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Telemed ROI Analysis

Complete the form below to request a free report detailing the potential savings your business or organization may achieve when implementing our Telemedicine platform. Enter as much data as possible to receive an accurate result based on your specific criteria. If you are not able to provide actual claims experience, a basic analysis will be generated using national averages. . A copy of this file as well as the results will be sent to the email address provided.

Company Name (*)

Please type Company name
Company Address (*)

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City (*)

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State (*)

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Zip Code (*)

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Contact Name (*)

Please type your full name.
Position (*)

Please specify the contacts position in the company
E-mail Address (*)

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Telephone (*)

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Current Coverage Offered (*)

Enter the type of insurance

Claims History: Contact your benefits admin and request a claims history report for the past 12 months. The report should include ER Visits, Urgent Care Visits, Primary Physician Visits with CPT billing codes.

Upload Claims File (Health Census) YOU WILL NOT HAVE TO COMPLETE THE QUESTIONS BELOW THAT ARE RELATIVE TO CLAIMS IF YOU ARE UPLOADING A COMPLETE CLAIMS HISTORY.

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Number of Employees

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Total number of lives covered in your current plan including family members

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Number of Part Time Employees and/or Independent Contractors NOT Covered in your plan

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Do you pay sick days

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Total number of sick days reported in the past 12 months

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Additional Comments

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Name of the person who referred you? (*)

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