Mercy Managed Care

Medicare Replacement Plans

MMC-NI is non-par with all Medicare PPFS plans. Plans aggressively marketed in this area:

  • UniCare
  • Sterling One
  • Humana Gold
  • SecureHorizons Direct (PacifiCare)
  • Today's Options (Pyramid Life Insurance Company)

Unique features to the Medicare PFFS plans:

  1. We do not sign a contract
  2. We do not negotiate reimbursement rates
  3. Providers are "deemed" participating purely by accepting/treating the patient.
  4. We cannot balance bill the patient because we've been "deemed", i.e. participating. We are obligated to accept the plan's reimbursement as payment in full (minus deductibles and co-pays).

Why are we non-par?

  1. To date, we have not received "promised" reimbursements.
  2. Today, Medicare PFFS plans are unable to address our complex Medicare structure, e.g. Critical Access Hospitals, Provider Based Clinics, Rural Health Clinics.

Resources:
Medicare & You 2006 (CMS publication)
Prototype Letter (This link opens a Word document for you to customize. Please save edited copy to your personal drive.)

More Details

 

 

Please contact Kristi Larsen at 641.422.6986 with any questions/comments regarding this web page.