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This
section is designed to answer many of the most common questions.
You may also contact us by email for questions that are not covered
in this section.
Who
should I call with questions about my medical insurance?
When
I call you, why do you need to know my employer?
Who
owns Crescent?
Who
elects the members of the Board of Trustees?
Do
you have employer representation in Crescent?
If
Crescent does not charge access fees, how do you make enough money
to stay in business?
What
is a messenger model, and why did you choose to use it?
I
am an employer, and I do not have a fee schedule. How do I get one?
Who
should I call with questions about my medical insurance?
Crescent is not an insurance company and we don't handle claims
but we can usually point you in the right direction. Call our customer
service department at (828) 670-9145 and tell us your employer and
we can give you the contact information you need. back
When
I call you, why do you need to know my employer?
Crescent has
the largest medical provider network in the area but the fee schedule
used by your employer may not have been accepted by all the providers
in our network. If we know your employer, we can tell you which
providers offer in-network services for you. back
Who
owns Crescent?
Crescent is a not-for-profit, taxable company. It is not "owned"
in the same sense as companies who are for profit and/or who sell
stock or require partners who have ownership equity. Crescent is
governed by a Board of Trustees from fourteen local medical communities
in Western North Carolina. The Board consists of ten physicians
and five hospital representatives. back
Who
elects the members of the Board of Trustees?
Each local medical community elects representatives to the Board
of Delegates. The Board of Delegates meets once each year and elects
the members of the Board of Trustees. back
Do you have employer representation in Crescent?
Crescent providers hold the belief that employer/payers should play
a primary role in the direction Crescent takes - in provider relations,
customer service and product development. An Employer Advisory Council
has been established to assist Crescent in developing these efforts.
This council elects a chairperson and vice chairperson who become
members of the Board of Trustees. back
If
Crescent does not charge access fees, how do you make enough money
to stay in business?
Providers who join Crescent agree to pay Crescent two percent of
their paid claims to fund operating expenses. This amount is determined
after all co-pays, co-insurance and/or deductibles are taken into
consideration. This amount is not paid by the employer, but by the
provider. back
What
is a messenger model, and why did you choose to use it?
Since Crescent is a provider-sponsored organization, those who worked
to establish the business knew that it would be necessary to take
steps to avoid price-setting among providers as well as to avoid
monopolistic practices. Anti-Trust Counsel for Crescent and the
Attorney General of the State of North Carolina explored several
options and agreed that the messenger model would be most effective.
Crescent cannot
own a fee schedule, and therefore must receive fee schedules from
employers, third party administrators or some other third party
which are then messengered to the more than 1700 participating physicians,
ancillary providers and hospitals in the network. Each provider
has the opportunity to respond by saying, "yes," "no"
or "we would like to negotiate further" to each entity
messengering a fee schedule through Crescent. Crescent facilitates
this messengering process with the goal of building an acceptable
provider panel for the employer or other third party. This process
takes approximately 90 to 120 days. back
I
am an employer, and I do not have a fee schedule. How do I get one?
Crescent is currently working with several Third Party Administrators
(TPAs) that have established individual fee schedules with corresponding
participating provider panels. Your TPA may be working with Crescent
currently. If not, and you would like to explore using one of the
available fee schedules please call Crescent at 800-707-7726 or
e-mail your inquiry to information@crescentppo.com.
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