Re: Medicare HMO changes for 2002
Description
Collection
Title:
Re: Medicare HMO changes for 2002
Text:
Dear List members;
I was informed by a local colleague and subsequently by a well informed
patient that the Medicare HMO benefits of Secure Horizons in some California
counties are changing for 2002.
Specifically, Secure Horizons patients will be liable for 20% of the
CONTRACTED rate that the provider has with the HMO. There are also some
limitations which I have not been able to obtain clarification about
concerning custom vs prefab prosthetic devices. Additionally they now have a
per incident copay for all DME ranging from $50 to $150.
Upon further research it appears that a similar trend/strategy is also being
employed by other Medicare HMO's in California. (I won't name them until I
have written confirmation). I do smell some collusion on the part of these
plans though.
If you are contracted with any Medicare HMO's you have now been given the
added task of collecting significantly discounted payments from beneficiaries
in addition to collecting form the plan and asking/begging for prior
authoriation. These beneficiaries are also typically the most difficult to
collect from. There is a reason why they have opted for these plans. The HMO
is within its legal rights as it is giving the beneficiaries 60 days written
notice according to HCFA.
Might behoove everyone to review their provider agreements and office
policies.
Good Luck,
Ralph W Nobbe CPO
I was informed by a local colleague and subsequently by a well informed
patient that the Medicare HMO benefits of Secure Horizons in some California
counties are changing for 2002.
Specifically, Secure Horizons patients will be liable for 20% of the
CONTRACTED rate that the provider has with the HMO. There are also some
limitations which I have not been able to obtain clarification about
concerning custom vs prefab prosthetic devices. Additionally they now have a
per incident copay for all DME ranging from $50 to $150.
Upon further research it appears that a similar trend/strategy is also being
employed by other Medicare HMO's in California. (I won't name them until I
have written confirmation). I do smell some collusion on the part of these
plans though.
If you are contracted with any Medicare HMO's you have now been given the
added task of collecting significantly discounted payments from beneficiaries
in addition to collecting form the plan and asking/begging for prior
authoriation. These beneficiaries are also typically the most difficult to
collect from. There is a reason why they have opted for these plans. The HMO
is within its legal rights as it is giving the beneficiaries 60 days written
notice according to HCFA.
Might behoove everyone to review their provider agreements and office
policies.
Good Luck,
Ralph W Nobbe CPO
Citation
“Re: Medicare HMO changes for 2002,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 25, 2024, https://library.drfop.org/items/show/217543.
