FREQUENTLY ASKED QUESTIONS FOR PROVIDERS

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. CooperativePlus primary care providers offer traditional medicine, integrative, alternative, and holistic care.

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 all of the entities that participate in the members’ healthcare programs work together. They protect against excessive billing practices and support high quality medical outcomes.

What services are covered by CooperativePlus Providers?

The services provided by our contracted providers that are members of our Physician Association are those that the provider has the required licensing and skills to perform. Payments for those services are the responsibility of the patient. CooperativePlus does the price setting agreements between the physician and the patient. Employers contribute to the payments using money they would normally have paid to their employee in wages.

Any insurance that is purchased by the employer or employee mitigates the payments to providers. They owe the policyholder a reimbursement. As a convenience, the patient assigns his or her right to the reimbursement to the provider. After the assignment, the health plan can pay the provider directly. That is the reason the agreement is between the patient and physician who are together cooperating on services and their cost.

How do I get patient members?

CooperativePlus is a community-based organization dedicated to building and strengthening providers’ practices. CooperativePlus’s marketing efforts range from social media, community events, poster marketing, and provider education to patients. Often members are our best promoters – they love to share about the value offered by CooperativePlus!

We advise our providers to participate in our development efforts by encouraging patients to join CooperativePlus, thereby converting them into a regular source of income.

How do I get paid?

Monthly checks are sent to all providers who have active contracted members. Checks are mailed at the end of each month along with the list of all current paid members for that month.

What if a member patient needs a specialist?

CooperativePlus has an excellent group of specialists for in-network referrals, and we’re constantly expanding. Members can see any of our provider members for reasonable rates. If a patient needs to see a specialist outside of our network, CooperativePlus has access to other networks to facilitate access to care. Our patient advocates work with patients and providers to facilitate care coordination.

How will my existing patients be affected by my membership in CooperativePlus?

Existing insured patients will not be affected; however, member providers can make CooperativePlus literature available to patients who have high deductibles or otherwise lack comprehensive health care plans.

How do I get started?

Credentialing is the first step. Contact us today to start the conversation. After completing a simple enrollment form, we will discuss rates and terms to offer our members, and establish your web page profile. As soon as you join CooperativePlus you’ll immediately be able to accept members!

What do you need for the credentialing process?

We’ll require the standardized credentialing application form and the attachment listed in that state form. Most practices already have that on file.

How long does the contracting process take?

It’s easy for a physician to join CooperativePlus. Call Provider Services at 1-866-549-4199 and get started. The contract is generally completed in less than 10 days.

How do I add/change a practitioner in my medical group?

You can add, remove, or change a practitioner and location information by calling Provider Services at 1-866-549-4199 or online by emailing [email protected].

What are the patients’ membership fees used for?

The primary care monthly payments go directly to the provider! The portion of membership fees that cover other benefits go primarily to support patient advocacy services, to maintain our provider network, and to reach out to the community about CooperativePlus.

That sounds great! How do I get started?

Contact us to apply now! Call Member Services at 1-866-549-4199 or e-mail us at [email protected] to apply or ask any additional questions.