FREQUENTLY ASKED QUESTIONS FOR AGENTS
What is CooperativePlus?
CooperativePlus was established in 2005 as Patient/Physician Cooperatives (PPC), an organization of patients, physicians and member representatives, with two clinics in Houston, Texas. Since then, the organization has grown to 125 clinics distributed throughout the Houston area and beyond, including clinics and employer groups in Oregon, Arizona, New Mexico, and Oklahoma.
In 2017, PPC established CooperativePlus as a business name for member services.
How is CooperativePlus different from insurance?
CooperativePlus is a healthcare system focusing on wellness and comprehensive healthcare services. It provides members easy access to affordable, medically necessary services at affordable rates.
Unlike most insurance companies, CooperativePlus has no exclusions for age (under 65), income, or pre-existing conditions.
By creating this comprehensive system, incorporating medical discount programs, and a variety of Association Group or Employer Sponsored insurance plans, CooperativePlus has simplified access to a high quality healthcare.
Why do we focus on primary care?
The main focus of CooperativePlus is continuity of care to achieve and to maintain wellness.
We encourage members to develop real relationships with their providers. This allows members to seek healthcare before their issues become critical. The primary care provider offers services such as general health and wellness exams, diagnosis and treatment of acute and chronic conditions.
Who can become a contracted provider with CooperativePlus?
CooperativePlus provides its members access to a wide variety of services from primary care to specialists in numerous licensed medical professions.
Any licensed provider can become a contracted CooperativePlus provider member.
What if a member doesn’t want to switch from his or her current provider?
It’s easy for a physician to join CooperativePlus. Members can call 1-866-549-4199 and let us know his or her preferred doctor, and we will contact him or her to inquire whether that practice would like to accept an agreement with CooperativePlus.
What is patient advocacy and why is it so important?
Patient advocacy is one of the most important benefits of the CooperativePlus model. The CooperativePlus Patient Advocacy Team performs care coordination to ensure the entities that participate in the members’ healthcare programs work together. They help the members get what they need and want, and support high quality medical outcomes.
What if the member needs a specialist?
CooperativePlus has many excellent specialists for referrals. Members can see any of our member specialists for reasonable rates.
If a patient needs to see a specialist outside of our network, CooperativePlus has access to other networks to facilitate receiving of care. Our patient advocates work with members to bring the costs down to Medicare equivalent rates.
What documentation is necessary for enrolling a group?
All required forms and a list of enrollment documents are in the Agents page of the CooperativePlus website.
How do I submit enrollment files?
Enrollment files can be submitted electronically.
What is the average turnaround time required to determine a group or a subscriber’s eligibility or status?
The average time is three days.
How do I obtain a small-group quote?
An agent can use the group census with the claims vs premium report.