Who is eligible for the program?
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Carrum Health Benefit Frequently Asked Questions
Eligible members must receive primary health coverage through their employer-sponsored health enrolled in PPO, EPO, or HDHP (HSA Eligible) insurance plans and may include the following populations:
Carrum Health Benefit Frequently Asked Questions
- Active employees and their covered dependents
- Early retirees (not eligible for primary Medicare coverage)
- COBRA participants and their covered dependents
How do I qualify for these services?
The following criteria must be met to qualify for the Carrum Health program:
- You have primary medical coverage through an eligible health plan: PPO, EPO, and HDHP (HSA eligible) plans are eligible. Medicare primary and HMO plans, including Kaiser, are not eligible.
- Your local physician agrees to assume care for you upon return home.
- You meet the requirements of the facility and physician/s considering your case. (Additional diagnostic or medical services may be required.)
- You have an adult caregiver physically able to assist you during your care and travel if travel is needed.
When do I automatically not qualify?
You are ineligible for the Carrum Health benefit if you have primary coverage through the following insurance plans:
- Medicare
- Employer-sponsored HMO, including Kaiser Permanente
Which procedures and services are covered?
Carrum Health covers more than 120 surgical and complex care services from hip and knee surgeries to neck and back surgeries. To see what is covered, register or log in and search for your health condition or procedure.
What is the Carrum Gold-Experience?
Carrum Health is a surgical and complex care benefit that makes it easier and less expensive to get world-class care. We identify and partner with the top 10% of doctors across the nation to deliver the Carrum Gold-Experience, so you always know you’re receiving the best care that’s right for you. When you choose a Gold-Experience provider, you’ll receive dedicated support from our Care Team, who helps you with all of the planning, gathering of medical records, and completion of any paperwork. The best part? When you use a Gold-Experience Provider, most, if not all, costs are covered.
How much will I pay?
When you select a Carrum Gold-Experience provider, your employer covers most, if not all, expenses and you shouldn’t receive any surprise bills. Depending on your medical plan, you may first need to meet your deductible, but there are typically no copays or coinsurance. To see how much you may need to pay before expenses are covered, log in to your Carrum Health account or contact your Care Specialist.
What if I don’t live near a facility that specializes in my procedure?
Depending on where you live, to get the best possible care, you may choose to travel to a Gold-Experience specialized hospital or facility. For procedures that don’t require you to live nearby, you may be eligible to have your travel expenses covered when you select a Gold-Experience provider. Your Care Specialist will even make all your travel plans, so all you have to do is focus on what matters most — you.
Is my current doctor covered by Carrum or part of the Carrum program?
If your current doctor practices at one of our covered facilities, they may be part of our program. Register or log in and follow the prompts to see which doctors and facilities are available through our program.
I already had surgery. Can I be reimbursed?
We are unable to reimburse members who have already undergone surgery. If you are currently scheduled for one of our covered procedures and are interested in switching to our program, please register or log in and securely message your Care Specialist to see if you meet the pre-qualification criteria to have care through Carrum Health.
Which travel expenses are covered and who coordinates travel?
When you select a Carrum Gold-Experience provider, your Care Specialist will help you coordinate covered travel and expenses.
What forms do I need to complete?
Required forms will vary based on the type of procedure needed. To view available forms you must complete, log in to your account. Once you are qualified for care through our program, a Care Specialist will help provide any additional forms you may need to complete.
Do I need to provide medical records?
Once you complete the online release form, your records and images will be collected and sent to your surgeon’s medical team for review. Your Care Specialist will inform you about specific requirements based on your procedure and help ensure your provider has the medical information needed to review your case.
What about post-surgery follow-up?
Any post-surgical follow-up care is typically covered by your insurance, but your Care Specialist will help make sure you are set up for a successful recovery after treatment when you select a Carrum Gold-Experience provider. This includes:
- Coordinating the collection of your post-discharge plan and hospital records to share with your selected local provider.
- Helping you select a local in-network physical therapy office as required by your procedure.
To delete your account, log in to your account and send a message in the Carrum Patient App requesting your account to be deleted. Your account will be deleted within 30 days from the time of the request.
Please note: When you delete your Carrum account, your chat history, profile, and forms will be removed.
If you wish to use Carrum's services in the future after deleting your account, you can register again.