PinnacleCare Membership FAQs

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What does PinnacleCare do?

PinnacleCare is a private health advisory service that represents the best interests of individuals and their families when it comes to protecting their most valuable assets – their health and wellbeing. We are an unbiased resource to which you can turn when facing or trying to prevent a major health problem. PinnacleCare Connection services are specially designed to guide you through some of the most serious and complex medical decisions you will face. Our team will connect you with top-rated specialists who are trained and experienced in your condition to provide a second opinion on your diagnosis and range of available treatment options.

How does this differ from what we get through our doctors and health plans?

PinnacleCare is not contractually affiliated with any particular physicians, hospitals, or medical facilities. We work solely for you and have no conflict of interest associated with your specific care or treatment. PinnacleCare guides you through an incredibly confusing and time-consuming process – helping to prevent unnecessary or inappropriate treatment. We work to confirm a diagnosis at the onset and connect you with experienced specialists to inform you about the most current and effective treatment options. With PinnacleCare, you do not have to carry the burden alone for your family, feeling your way through the dark, and hoping for the best possible outcome.

When should I contact PinnacleCare?

You should contact PinnacleCare when you or your spouse/partner receives a serious diagnosis or is struggling with a complex condition, a recommendation for surgery, or a significant change in a current treatment plan.

What defines a serious diagnosis or complex treatment?

PinnacleCare defines a major condition as a serious diagnosis that will involve rigorous treatment, a choice of treatment options, or a prolonged recovery and can result in significant healthcare costs and/or time away from work. Examples include: cancer, cardiac surgery, back surgery, joint replacement surgery, transplants, and persistent diagnostic challenges.

Can you provide an example of a change in treatment?

For preexisting conditions, a change of treatment might entail a new drug or a recommendation for a surgical procedure, changing a previous prescription, or therapy. For example, a patient has been receiving injections for back-related issues and a physician is now recommending surgery.

What should I expect when I contact PinnacleCare?

When you reach out for a PinnacleCare consult, our intake team will ensure the security of your medical privacy by asking you a few questions to verify your eligibility. A Connection Advisor will then contact you to gather your medical history and the details of your current diagnosis. The Advisor will review your case and consult with our Medical Team to determine the appropriate course of action.

What services are covered under this benefit?

For the last decade, PinnacleCare has been supporting individuals and their families with the information needed to confirm their diagnoses and make proper treatment choices. Depending on your particular situation, PinnacleCare may provide you with a confirmation of your diagnosis, provide recommendations on top specialists, facilitate appointments, and/or provide research on a diagnosis and appropriate treatment options. In certain cases, PinnacleCare will help to coordinate the gathering and forwarding of key medical records to a recommended specialist.

How will this work with my insurance/Medicare plan?

PinnacleCare will work with your decision whether to find specialists in or out of your insurance network. Our goal is to find the best specialist for your needs. Top specialists can typically be found in-network, however other specialists from outside of your network may be recommended, as an option, if the diagnosis is one where the specialist’s expertise is crucial to the best outcome. We encourage you to contact your insurance provider for any questions or concerns associated with claims and/or coverage.

Are our conversations kept confidential?

Yes, all of your activity with PinnacleCare is strictly confidential. We are a HIPAA-compliant company. No personal health information will be shared without your consent.

How do you select your specialists?

We consult with a wide range of sources to select medical specialists based on their education, experience, and other qualifications. Sources include, but are not limited to:

  • our internal PinnacleCare medical directors, physicians, and Ph.D. researchers
  • our Medical Advisory Board of nationally-acclaimed physician specialists
  • our network of leading hospitals and medical research centers

Each physician office that we recommend is interviewed by a member of the research team in order to confirm details about the practice and their specialty.

 

Does the PinnacleCare Connection plan have waiting periods?

No, PinnacleCare does not require a waiting period for initial enrollment. When a retiree enrolls during open enrollment, the benefit will become active January 1st of the following year. New retirees throughout the year will have a 60 day window to enroll. The benefit will then become active the first of the month following enrollment. If a retiree cancels the benefit mid-year and then decides to re-enroll, only then do we require a 6 month waiting period.

Why is it important to enroll in this benefit during the open enrollment period?

PinnacleCare follows the same enrollment guidelines as most benefit plans. Retirees may sign up at the time of retirement or during the annual open enrollment period. It is critical to enroll during one of these times, because PinnacleCare wants to be able to help retirees facing a medical crisis. If a retiree is not enrolled, he/she will be unable to access PinnacleCare’s personalized service until the following open enrollment period.