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Join Cost Plus Wellness as a Provider

Ready to work directly with employers with a transparent contract? Fill out the information below to get started.

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Contact Information

First Name *

Last Name *

Email *

Role/Title/Degree

Your position or title within the practice/group.

Practice or Facility Name*

Practice Website

Phone

Select the option that best describes your practice. *

Location

States and Cities Where You Operate *

Please list all states and cities where you provide services, including any telehealth coverage areas.

Organization Size

Number of Physicians

Number of Locations

Specialties *

Is your practice able to negotiate its own payer contracts? *

Yes No Other

Please specify

Proposed Rates (Optional)

Rate Structure

Percentage of Medicare

% of applicable Medicare Fee Schedule, locality

Fee Schedule/Cash Prices

Upload Fee Schedule (.xls, .xlsx, or .csv)

Please include HCPCS/Procedures Codes or a detailed description of each procedure, bundle, or capitated service.

I have reviewed and confirmed that the file I am uploading contains no confidential information, no personally identifiable information (PII), and no protected health information (PHI). *

Contract Review (Optional)

We will prioritize reviewing providers who have read the Cost Plus Wellness Provider Contract template and agree to the contract's terms without modification.

If my proposed rates are accepted, I will use the Cost Plus Wellness Provider template contract without modifications. My practice/facility will require modifications to the template's terms.

Consent

I agree to receive communications from Cost Plus Wellness. * I agree that any contract I sign with Cost Plus Wellness will be published on costpluswellness.com with names and contact information redacted. * I would like to receive updates and newsletters from Cost Plus Wellness.

Submit Information

After you submit your information, we will review your submission and send you next steps via email.

Have questions? Email us at providers@costpluswellness.com