Health insurance the way it ought to be.
Health insurance should put people first, not profits or stock price. It should be easy to use and easy to understand. Your benefits should work together with doctors and employers to help people get healthy and stay healthy.
Continental Benefits agrees that the future of healthcare requires rebuilding that legacy. That’s why we’ve built healthcare programs that help employees focus on being and staying healthy with flexible programs deliver high quality care at surprisingly reasonable costs.
How Health Insurance Should Work
Self-funded organizations typically see cost reductions of 10%-20% when they choose Continental Benefits as their third-party administrator (TPA). This intense focus on your company’s reduction of unnecessary tests and treatments, supported by positive, easy-to-follow health management programs that help ensure valued employees stay well.
The best quality care – and the best value
When you’re hurt or sick, your priority should be to get well. That’s why we do the hard work for you, finding doctors, facilities, and programs that deliver the best results – without wasting your time or your money. We also supplement your healthcare with unique health management programs that make it easy to lower your risk for getting sick in the first place.
We are your advocate
We see our members as our partners, not statistics or profit centers. In fact, our business model means that we succeed when you get well and stay well. That’s why we work with your employer and your healthcare providers to keep things as simple as possible.
A healthcare investment in your future, avoiding stress and expense when you can least afford them.
Our data-driven programs use advanced analytics to make sure that your premiums and payments go to highest quality care, not excess corporate profits or bureaucratic waste. And we prove it, with fast claims processing and simple access to the information you need, presented in clear, understandable language.
How Health Insurance Works
Call Continental Benefits
We will help you find the right healthcare provider based on location, participation and quality of care. In addition, we will estimate your out-of-pocket expenses.
Schedule your appointment
If you need helping scheduling your appointment, let us know! We’d be happy to help.
Check-In
Remind the office staff to call Continental Benefits directly to verify coverage. You’ll pay your deductible or copay at this time as well.
Receive Care
Get the quality care you need from your healthcare provider.
Payment
Continental Benefits will pay the provider bill when it is received.
When To Call
Call Continental Benefits if you receive a bill showing “Insurance Pending” or “final balance.” We will verify accuracy and what you should pay (if anything) or make a call to the provider to have the bill adjusted.
Population Health Programs
Unique population heath programs that no major carrier or TPA can match
We believe that healthcare begins long before you become sick or hurt. By linking data-driven health management programs with your individualized needs, we help you build an ongoing cycle of healthier behavior and better clinical outcomes through the following programs.
TopCare connects members with the highest quality in-network providers and facilities, working with each member to ensure they receive the care and attention they deserve.
This value-driven guided service builds on the best data resources in the industry to generate recommendations based on five key criteria:
- Inpatient quality
- Patient Safety
- Complications
- Readmissions
- Mortality
We also monitor care transition, care goals, provider communication, staff responsiveness, and post-discharge information across providers, creating a concierge-style experience for members but with reasonable, carefully managed costs.
Continental Benefits’ clinical care programs reach across medical disciplines to provide a unified, integrated approach to care. Members receive targeted care from high-quality providers – and without unnecessary treatments or unwarranted expense.
CB Care Advocate – Our comprehensive care management solution increases health and wellbeing engagement throughout the workforce, with a particular focus on higher risk populations. This suite of services personalizes and improves the healthcare experience by typically engaging more than 90% of your population.
GI Thrive – Gastrointestinal issues represent one of the most common and most expensive areas of health management. They also represent one of the most straight-forward opportunities to promote a healthier lifestyle and generate rapid positive results. GI Thrive makes it happen for Continental Benefits members through intuitive, easily followed programs geared for each member’s individual needs.
Orthobiologics – Continental Benefits helps members recover faster from orthopedic procedures when the appropriate application of advanced orthobiologic therapies provide a clear, cost-effective benefit over more invasive approaches to healing.
CancerCare – Cancer affects more than just the patient. Continental Benefits helps members and employers with a holistic approach, treating not just the disease, but its extended impact, from diagnosis and economic impact through recovery.
Pharmaceutical costs represent a significant and rapidly growing proportion of healthcare costs. At the same time, managing those expenses increases in complexity every year. Continental Benefits helps reduce the burden on employers and members through:
- Best-in-class pharmacy pricing through Continental Benefits’ national reach and partnerships
- Data-driven analyses to ensure appropriate therapy and minimize risk from drug interactions
- Active pharmacy benefits manager (PBM) oversight to promote access, control costs, and direct appropriate discounts back to each employer or member
Continental Benefits works aggressively to assess and provide newly developed precision medicine for members, starting with pharmacogenomics that analyze how the individual genetic makeup of an individual affects their response to medications. This information provides insights that providers use to select the most appropriate drugs and dosages when treating challenging diagnoses while also minimizing costly adverse drug events.
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