Smart Shopper is a consumer advocacy benefit that couples cost and quality data from a number of sources to assist you in locating same or better quality care options at less cost to you.

How does it work? 

Avergent partners with an ever-growing list of providers and partners to identify and direct you to the best in quality and cost for non-emergent medical care and prescriptions.

It could be the difference in you paying out-of-pocket expenses. Where it makes sense, your employer has agreed to waive any applicable deductible, coinsurance and co-pays. We'll work with you to determine if it's an option for what you need.

We don't guarantee a Smart Shopper option with all non-emergent medical care or prescriptions. We do promise we will shop for your best options and provide you with transparency to our findings.

 

• Certain Generic, Brand and Specialty Prescriptions

• Outpatient or Inpatient Surgery

• Inpatient Care

• Specialty Care

• Diagnostic Testing

• Imaging

• Durable Medical Equipment

 

As long as it’s non-emergent, we’ll research options for you!

Submit a request through our online form.

Rest assured, your plan will then work the same as any other with normal benefit levels applying. Smart Shopper is merely a VALUE ADD, meaning we’ve added a way to improve the benefits available unlike most other plans on the market. If we don’t have one available, together we will try to locate options and find quality providers willing to give better pricing than what is otherwise available to the plan currently.

The program is really designed for higher cost drugs and procedures since we’ve found that those are areas where pricing has been over-inflated in the market for years. While we won’t turn away an option to find and add primary or specialty care as a contracted option, we haven’t found the cost difference to be dramatic enough for most primary and specialty care providers to become Smart Shopper options.

They must demonstrate basic quality of care (board certifications, low infection and re-admission rates, etc…) for competitive, fair pricing and a willingness to establish a direct pay relationship to the health plan. This combination is what then allows the plan to consider waiving normal plan out-of-pocket expenses.

Simply because a provider is not a Smart Shopper does not mean they are sub-par. We want all providers to have direct pay relationships so that is an option regardless of cost and quality. You can help us achieve that by asking a provider to establish that relationship if it’s not. Providers generally want that type of payment relationship so they’re willing to talk with us about the cost and quality criteria.

Refer them to the Avergent team and we will coordinate a conversation to establish that type of relationship.

Medical Care Example:

Phil was a member on a health plan with the Smart Shopper benefit. He needed a fairly routine eye procedure done to correct a cataract issue. His physician recommended procedure code 66820. Prior to scheduling within his physician’s health system, he reached out to Avergent. Our team identified an eye care clinic and surgeon that had done thousands of these procedures in his career, met the quality criteria and could do that same procedure for 80% less. The plan coordinated care with the member and the procedure was fully paid by the health plan.

Pharmacy Care Example:

Jill had a high cost prescription drug that needed to be filled monthly. Together with Avergent and several vendor partners, we identified a patient assistance program that was specifically suited for Jill. She was able to receive the same prescription at no cost.

During your open enrollment, we shared some examples of providers we have added or are adding to the program. This program is new as of 2018 so our provider and partner relationship are an ever-expanding list based on patient needs. As an advocacy style program, before we can determine availability of options, we need to first understand what services are needed. It requires a personalized approach because we work with many employer plans in many geographic areas. Think of it like a travel agent. We need to understand first where you want to go and for what reasons, all with your current plan in mind, before we can make recommendations to you.