Once signed in, you will see a few commonly searched procedures on the home screen. These are shortcuts you can click on to quickly view nearby providers.

If you would like to search for a procedure not listed on the shortcuts, type your procedure name into the search bar. As you type, suggested options will appear. Continue to type until you see your procedure, then select it.

Note: if you do not see your procedure and have tried typing other keywords, please let us know via the Chat function on the bottom right corner of the screen or email us at info@getwinstonhealth.com. Over 500 procedures are available on Winston Health and we will continue to build out our list based on your needs.

After selecting a procedure, from the home screen you will be taken to the next page where you can select your provider. 

• If you have a current provider: type their first name, last name, or practice name into the search bar and scroll to locate your provider. Click on their name to move to the ahead to view locations where the provider can perform the procedure.
• If you do not have a provider: Click "See all options" and you will be taken to a screen where you can view nearby providers within a 35 mile radius. You will see helpful information to assist with your decision such as Name, Specialty, Practice Name, Cost (if enabled), and Quality.

To filter the list, you can select a number of options below the search bar: distance, cost, and quality. To sort the list, click on the column headers above the search results.

After selecting a provider, you will be taken to the next page where you can view the facilities affiliated with your provider. These are the specific hospitals and surgeries that your doctor has approved privileges to perform the procedure. This information is constantly changing, and we do our best to keep our data as up to date as we can. Double check with your provider during the scheduling process to confirm your options, and let us know of any discrepancies.

You will see a list of nearby facilities within a 35 mile radius, sorted by proximity to your home zip code. In each tile, a wealth of information is available to you:

• Name and address of the provider
• Distance from your preferred zip code
• Total cost billed to your employer's health plan for the procedure (if enabled)
• Cash reward, if applicable
• Quality star rating

*Only applies to accounts with procedure costs enabled.* In the facility search results list, each tile contains a wealth of information available to you. Let's dive into understanding procedures costs further.

The amount shown is the total estimated cost billed to your employer's health plan for the procedure. This amount is before any deductible, coinsurance or copay is applied by the insurance company processing the claim. Refer to your Summary of Benefits and Coverage to calculate the amount you will owe the provider.

Click on the tile to view more detailed information about the procedure. A new module will appear showing an itemized list of commonly billed services and applicable medical billing codes.

Note: Each procedure may consist of several services, tests, etc. performed during the course of the procedure. The itemized list of services shown include details on billing code, description, quantity and cost. It is important to understand that your care needs may be different than what is being shown. Billed amounts may vary from the estimated prices based on the actual services rendered. To ensure the estimated price will match the bill from your healthcare provider, contact your healthcare provider to get a list of the services they plan to render and notify us of any discrepancies when you select the procedure.

In the event of a discrepancy between the estimated price and the billed amount, we recommend that you submit your Explanation of Benefits or bill for verification under the "Procedures" section. Our team at Winston Health will review the information and either adjust your reward accordingly or provide necessary information to dispute the bill.

In the provider and facility search results list, each tile contains a wealth of information available to you. Let's dive into understanding quality ratings further.

On the right side of the tile you will see 0-5 stars, 5 being the highest. If the provider or facility has no rating shown, they may be too new to have a quality rating or may not participate in the CMS's quality program. Click on the stars to view more information.

A new browser tab will open with detailed information about what goes into each quality rating. Quality information is sourced from the Center for Medicare and Medicaid Services and is based on important factors such as mortality rates, readmissions, proper patient follow up, patient satisfaction and more.

As an employee, you have the power to make a difference in not only your own healthcare costs, but those of your entire company. And with the cost of a single service differing by 200% or more at different locations, our comparison tool helps you make informed decisions and choose the best option.

You'll be incentivized to select high-quality, low-cost providers with a cash reward from your company. Rewards are based on price variation within your 35 mile zip code radius, as well as providers with a 4 or 5 star quality rating. The greater the price difference the greater the reward. Look for the reward amount highlighted in green on the provider tile. This is an estimated cash amount that will be transferred to your bank account after Winston Health verifies the procedure was received at the selected location.

Note: Rewards are subject to income tax like any other compensation, unless you are enrolled in a qualified high deductible health plan and deposit rewards into a Health Savings Account.

After reviewing options for your procedure on Winston Health, it's time to schedule your procedure. Click on the tile for the facility you would like to use, a module will appear summarizing the information. Click on "Go Here" and you will be taken to a new page to assist with next steps.

Contact the provider directly to schedule your procedure and enter the date under the "Procedures" section of the Winston Health website to let us know you've scheduled the procedure.

Note: Entering a date into Winston Health does NOT schedule a procedure. You must contact the provider directly to schedule.

Once you have received an Explanation of Benefits document from the insurance carrier, it's time to submit your documentation to earn your reward!

Navigate to the "Procedures" area on the left panel menu and locate your recent procedure. Click on the Upload button under "Action" and attach your picture, screenshot or PDF document. Winston Health will review and respond with any questions within 1 business day. If there are no discrepancies between the estimated price and the billed price, the reward will be approved the same business day and a bank transfer initiated.

Note: Explanation of Benefit documents typically are made available within 10 business days of the date of service. You can access these documents from your insurance carrier's online portal, or via US mail depending on your communication settings. Dependent documentation is often addressed and accessible online for the primary contract holder - the employee.

In the event of a discrepancy between the estimated price and the billed amount, we recommend that you submit your Explanation of Benefits or bill for verification. Our team at Winston Health will review the information and either adjust your reward accordingly or provide necessary information to dispute the bill.

When your procedure verification has been completed, you will receive a notification from Winston Health via email. Login to Winston Health and navigate to the "Rewards" page on the left panel menu.  Click the "Action" button next to your procedure to transfer rewards to your account. By clicking on "Manage Payouts", you will be redirected to Stripe's financial management platform page and can view the status of the transfer from here. Note that it will take about 1 business day for the payout to appear in your Stripe dashboard.

Note: If your procedure is not approved, we will let you know if additional documentation is required, the reason for denial, etc. The process above is for organizations using Stripe for reward management only. If you do not see the "Setup Payouts" or "Manage Payouts" button on the rewards page, your rewards will be delivered by your employer directly.

Winston Health shows the total estimated cost your insurance plan will pay the provider. To calculate your personal out-of-pocket costs, request that your provider submits a request to your insurance carrier for a "predetermination of benefits."

Alternatively, you can refer to your Summary of Benefits and Coverage document to estimate this yourself. There are a few questions to consider as you dive in:

• Have you met your deductible this plan year?
• Have you met your total maximum out of pocket limit this plan year?
• What service category does your procedure fall under: Imaging, Inpatient, Outpatient, etc.?
• What type of cost sharing applies to that service category: deductible, coinsurance, or copay?

Rewards are subject to income tax just like any other employer-sponsored compensation, unless you are enrolled in a qualified high deductible health plan and deposit rewards into a Health Savings Account. Your employer will include the reward amount you've earned for the year on your annual W-2 report so that taxes can be allocated accordingly when you file them each year.

If you have health insurance, call the provider in advance to confirm that the provider is in-network, the procedure will be covered, and your procedure has been preauthorized by your insurance carrier (if applicable). For preauthorization, we also recommend independently verifying with your insurance company.

To calculate your personal out-of-pocket costs, request that your provider submits a request to your insurance carrier for a "predetermination of benefits."

The No Surprises Act protects insured consumers from receiving unexpected medical bills for most procedures. It also establishes an independent dispute resolution process for insurance carriers and medical providers to help resolve payment discrepancies and come to an agreement. 

Uninsured consumers have the right to receive a good faith estimate detailing the itemized costs for their procedure. If the bill is $400 or more than the good faith estimate, the consumer is entitled to dispute the bill through a similar resolution process.

Under the Affordable Care Act, insurance plans can’t require higher copayments or coinsurance if you receive emergency care from a hospital outside your plan's network. They also can’t require you to get prior approval before receiving emergency room services from an out-of-network provider or hospital.

Medical bills are confusing and often contain errors. Request an itemized bill and review for common mistakes such as being double-charged, being charged for incorrect amounts, or being charged for services you never received. If you find any questionable information, reach out to your provider for an explanation before paying the bill.

Under the Affordable Care Act, nonprofit hospitals are required to offer financial assistance programs to those who are unable to afford care. The program requirements vary by hospital, but often look at household income compared to the federal poverty level. For example, one hospital offers the following program:

• Individuals under 300% of the federal poverty level ($45,180/year, single member household) receive a 100.00% discount on the their bill.
• Individuals under 350% of the federal poverty level ($52,710/year, single member household) receive an ~89% discount (50% of medicare) on their bill.
• Individuals under 400% of the federal poverty level ($60,240/year, single member household) receive a ~75% discount (100% of medicare) on their bill.

Ask your provider if they offer any assistance programs, payment plans, or patient advocacy services. Some hospitals offer discount programs for paying costs up front. Additional options include applying for medical loans or medical credit cards. While you should always try to pay your bills, it's important to know that amounts under $500 won't negatively affect your credit score or appear on your credit report, according to LendingTree.

If the amount you are required to pay the provider after insurance is incorrect, you have the right to submit an internal appeal and request an external review:

• Internal appeals: If your claim is denied by the insurance carrier, you can request they do a fair and complete review of the decision to deny the claims. Your state's Consumer Assistance Program can help you through this process. If the claim is still denied, you can file an external review.
• External reviews: Within 4 months of receiving a denial from the insurance carrier, you can file an external review with either the state or federal government.

You can find more information about these options on the Explanation of Benefits document you receive from the insurance carrier after your procedure.

Health systems have historically made it difficult to switch providers through cumbersome processes for sharing medical records and test results. Recently passed legislation now prohibits information blocking, the practice of preventing patients from accessing their own health data or sharing it with others (21st Century Cures Act).  Providers are required to make your medical record available electronically and securely so that you may share it with other providers and approved third parties. 

For example, if your family doctor or specialist orders a lab or imaging procedure, often times it's more cost-effective to receive the procedure at an independent facility not affiliated with a large health system/hospital. When you arrive at a new facility, ask if they will automatically send your results to the doctor who ordered the test and when. If they do not, ask when and where your results will be available, and check with your doctor to understand the best way to share the results. Many online medical record systems have the ability to enter an email address or fax number so you can securely send your results right to your family doctor or specialist.