Re: Insecure Horizons

[Guest guest]

Good morning Les,

May I share this post with our national Medicare carrier advisory committee? Secure Horizons sounds like a Medicare Part C plan. I believe the carrier must still reimburse based upon the Medicare fee schedule, I'm assuming minus the patient $25 copay. We have been discussing Medicare Part C and collecting provider info on problems encountered with Part C plans.

J. Holzapfel, DCAlbany-- "c3ipo" <feinberg@...> wrote:

Dear Colleagues;Here is an email from my office manager who had one of those experiences with insurance company BS we all have grown to loathe, and yet, expect. Just in case you run into this I thought you would like to know. S. Feinberg, D.C. Hi Dr. Feinberg,Here's a good one for you. A patient of Dr. 's come's into the office today and presents us with a SecureHorizons Direct insurance card offered through PacifiCare Life and Health Insurance Co. she tells us this is her new secondary insurance. After my experience with SecureHorizons in my old job I knew something was fishy. So you know me I made my stern phone call to the patient's secondary insurance (SecureHorizons Direct). I spoke with Latravia with SecureHorizons Direct. Latravia states to me that this plan is a Medicare Replacement plan not a supplemental insurance plan for this patient (bells are going off and the smoke is rolling out my ears by now). You know I just hate it when an insurance company gives the wrong information or impression to our patients. Latravia than states this plan is a point of service plan for the patient and is not required to obtain medical services from a primary care provider. She also states SecureHorizons Direct follows Medicare guidelines. So if a provider accepts assignment on SecureHorizons Direct claims they are accepting the $25 patient copay required from the patient as payment. Then the provide has to accept the allowable on any reimbursement if any from PacifiCare Life and Health Insurance Co. aka SecureHorizons Direct we cannot bill the patient for the balance. Advance Beneficiary Notices forms signed by Medicare patients do not apply in these situations as this is a Medicare Replacement Plan offered through PacifiCare Life and Health Insurance not Medicare itself. I hope my rambling makes since as I'm still seeing lightening bolts going through the SecureHorizons offices. Ann---------------------------------------------------------------------Groups are talking. We´re listening. Check out the handy changes to .