Frontier Health Case Studies

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Employer FAQs

What employers does this work for?

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Self insured employers (candidates for self insured) with a concentrated geographical locations (example: 800 life group in DFW)

What employers does this not work for?

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Jumbo employers spread out across the US, small fully insured employers with no plans to move to self insured.

What is the difference between the “bolt-on” and “replacement”?

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The ‘bolt-on” works in conjunction with the employers existing health plan and is a great first step in innovation. The “replacement” works as either a slice plan next to existing plan or as a full replacement of the employers existing health plan

How can I request a quote?

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Fill out the intake form on our website and email Sales@frontier.heatlh

Where are you currently located and where are you expanding to?

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Currently located in South texas but we are expanding down the I-35 corridor from San Antonio to DFW in 2024 ready for 10/1 & 1/1 start dates

Can you expand outside of the i-35 corridor?

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Yes we are opportunistic and can go to any city in the USA with a min of 2000 lives (2000 = 1 larger employer or multiple smaller employer)

How large is a clinic and how many people can a PCP manage?

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One clinic is max 5600 member and each provider has max of 800 members (vs national avg. of 3500 patient per provider)

Is there minimum participation or group size?

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We require no participation minimums or specific group size.

Who is in the Frontier Direct Pay Network?

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Any specialist/ hospital that accepts cash and is ok with being paid upfront before service.

What is the non Frontier Direct Pay network (PPO wrapper)?

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We can use a network as the PPO wrapper that you and/or the employer chooses (example: Aetna, Cigna, PHCS etc..)

Who is the TPA and PBM?

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We have many TPA’s and PBM’s under our fiduciary master service agreement but our preferred vendor partner is Centivo and Disclosed RX. (all are fully transparent and all rebates flow back to client)

How does Frontier Insurance take risk?

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We use a captive as our risk vehicle with the following strategy. Level 1 Employer $0 - 100k, Level 2 Frontier $100k - 600k, Level 3 Reinsurance $600k + (this aligns incentive between employer and frontier because we share in the risk)

How does this work with an HSA plan?

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Both our “bolt-on” and “replacement” eliminate the need for HSA/ FSA however if one is still desired we have successfully integrated this strategy with employers.

What are your reporting capabilities?

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With our proprietary tech we can report on all components of Frontier Health live via a dashboard that is built for employers, brokers/ advisors and others. example: real time ROI, utilization, referrals, total spend, eligibility, NPS, visit data etc…

Member FAQs

Does Frontier accept insurance?

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Frontier Direct Care is a membership based subscription to a team of doctors and clinics. Your insurance may be utilized for lab services. For example, if your PCP orders lab work or imaging your insurance can be utilized. Your insurance is not necessary for the clinic visit since this cost is covered through your monthly membership.

What is the copay or office visit fee?

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Since your visits are covered through your monthly membership fee or employer sponsored plan, no co-pays are required. With your membership you can call, text, and visit your provider as much as you need. The only items not covered through your membership cost are lab and imaging services which can be filed to your insurance carrier.

What’s included in membership?

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Direct access

  • On time appointments with no wait times
  • Frontier Direct Pay: negotiated rates for ancillary services
  • Transparent pricing: no added fees for common office procedures

What is Frontier Direct Pay (FDP)?

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FDP is for the 15% (specialists) of health needs that Direct Care does not cover. This is the contracting arm for specialty services. FDP gives you our member transparency and access to cash pay agreements we have signed on your behalf.

What services are at no extra cost/what do I have to pay for out-of-pocket?

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Our healthcare teams have the ability to treat a wide range of needs at no additional cost such as acute illnesses, sports physicals, women’s health, and other minor procedures. For a more comprehensive list, please talk with a provider or Member Services. Transparent pricing is our goal. We are here to help answer any questions you might have. Please call/text Member Services with any questions you may have.

Does FDC see patients who are pregnant?

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We do see pregnant patients up until the 2nd trimester, after which time, we will refer you to an obstetrician for the rest of your care for pregnancy and labor/delivery. After your baby is born, we would be happy to resume care for you and your newborn. Of course if you have any questions or concerns during your 3rd trimester, please feel free to contact your health care team.

How do I schedule an appointment?

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For urgent needs or same day appointments, you can schedule an appointment:

  1. Online
  2. By calling/texting your health care team
  3. By calling/texting Member Services (M-F 8-5)

For routine, follow up, and non-urgent needs, you can schedule an appointment:

  1. Online
  2. By calling/texting Member Services (M-F 8-5)

Does Frontier take Walk-Ins?

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Although we do not accept walk-ins, we may be able to get you scheduled for a same-day appointment. To schedule, make an appointment online, call/text your health care team, or call/text Member Services.

Do I have to show up early for my appointment time?

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There is no need to, unless you want to enjoy a cup of coffee away from the world for a minute. We strive for on time appointments and we do not double book because your time is valuable. With that being said, if you are running late, please call Member Services and they will help navigate the next steps.

How long is a member’s visit at Frontier?

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For your first visit, we schedule an hour for you to meet your healthcare team! During this time you can go over all your medical history and needs. Subsequent visits are 30 minute appointments.

Who should I contact for a prescription refill?

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While prescription refills can be fairly simple, it’s important to contact your health care team directly to request the refill. Please give them plenty of notice.

Who should I contact about billing/payments?

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We ask that you call Member Services using the phone number for your assigned clinic

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