The Direct Health Plan is a health plan design operated by Cavalry Partners out of Greenville, South Carolina. Employers across the southern United States from the coast of South Carolina to Arizona chose the Direct Health Plan for savings, experience, and simplicity.  .

The cornerstone of this plan is Direct Primary Care where individuals can afford a relationship with a doctor that has time for them.

For more information, see www.directhealthplan.com/members

Your employer may have many reasons for selecting the Direct Health Plan for its valued team members. As you likely know, the cost of health insurance has increased nearly 40% over the past 10 years, and those costs affect everyone.

There is no traditional “insurance company” paying Buist, Byars & Taylor’s health claims. Employee premiums cover only a portion of the cost, while your employer pays the majority of claims directly. That means the price of healthcare matters to all of us.

The Direct Health Plan was chosen to help continue providing strong benefits, limit premium increases, and create a better healthcare experience for employees and their families.

We are honored to be the health plan of choice, and your experience matters to us. While our plan design is unique and may ask for some member interaction, that interaction will always be with a real person and handled with care.

Please stay in touch with us for any matter, large or small. We are here to help.

A Copay means…you have copays for office visits and prescriptions.  Copay plans allow an employer to kick in and pay for any portion of your health expenses from Day 1.

Instead of In Network and Out of Network…you have Coordinated and Uncoordinated tiers. If your medical care is Coordinated, you will not have out of pocket expenses in this plan.

The Direct Health Plan Coordinated Tier is a world class benefit taken advantage of by thousands. Coordination means that The Direct Health Plan has had an opportunity to make sure your next visit meets financial and medical plan guidelines and then provides funding for the visit.

At Buist, Byars & Taylor, you have the option of selecting a Direct Primary Care Membership or not. How visits are coordinated are dependent on this selection.

1. If you are enrolled in Direct Primary Care, they will copy The Direct Health Plan team on referrals to begin the Coordination process.
2. If you are not enrolled in Direct Primary Care or choose not to coordinate with Neighbors Med or ModRn Health, you will be responsible for letting the Direct Health plan know about upcoming appointments. Send via portal below, text 864-387-1994, or email help@directhealthplan.com.

The Direct Health Plan team need 48 hours notice to coordinate routine appointments. Complex care will require more advanced notice.

Once a referral has been received,

1. The Direct Health Plan will reach out to the provider to determine their “self pay” rates and make sure that their pricing meets plan financial thresholds.
2. A plan document review will determine if this event is medically covered or not. For example: tattoo removal is not covered. 
3. Anything above a total dollar threshold (often complex or surgery) will be required to go through independent medical pre-certification. The Direct Health Plan nor the employer does this review.
4. If additional information, good faith estimates, or other documentation is required, the Direct Health Plan will communicate that need directly to you.

Last, with all approvals in place,

1. We will text you a virtual debit card a day or two in advance of your appointment.
2. The funds will be on the card, in full, for your visit.
3. You will not need to show your insurance card.

Finally – upload your receipt to the matching event in the portal. We’ll send you a prompt.

*Not all events can be coordinated to the provider/facility of your choosing. For example, your plan cannot pay $15,000 for a colonoscopy when world class independent GI doctors do this for $1,500. 

*Medical prior authorization is required above a certain price threshold and may require member support in obtaining medical records.

The Direct Health Plan Uncoordinated Tier offers you the opportunity to see a provider outside of coordination and make financial decisions that are important to you.

Similar to other health plans, this tier has medical copays, deductible expense, and maximum out of pocket thresholds. Copays do NOT apply to deductible but will apply to maximum out of pocket.

You are Uncoordinated when:

1. The Direct Health Plan team was not notified of an upcoming appointment with reasonable time to coordinate.
2. If you present your insurance card to a provider who collects a copay and submits a claim. The plan will receive provider claims and can only pay up to plan guidelines.
3. If you choose to work with a provider whose charges did not meet plan guidelines, the Direct Health Plan can only fund or reimburse an approved portion of the expense. Only that portion can be applied to your deductible. Providers may balance bill you for additional charges.

*Only charges that fall within plan guidelines are subject to reimbursement, can be applied to deductible, and can be applied towards maximum out of pocket.

*Once you meet maximum out of pocket threshold, plan expenses are still governed with maximum allowable thresholds and medical plan rules in the uncoordinated tier.

Pharmacy coverage in a Copay Plan features copays from day one. The information that the pharmacy needs to file a claim is on your insurance card.

Pharmacy copays do not apply towards your deductible – they do apply to max out of pocket.

ServeYouRx is a Pharmacy Benefit Manager meaning they administer pharmacy claims, manage eligibility, manage prior authorizations when needed, and work on your behalf.

Log in to determine where you might find the best pricing.  www.serveyourx.com

Emergency Room visits cannot be Coordinated. Please present your card and plan rules will apply.  

FAQ’S

The HDHP Direct Health Plan refers to how you have chosen for your Direct Health Plan to be funded and paid for.

A High Deductible Health Plan means…you don’t have copays.  An HDHP plan prohibits the plan from paying for any portion of your health expenses (outside of routine preventative services) until your deductible is met. You may be issued an HSA (Health Savings Account) to help offset the cost of care in this arrangement.

Instead of In Network and Out of Network…you have Coordinated and Uncoordinated tiers. If you follow the Coordinated tier, you could save a considerable amount of money and time prior to reaching your deductible and not pay $1 for medical care after meeting your deductible!

The Direct Health Plan HDHP Coordinated Tier means that The Direct Health Plan has had an opportunity to make sure your next visit meets financial and medical plan guidelines therefore lowering the cost of care and assuring that 100% of your pre-duductible expense can be applied toward deductible.

At Buist, Byars & Taylor, you have the option of selecting a Direct Primary Care Membership or not. How visits are coordinated are dependent on this selection.

1. If you are enrolled in Direct Primary Care, they will copy The Direct Health Plan on referrals to begin the Coordination process.
2. If you are not enrolled in Direct Primary Care or choose not to coordinate with Neighbors Med or ModRn Health, you will be responsible for letting the Direct Health plan know about upcoming appointments. Send via portal below, text 864-387-1994, or email help@directhealthplan.com.

The Direct Health Plan team need 48 hours notice to coordinate routine appointments. Complex care will require more advanced notice.

Once a referral has been received,

1. The Direct Health Plan will reach out to the provider to determine their “self pay” rates and make sure that their pricing meets plan financial thresholds.
2. A plan document review will determine if this event is medically covered or not. For example: tattoo removal is not covered. 
3. Anything above a total dollar threshold (often complex or surgery) will be required to go through independent medical pre-certification. The Direct Health Plan nor the employer does this review.
4. If additional information, good faith estimates, or other documentation is required, the Direct Health Plan will communicate that need directly to you.

Last, with all approvals in place,

1. We will text you what you should expect to pay for the visit.
2. You will visit the doctor and pay in full at time of service (or be billed for that amount).
3. Providers reserve the right to bill for services provided that were unknown prior to coordination or unexpected prior to the appointment.  Please inform the Direct Health Plan.

Finally – uploading receipts is necessary to ensure that your out of pocket receipts apply towards your deductible.

*Not all events can be coordinated where you want to go or are previously scheduled. For example, your plan cannot coordinate a $15,000 for a colonoscopy when world class independent GI doctors do this for $1,500. 

*Medical prior authorization is required above a certain price threshold and may require member support in obtaining medical records.

Once you have met your deductible in the Direct Health Plan HDHP Coordinated Tier, we will work to coordinate all events where the plan can pay 100%.

You may track your progress towards meeting your deductible at portal.directhealthplan.com. Your team at Direct Health Plan will also be tracking.

Coordination means that The Direct Health Plan has had an opportunity to make sure your next visit meets financial and medical plan guidelines therefore funding your visit.

At Buist, Byars & Taylor, you have the option of selecting a Direct Primary Care Membership or not. How visits are coordinated are dependent on this selection.

1. If you are enrolled in Direct Primary Care, they will copy The Direct Health Plan team on referrals to begin the Coordination process.
2. If you are not enrolled in Direct Primary Care or choose not to coordinate with Neighbors Med or ModRn Health, you will be responsible for letting the Direct Health plan know about upcoming appointments. Send via portal below, text 864-387-1994, or email help@directhealthplan.com.

The Direct Health Plan team need 48 hours notice to coordinate routine appointments. Complex care will require more advanced notice.

Once a referral has been received,

1. The Direct Health Plan will reach out to the provider to determine their “self pay” rates and make sure that their pricing meets plan financial thresholds.
2. A plan document review will determine if this event is medically covered or not. For example: tattoo removal is not covered. 
3. Anything above a total dollar threshold (often complex or surgery) will be required to go through independent medical pre-certification. The Direct Health Plan nor the employer does this review.
4. If additional information, good faith estimates, or other documentation is required, the Direct Health Plan will communicate that need directly to you.

Last, with all approvals in place,

1. We will text you a virtual debit card a day or two in advance of your appointment.
2. The funds will be on the card, in full, for your visit.
3. You will not need to show your insurance card.

Finally – upload your receipt to the matching event in the portal. We’ll send you a prompt.

*Not all events can be coordinated to the provider/facility of your choosing. For example, your plan cannot pay $15,000 for a colonoscopy when world class independent GI doctors do this for $1,500. 

*Medical prior authorization is required above a certain price threshold and may require member support in obtaining medical records.

The Direct Health Plan Uncoordinated Tier offers you the opportunity to see a provider outside of coordination and make financial decisions that are important to you.

Similar to other health plans, this tier has medical deductible expense, and maximum out of pocket thresholds.

You are Uncoordinated when:

1. The Direct Health Plan team was not notified of an upcoming appointment with reasonable time to coordinate.
2. If you present your insurance card to a provider who collects a copay and submits a claim. The plan will receive provider claims and can only pay up to plan guidelines.
3. If you choose to work with a provider whose charges did not meet plan guidelines, the Direct Health Plan can only fund or reimburse an approved portion of the expense. Only that portion can be applied to your deductible. Providers may balance bill you for additional charges.

*Only charges that fall within plan guidelines are subject to reimbursement, can be applied to deductible, and can be applied towards maximum out of pocket.

*Once you meet maximum out of pocket threshold, plan expenses are still governed with maximum allowable thresholds and medical plan rules in the uncoordinated tier.

Pharmacy coverage in a HDHP Plan does not have copays until the deductible is met.

Approved pharmacy expenses are applied towards your deductible.

ServeYouRx is a Pharmacy Benefit Manager meaning they administer pharmacy claims, manage eligibility, manage prior authorizations when needed, and work on your behalf.

Log in to determine where you might find the best pricing.  www.serveyourx.com

Emergency Room visits cannot be Coordinated. Please present your card and plan rules will apply.

FAQ’S