How PlushCare works: board-certified primary care physicians and licensed therapists

PlushCare currently offers two types of membership plans: annual and monthly. Both will give you the same membership benefits! These include but are not limited to:

• Same-day appointments

• Prescription discount card

• Discounted labs

• In-app messaging with your Care Team

The only difference is the billing frequency and price:

• Annual membership - $99/year - billed annually

• Monthly membership - $16.99/month - billed monthly

Your membership starts when you first book an appointment with us. After your 30-day free trial, the card on your profile will be charged. Your membership continues until canceled. You may cancel anytime if you do not wish to pay for a membership. Learn more about how to cancel your membership.

Paying with insurance: This visit, when paying with insurance, varies depending upon your plan. To find out the estimated cost of your visit, begin the appointment booking process or contact the Care Team.

• How is the cost estimated? The estimate is calculated in good faith based on the information known at the time the estimate was created. This amount is an estimate only and in no way a quote or guarantee of the amount you will owe or what the charges for the service will be. Your final cost(s) could be higher or lower. We try our best to give you an accurate estimate. However, many factors include the final cost, like services performed and your unique insurance benefits (deductible, copay, coinsurance, out-of-pocket maxes, and network coverage). Benefits and eligibility are subject to change and are not a guarantee of payment. Please contact your insurance company to confirm how your costs will be calculated.

Paying without insurance: For new PlushCare members not paying with insurance, the prices for doctor visits are:

• $129 for a visit

• We also offer discounts to veterans and active military service members paying without insurance.

Therapy pricing: PlushCare therapy appointments are $169 for each appointment and are FSA/ HSA eligible. You can book therapy appointments with us online or through the app.

Please note: Access to the PlushCare service is paid through your monthly/annual membership fee and is only valid if you stay an active member.

The membership fee allows us to offer you the innovative digital health tools and value-added services that make PlushCare unique. The membership fee is paid to PlushCare, Inc., the healthcare technology and management company affiliated with PlushCare of California, which develops the digital health tools and enhanced services that PlushCare of California, Inc. offers to its members.

The membership fee covers costs associated with access to the PlushCare, Inc. proprietary technology platform, including but not limited to benefits such as online appointment booking, online prescription renewal requests, free online messaging with your care team, online care coordination services, and more. Members who pay the membership fee also have access to time-saving services through the PlushCare Mobile App offered by PlushCare, Inc., including online appointment booking, online prescription renewal requests, free online messaging with your care team, online care coordination services, and more.

The membership fee also covers costs associated with high-touch and value-added non-medical services, including lifestyle and wellness offerings and value-added personal assistance services. The membership fee is not a covered benefit under most health insurance plans.

Payment of the membership fee is not a prerequisite for receiving medical care. To understand your options for accessing medical services with PlushCare without payment of the membership fee, see the article titled “Can I request limited access to PlushCare?”.

They can also provide you with a doctor’s note at your visit if necessary.

If prior authorization is necessary for your prescription, our Care Team can help. If you’ve been prescribed an injectable medication for weight loss or type 2 diabetes, our team will start compiling the necessary information automatically. This usually takes 3-7 business days but can vary. If you’ve been prescribed a different type of medication and your pharmacy has told you a PA is needed, you can let us know by calling 1-888-729-0438 or by emailing [email protected]. You may be asked to fill out a short intake form with information about your insurance and prescription history.

Once your PA is submitted, you’ll receive an email titled “PRIOR AUTH SUBMISSION”. Your insurance will now review the documentation provided and issue a determination. Processing times vary, but the average is 7-14 days. We’ll notify you once we receive a determination. If you have any questions during this time, you can reach the Prior Authorizations team directly by responding to the message titled “PRIOR AUTH SUBMISSION” or contact your pharmacy benefit plan directly. Please make sure you call your pharmacy benefit manager (PBM) as they are responsible for managing the prior authorization for your prescription, rather than your medical insurance network. The contact information for your PBM should be on your insurance card but may be on a separate card - common PBMs are ExpressScripts, CVS Caremark, and OptumRx. 

If you have contacted your PBM and they do not have your prior authorization on file, even though you received communication from us confirming its submission,  please give us a call at 1-888-729-0438.

Our doctors can provide either a refill or initiation on most medications except for controlled substances. Our doctors can prescribe common medications such as: Valtrex, Zoloft, trazodone, propranolol, Prozac, acyclovir, metformin, tamsulosin, amlodipine, and valsartan.

However, it is essential to note that our doctors will still defer to their best medical judgment during your visit, which may result in a treatment plan that does not include prescribing medications. 

If you want to check whether we can help you or prescribe any specific medications, please send a message to [email protected] or give us a call at 1(800) 221-5140.

PlushCare physicians can provide simple forms such as work/school excuses or return to work/school documents whenever clinically appropriate. 

Please discuss your need for a work note with your PlushCare physician at the time of the appointment for swift processing. In some instances, PlushCare can provide more substantial documents like FMLA forms, Disability forms, or Handicap/DMV card documents. These evaluations may require more than one appointment before completing the forms so the doctor can learn more about your condition and review any prior medical records. Sometimes, additional tests or an in-person evaluation may be necessary. 

Want to learn more about online doctor's notes? Check out our article about getting a doctor's note online.

If it’s been less than 15 minutes since the start of your appointment time, first try quitting the app and re-joining.

If that does not work and your doctor is still not on the call, please call us immediately at 1(855) 913-0255. We can contact the doctor to see if they are running late or reschedule your appointment with no additional charges.

If you would like a refund, call us at (855) 559-2285 or submit a request to the Care Team. Please note that refunds take 5-10 business days.

We can often diagnose, recommend treatment, and prescribe medication for ongoing (chronic), urgent care/non-emergency medical issues and chronic conditions, including ongoing (chronic) PrEP, high blood pressure, erectile dysfunction, birth control, asthma, hypothyroidism, anxiety, diabetes (type II controlled or un-controlled), depression, high cholesterol, seizures, migraine, hair loss, acne, back pain, and more.

Urgent care/non-emergency conditions that we treat include allergies, gout, migraine, PEP, sinus infection, UTI, bronchitis, flu, cold, strep and sore throat, yeast infection, male urethritis, bacterial vaginosis, rash, cellulitis, dental infection, diarrhea, pink eye, ear pain, swimmer's ear (external ear infection), nausea, headache, pneumonia, tonsillitis, vertigo, and more.

Please note that not all issues can be treated best by telehealth, and your doctor may let you know that an in-person visit is necessary instead. Cases that require in-person examination by a physician will entitle the patient to a refund of any charge for the appointment.

If you have a scheduled appointment to share lab results, pictures, or other documentation with your doctor, please complete your pre-appointment checklist.

iOS & Android

• Open your app 

• Under “Join Call,” you should see an area that says “Prepare for your appointment.” 

• Tap on “Upload Lab Results” or “Upload a photo related to your visit.”

• Choose the file method - file, camera, or photo library. 

• Once uploaded, it will show a number to the right of the option you chose in step 3.

If you have a membership with PlushCare, you can share your membership with up to 5 adult family members at no cost to the family members.

Each adult family member will get a private account with access to all the same features—including same-day bookings and prescriptions and unlimited in-app messaging—so they can get complete, convenient care whenever needed. Family members pay no extra charges for membership as long as the principal account holder remains a member of PlushCare. Each patient is still responsible for copays and doctor’s visit fees.

To add a family member,  open the PlushCare App, log into your account, and select ‘add a family member.’ Type in their name and email, and they will receive an email to set up their account.

Each adult account is independent and private, so it will not be visible to anyone other than the account owner. Children’s accounts are linked to an adult account, so the child’s information will be visible to the managing adult.

• Appointment cancellation: Patients can cancel their appointment for free 2 or more hours before the appointment is set to begin.  

  • Patients who need to cancel their appointment within 2 hours of the appointment start time will be charged a $50 late cancellation fee and will not be charged the appointment price quoted at booking.

• Appointment rescheduling: Patients can reschedule their appointment for free 2 or more hours before the appointment is set to begin. 

  • Patients who need to reschedule their appointment within 2 hours of the appointment start time will be charged a $50 late rescheduling fee.

• No-shows: Patients who cannot attend their appointment must cancel or reschedule or contact PlushCare support to cancel or reschedule the appointment. If the patient does not show up for their appointment, it is considered a no-show, and the patient will be charged a $50 no-show fee. The patient will not be charged with the appointment price quoted at booking. 

• EAP Program: Patients who are eligible for EAP visits, who do not cancel their appointment within two hours of the scheduled visit time, or who do not show up for their appointment will lose one 1 EAP visit from their visit counts.

• PlushCare cancellation or rescheduling: In some cases, PlushCare may need to cancel or reschedule an appointment to ensure patients get the appropriate care they need. When PlushCare cancels or reschedules the appointment, the patient will not be charged a change fee.

Paying without insurance:

You do not have to use health insurance to pay for a PlushCare visit. The non-insurance prices for PlushCare appointments are below:

• $129 for each visit + our membership fee

Paying with insurance: 

If you have health insurance from a payer we accept, we will charge you an estimated visit price at the time of booking.

After your visit, we will file a claim with your insurance. Typically we receive a response within 4 weeks and at that point, we will let you know whether you owe more or less. You will also receive an EOB (Explanation of Benefits) from your insurance indicating the same information.

In the case you owe more because your insurance didn’t cover the full cost of the visit, we will send you a bill to the email address you have on file.

In the case where you owe less, we will process a refund to the card on file and send a receipt to your email.

In the case where you paid the exact amount upfront, we will not reach out to you.

Patients with an in-network insurance plan can pay as low as their regular PCP office visit copay.  See more: Does PlushCare work with my health insurance?

Credit Cards/HSA/FSA

You can pay for your visits using a credit card, debit card, or your HSA/FSA funds. If you need an itemized receipt for your visit to submit for reimbursement, simply email us at [email protected].

You can also use FSA and HSA distributions to cover prescriptions from a PlushCare doctor and lab costs if referred by a PlushCare doctor.

Please note that HSA/FSA funds cannot be used to cover the PlushCare membership fee, and you will need to keep a credit or debit card on file to keep your account in good standing.

Read more on our blog about HSA vs. FSA.

Have Questions? If you have any further billing questions please feel free to contact us at (855) 559-2285.

PlushCare accepts the copays of most Aetna, Blue Cross Blue Shield, Anthem Blue Cross, Blue Shield of California, Humana (non-Medicare), Medi-Cal, and United Healthcare PPO plans. We do not accept Medicare or Medicaid at this time.

If you refer someone to PlushCare via your referral link, they book an appointment, and finish their 3 month free trial then you will receive one month free of membership.

Terms and Conditions:

To receive your one free month of membership, the referral must:

• Never created an account with PlushCare

• Pay for their first month of membership (month 4)

If you have any other questions, please submit a request to the Care Team.