Question 1

What Happens the First Time You See a Doctor?

Accepted Answer

When you first join Ryze our team asks you for your doctors and we proactively contract with them and their practices.

As a member of Ryze, when you need to see a new provider, you start by contacting the Smart Care Navigator — your 24/7 health concierge.

They will schedule your appointment for you. At the same time in the background our team will work directly with your doctor. As long as they take insurance we can contract with the provider so that when you arrive they will already be in Ryze’s network.

What if there is a situation where you see a provider directly? See the sample insurance card and the steps laid out below.

Show card or provide information to provider prior to your visit:
• Ryze Health will always be your primary network
• You will also have a nationwide network provided by Cigna or BlueCross Blue Shield. You will have one or the other but not both.
• EDI (Electronic Data Interchange) number is needed to check with Cigna/BCBS clearing houses.
• The provider can also call us directly for eligibility and coverage.

Question 2

Who's in the Ryze Network?

Accepted Answer

Ryze is accepted at over 90% of providers and hospitals across the nation so you can see your existing doctor and feel at ease when you travel cross country.

Ryze direct network: Ryze is building out our direct network with practices and hospitals.

Ryze nationwide network: Ryze utilizes Blue Cross Blue Shield and Cigna for our extended network (in network). Your ID card will indicate the nationwide network you are on.

Question 3

What is Considered Out of Network?

Accepted Answer

The only scenarios where you would be out of network:
• The provider does not take any form of insurance
• The provider does not take Blue Cross Blue Shield or Cigna
• The provider is unwilling to contract directly with Ryze

Question 4

If Ryze Offers Both Cigna and Blue Cross Blue Shield Am I On Both Networks?

Accepted Answer

No, you will have one of the two networks based on which has the stronger network in your home location.

Ryze network will always be the primary network.

Question 5

Why Would a Provider Want to Contract with Ryze?

Accepted Answer

Ryze is private insurance which is the majority of coverage in the US. Both hospitals and independent practices are used to taking private insurance.

As a champion of private practice, Ryze pays a higher reimbursement rate to independent providers than other insurances which creates a strong incentive to contract with Ryze.

Faster payment. You get paid in days vs weeks or months.

Question 6

Can You Go to Local Pharmacies?

Accepted Answer

Yes you can go to local pharmacies as they are on a common network. This includes all the big pharmacy chains such as Walgreens and CVS as well as your independent pharmacies. Members have access to a live search function in your member portal.

Question 7

How Does Ryze Cut the Cost of Prescriptions?

Accepted Answer

We use preferred mail order partners and leverage advocacy programs such as 403B plans and direct manufacturer partnerships to lower costs for members.

Question 8

What Labs are in Ryze’s Network?

Accepted Answer

Ryze has large group and hospital labs in network.

As champions of independent providers we actively incentivize patients to go to independent labs. If you have a preferred independent lab please call the support number on your membership card so that we can check eligibility.

Question 9

Are Dental and Vision Covered?

Accepted Answer

Dental and vision insurance only covers routine check ups, glasses/contacts, teeth cleaning, orthodontics and endodontics.

We don’t recommend this type of coverage because these routine costs are low enough that it is more beneficial to save the money and pay directly out of pocket rather than pay a company to hold and administer your own money.

However, Ryze does cover medical dental and medical vision as part of your health insurance.

These vision and dental services are not covered:

For normal dental care benefits, including any dental, gum treatments, or oral surgery, except as otherwise specifically provided herein.

Vision Care. Expenses for the following are not covered:

1. For eye refractions, eyeglasses, contact lenses, or the vision examination for prescribing or fitting eyeglasses or contact lenses (except for aphakic patients, and soft lenses or sclera shells intended for use in the treatment of Illness or Injury).
2. For refractive procedures or other plastic surgeries to correct vision in lieu of eyeglasses.
3. Vision therapy (orthoptics) and supplies.
4. Orthokeratology lenses for reshaping the cornea of the eye to improve vision.

Question 10

Is this available in my state and for my size?

Accepted Answer

Yes—Ryze supports practices in all 50 states and is ideal for individuals and clinics of all sizes.

Question 11

Can we keep our current brokers or systems?

Accepted Answer

We’ll review your current setup and recommend the cleanest path—whether replacing, integrating, or phasing tools to avoid disruption.

Question 12

What about HIPAA training and healthcare-specific compliance?

Accepted Answer

Your package can include learning and policy workflows aligned to healthcare environments. We’ll configure training and acknowledgement flows that fit clinical operations.

Question 13

How does co-employment impact control?

Accepted Answer

Co-employment lets the PEO handle many employer-of-record tasks and risks while you retain day-to-day control of your practice and people decisions.

Question 14

Coverage Benefits

Accepted Answer

• Primary Care Visit to Treat an Injury or Illness
• Specialist Visit
• Other Practitioner Office Visit (Nurse, PA)
• Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
• Outpatient Surgery Physician/Surgical Services
• Preventive Care/Screening/Immunization
• Urgent Care Centers or Facilities
• Emergency Room Services
• Emergency Transportation/Ambulance
• Inpatient Hospital Services (e.g., Hospital Stay)
• Inpatient Physician and Surgical Services
• Prenatal and Postnatal Care
• Delivery and All Inpatient Services for Maternity Care
• Routine Eye Exam for Children
• Eye Glasses for Children
• Dental Check-Up for Children
• Well Baby Visits and Care
• Family Planning
• Rehabilitative Occupational & Physical Therapy
• Rehabilitative Speech Therapy
• Outpatient Rehabilitation Services
• Habilitation Services
• Generic Drugs
• Preferred Brand Drugs
• Non-Preferred Brand Drugs
• Specialty Drugs
• Mental/Behavioral Health Outpatient Services
• Mental/Behavioral Health Inpatient Services
• Substance Abuse Disorder Outpatient Services
• Substance Abuse Disorder Inpatient Services
• Skilled Nursing Facility
• Home Health Care Services
• Hospice Services
• Transplant
• Dialysis
• Chemotherapy
• Radiation
• Diabetes Education
• Infusion Therapy
• Reconstructive Surgery
• Durable Medical Equipment
• Imaging (CT/PET Scans, MRIs)
• Laboratory Outpatient and Professional Services
• X-rays and Diagnostic Imaging
• Allergy Testing

Question 15

Eligibility

Accepted Answer

Independent physicians, benefits-eligible employees of independent practices and your families.

Ryze can service practices with 25+ employees opting into the insurance. The 25+ is a count of only the employees not the total lives which include dependents. Total employee count for the practice does not matter, only the total employees opting in.

For practices with fewer than 25 employees opting in, we have partners that can assist you.

Question 16

Dependent Eligibility Rules

Accepted Answer

When you enroll in a benefit plan, you can add the following eligible dependents to coverage:

• Spouse
• Children under age 26 including biological, step, and legally adopted (or placed for adoption)
• Children age 26 or older who have been deemed disabled by the Social Security Administration prior to turning 26.

Question 17

Coverage Options

Accepted Answer

Choose from a range of coverage options including preventive care, prescription drug coverage, mental health services, and more. Find the plan that suits you best.

Question 18

Deductible

Accepted Answer

The amount that you are responsible for each year before the plan begins to pay for covered services (with the exception of preventive care services, which are covered 100% by the plan based on age guidelines).

Non-covered items do not count toward the deductible, and your deductible can vary by how many family members are covered and the networks your providers participate in. Deductible amounts incurred in different network tiers will cross over and be counted in the other network tiers.

Question 19

Copayment

Accepted Answer

This is a fixed amount you pay to receive services. Your copayment(s) will count towards your out-of-pocket maximum but not your deductible.

Question 20

Coinsurance

Accepted Answer

This is your share of the expense when the plan is paying a percentage, after your deductible is met.

Question 21

Out-of-Pocket (OOP) Maximum

Accepted Answer

The annual limit on your expenses for deductible, copayments and coinsurance.

Like the deductible, your OOP Maximum will vary depending on how many family members are covered and the networks your providers participate in. However, OOP Maximum amounts incurred in different network tiers will cross over and be counted in the other network tiers.

After your expenses have met the OOP Maximum, the plan will pay 100% of covered services for the remainder of the calendar year.

Question 22

HSA Account

Accepted Answer

Health Savings Account. It's a tax-advantaged savings account designed to help people save and pay for qualified medical expenses.

The funds do not expire at the end of the year. Single and family savings limits apply. Please make sure you check the annual limits each year.

Question 23

Do you support prior authorization (PA)?

Accepted Answer

Not yet. PA support is on our roadmap. Today, practices submit and manage PA with their payers directly.

Question 24

Can I see prices before ordering?

Accepted Answer

Yes, once you're a Ryze member you'll see the full catalog, prices and shipping options. You can order once you're credentialed.

Question 25

What shipping options are available?

Accepted Answer

• 48-hour cold-chain (guaranteed or we reship).
• Bulk shipping for 5+ orders with reduced freight.
• Standard delivery options (e.g., 5–7 business days).
• Delivery can go to your clinic or directly to the patient.

Question 26

Who pays for shipping?

Accepted Answer

The ordering physician/practice.

Question 27

What are your payment terms?

Accepted Answer

Net 15 via ACH only. We pay the pharmacy first and invoice you after you confirm receipt.

Question 28

What happens if a shipment is delayed, damaged, or lost?

Accepted Answer

We resolve directly with the pharmacy partner and reship as needed. Your practice and your patient are not liable.

Question 29

Do you sell to distributors, wholesalers, PBMs, or pharmacies?

Accepted Answer

No. Physician practices only.

Question 30

Which drugs are included?

Accepted Answer

A curated specialty formulary (no controlled substances; no chemo). You’ll see the active list and pricing in the portal post-credentialing.

Question 31

Can I order without specifying a patient (classic buy-and-bill)?

Accepted Answer

No. To satisfy regulatory requirements, our model requires a patient-specific prescription for each order.

Question 32

Is there an EHR integration?

Accepted Answer

Not required. Ordering happens through the secure Ryze physician portal.

FAQs