PinnacleCare's FAQs

Frequently Asked Questions

What does PinnacleCare do?

PinnacleCare is a health advocacy and care navigation company that supports individuals and their families when it comes to protecting their most valuable asset—their health and well-being. We are an unbiased resource to which you can turn when facing a major health problem or any challenges with routine care. PinnacleCare services will guide members through some of the most serious and complex medical decisions they will face—connecting them with top-rated specialists trained and experienced in their condition to provide an expert opinion on their diagnosis and appropriate treatment options.

How does this differ from the services provided by doctors and health plans?

We work solely on behalf of our members and we have no conflict of interest associated with specific care or treatment. PinnacleCare guides you through what can be an incredibly confusing and time-consuming process to help prevent unnecessary or inappropriate treatment. We work to confirm a diagnosis at the onset and connect you/your family members with experienced specialists to inform them of the most current and effective treatment options.

When does PinnacleCare get involved?

PinnacleCare is your go-to resource when you or your covered family member is facing a serious diagnosis or 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 received injections for back-related issues and a physician is now recommending surgery.

How does the PinnacleCare process work?

When a member reaches out to PinnacleCare, our intake team will ensure medical privacy by asking a few questions to verify eligibility. A health advisor will then gather the member’s appropriate medical history and the details of their current diagnosis. The advisor reviews the case and consults with our medical team to guide the member to the appropriate course of action.

What services are covered under this benefit?

PinnacleCare will provide a confirmation of a diagnosis, recommendations on top specialists, facilitated appointments, and/or 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 do you select your specialists?

We consult with a wide range of sources to select specialists based on their education, experience, and other qualifications:

  • PinnacleCare medical directors, physicians, and Ph.D. researchers
  • Medical Advisory Board of nationally acclaimed physician specialists
  • Network of leading hospitals and medical 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.

How are PinnacleCare services contracted?

PinnacleCare Connection is contracted as a sponsored group benefit plan. In addition, PinnacleCare services can be contracted through a customized retainer program to include executive physicals and comprehensive memberships geared toward senior management.

How are PinnacleCare services implemented?

PinnacleCare’s account management and implementation team will coordinate with your HR team and benefits provider to manage employee communications and administrative coordination, including eligibility and billing.

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