be excessive or too frequent
✓ Any Medical Service cost that exceeds the usual and customary cost for such Medical Service
✓ Any Medical Claim or collection of Medical Claims that exceed the Medical Services or Prescription Medications Plan Benefit Amount
✓ Any Medical Reimbursement Request not timely submitted to WHC for Reimbursement
✓ Any Medical Service whereby a Medical Reimbursement Request was denied by an insurance company or is not an accepted Medicare reimbursement
✓ Any non-life threatening, or Routine Medical Service received in Hospital ER or a Free-Standing ER instead of by a PCP or at an Urgent Care Facility
✓ Any Medical Service for substance abuse, physical abuse and mental health treatments including any habit or addiction treatments, counseling or services
✓ Any Medical Service whereby the Medical Provider’s diagnosis found no specific medical condition or there is no supporting documentation from a Medical Provider to justify the need for the Medical Service
✓ Any medical bill that was paid or should have been paid by any third-party, including, but not limited to: Stop-Loss insurance, other insurance policies, employer, state or federal programs or plan
A Routine Medical Service: The general definition is a Medical Service for general health and well-being performed or ordered by a Medical Provider. A Routine Medical Service is usually a single office visit with a cost of $250 or less.
Some examples are doctor office visits, lab and imaging tests, usually associated with an annual wellness exam, and minor medical and wellness treatments.
A Non-Routine Medical Service: The general definition is: (a) a Medical Service for an unexpected or unplanned Medical Event such as for an Accident, or a Non-Critical or Critical illness, (b) when there is more than one office visit for the same Medical Event or (b) when the Medical Service cost exceeds $250.
Some general examples of a Non-Routine Medical Service are:
✓ An Accident: A broken bone, a laceration or any type of injury
✓ Non-Critical Illness: Fever, mild arthritis, abdominal pain, hernia procedure, tooth extraction or crown
✓ Critical Illness: Heart Attack, Stroke, Cancer, Kidney failure, Diabetes, Paralysis
If possible, contact WHC before receiving any Non-Routine Medical Service. We want to confirm your coverage and help guide you to where you may receive cost-effective treatment.
For any Non-Routine Medical Service, you must receive treatment from a Medical Provider within 72 hours of the Medical Event causing the need for the Medical Service.
Note: All Medical Claims must be submitted within 7 days of any Medical Service.
An Existing Medical Condition: A Pre-Existing Medical Condition is defined as any physical, mental, dental, vision or hearing medical condition that existed, was diagnosed or treated by a Medical Provider or otherwise became known to you within five years immediately prior to the Effective Date.
All Pre-Existing Medical Conditions for any person included in your WHC Healthcare Plan must be disclosed to WHC.
Your Medical Benefit Amount has two definitions. Each are explained below.
First, Your Medical Benefit Amount is the amount of money you have available to pay your Medical Service costs. As you pay your Membership Contributions, your Medical Benefit increases. This is called “Self-Funding” your future Medical Costs.
On your Effective Date your Medical Benefit is $0 or low. Only one Membership Contribution may have been paid. To have money available to pay your medical costs on and after your Effective Date, you select an “Initial Medical Benefit”.
Your Initial Medical Benefit is your Medical Benefit until your Membership Contributions reach or exceed your Initial Medical Benefit amount. At which time your Medical Benefit is the money you have in your Member Medical Account.
Your WHC Membership Contribution Deposits: All WHC Membership Contributions from you and other WHC Members are deposited into an affiliated Bank’s depository account, called a Cooperative Pool Medical Account.
Your Member Medical Account (“MMA”): When your initial Membership Contribution is received, you are given an individual Account Number. Your account is referred to as your Member Medical Account (“MMA”). Your MMA is your Reimbursement source for all your Medical Reimbursements and Medical Provider payments.
WHC oversees the accurate accounting of your deposits into and out of your MMA, and the investing of your MMA account balances by the Bank.
Selecting your Initial Medical Benefit Amount: You want to have sufficient money available to pay routine medical costs. This amount is usually from $2,500 to $5,000. Your max amount is 12 times you monthly Membership Contribution. This why we require a 12 month initial WHC Membership Agreement.
If you want a greater Initial Medical Benefit Amount or to start or increase your CHSA deposits, contact WHC: ConciergeServices@WHCHealthcare.com
Your have Several Options
✓ Use your WHC Bank Account Overdraft Protection: If you have not set-up your Bank Overdraft protection, contact us ASAP: ConciergeServices@WHCHealthcare.com
✓ Make a Contribution to Your CHSA: If you have not set-up your CHSA, contact us ASAP.
✓ Use WHC “Crowd-Funding”: Crowd-Funding is a financial strategy whereby other WHC Members advance money to pay other Member’s medical costs on an “As Needed, Benevolent” basis. Crowd-Funding is a loan made to you from other WHC Members. Additional details will be provided to you if you chose to use this financial service.
✓ Use “GoFundMe”: GoFundMe is a popular online crowdfunding platform where individuals, groups, or charities create fundraising campaigns to collect money from many people for personal causes. Consider using GoFundMe when you have an expensive, on-going medical condition. Contact us for this option.
✓ Use Medical Provider Financing: Have your WHC Concierge help you arrange a financing plan you can afford with Hospitals and other Medical Providers.
✓ Use Business Medical Financing: Numerous companies offer Medical Financing, such as CareCredit. Check with your WHC Concierge if you are interested in learning more about your Medical Financing options.
✓ Use Home Equity Financing: If you have a home you might be able to use the home’s equity to pay your medical costs. Check with your WHC Concierge if you are interested in learning more about your Home Equity Financing.
Note: WHC does not assume any responsibility to pay your medical costs. At all times your medical costs are your obligation to pay.
We’ll do everything possible to help you afford your Medical costs!
Self-Funding & Self-Insuring – WHC’s Definition
To start, all WHC Membership Contributions from you and other WHC Members are collectively deposited into an affiliated Bank’s depository account, called the WHC Cooperative Medical Account (“CMA“).
Your Member Medical Account (“MMA”): When your WHC Membership and healthcare Plan is effective, you are given an individual Account Number. This is called your Member Medical Account (“MMA”). Your MMA is included in the CMA.
Your MMA is your Reimbursement source for all your Medical Cost Reimbursements and Medical Provider payments.
Because you are funding your MMA, you are paying is advance of your medical costs. This is called “Self-Insuring”. WHC use the both terms, “Self-Funding” and Self-Insuring”.
WHC oversees the accurate accounting of your Monthly Contributions and other MMA deposits into and out of your MMA.
Self-Insuring – General Definition
Self-Insuring is a risk management strategy where an individual or organization absorbs financial risks themselves rather than transferring them to a commercial insurance company. Instead of paying regular premiums, you set aside dedicated funds to cover potential out-of-pocket costs in the event of an unexpected loss (or Cost)
Risk Retention: You explicitly accept the financial burden of potential losses instead of buying an insurance policy to shift that risk.
Fund Allocation: You establish a specialized, on-balance-sheet fund calculated using actuarial data to cover expected future losses.
Claim Management: The self-insured party pays for damages, legal fees, or medical bills directly out of their own cash reserves.
After reading the General Definition, I’m sure you agree that WHC should manage your Self-Insuring of Your Medical Costs!
✓ Use WHC “Crowd-Funding”: Crowd-Funding is a financial strategy whereby other WHC Members advance money to pay other Member’s medical costs on an “As Needed, Benevolent” basis. Crowd-Funding is a loan made to you from other WHC Members. Additional details will be provided to you if you chose to use this financial service.
✓ Use “GoFundMe”: GoFundMe is a popular online crowdfunding platform where individuals, groups, or charities create fundraising campaigns to collect money from many people for personal causes. Consider using GoFundMe when you have an expensive, on-going medical condition. Contact us for this option.
Yes, you are correct. WHC does not sell health insurance and WHC is not a health insurance company.
We don’t sell health insurance because of the costs and the limited coverages and possible declines of coverage.
We don’t want to sell you a healthcare plan that is too expensive for most people to pay or use. There are other less expensive ways to have an Affordable Healthcare Plan. WHC is one of the ways!
If you want a health insurance plan we will refer you to your State Healthcare Exchange and to a licensed insurance broker.
Your Explanation of Benefits (EOB) gives you a detailed description of your Medical Services and your submitted Medical Cost Reimbursement Request.
Key details typically include:
✓ Medical Provider & Medical Service Information: The name of the WHC Member having the Medical Service, Date of Service, the Medical Provider, Provider Type, Treatment Type, Medical Purpose, and Procedure Type.
✓ Financial Information: The Retail Cost – Before Discounts, Medical Provider Adjustments & Discounts, Member Net Billed Cost, Amount Paid by Member, Amount Owed to Provider, Processing Adjustments & Costs, Processing Status, Approved Amount, Where Your Reimbursement Check Was Sent, Who received your Reimbursement or Payment, Your Medical Cost Savings & Medical Service Total Discounts.
✓ Your Member Medical Amount Transactions and Balances: Your Money, on deposit, to pay your medical costs; Your Medical Benefit. Your MMA increases with your Member Contributions and decreases as your Approved Medical Bills are paid. Individual Member Medical Benefit Amounts are shown under each Member’s Name.
✓ Total Claims Processed and Your Financial Results from your initial WHC Membership Date to the Present: Shows the number and dollar amount of all claims received and processed; The Retail Cost, Medical Provider Discounts you received, Net Billed Cost, CHC Total Reimbursements you received and your Total Member Savings.
Below is our Privacy Policy:
WHC and its affiliated companies are committed to providing healthcare services contemplated by this Agreement that are designed to meet your needs (“Services”). WHC is committed to respecting your privacy and protecting the information about you that we may receive.
What Information WHC Collects: As an essential part of our business, WHC obtains certain personal information about you in order to provide the Services to you. Some of the information we receive comes directly from you on applications and other forms and may include information you provide during visits to our web site.
We may also receive information from physicians, testing laboratories and health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with healthcare and financial institutions.
What Information WHC discloses: WHC does not disclose nonpublic personal information about current or former WHC Members to any non-affiliated entity, except as permitted by law.
Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer your Services that you requested or authorized; disclosures made with your consent, at your direction or as performed under the Limited Power of Attorney; disclosures made to your legal representative; disclosures made in response to a subpoena or other regulatory authority requests; disclosures made to comply with federal, state or local laws and to protect against fraud.
Notwithstanding the above, any request for information protected under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) must be approved by you in writing before such disclosure is made by us to the requesting party.
WHC Privacy Protection Procedures: WHC protects information about you by restricting access to information about you to those individuals and companies that need such information to provide the Services.
Finally, WHC employs secure technologies to safeguard transmission of information about you, and we have established and maintain procedures to comply with state and federal laws and regulations regarding the security of personal information.
