Presentation: SecureHorizons
SecureHorizons MedicareDirect
NARHC Technical Assistance Conference Call
March 13, 2007
SecureHorizons by UnitedHealthcare
(Live Secure. Be Secure.)
- Since acquiring PacifiCare in 2005, UnitedHealth Group combined
the Medicare Advantage plans offered by PacifiCare Secure Horizons,
UnitedHealthcare, John Deere Health Care, and Oxford Health into
a single national brand called SecureHorizons by UnitedHealthcare.
- In 2007, the PFFS plan's name changed to SecureHorizons
MedicareDirect.
- Although the plan is filed in 1515 counties in 50 states, remember
that a PFFS enrollee's benefit plan is not restricted by geography
or network affliation.
-- Enrollees can see any "deemed" doctor or hospital,
who is Medicare eligible and agrees to the plan's terms, conditions
and payment rates.
-- Health care professionals make their "deeming" decision
each time they see an enrollee in a PFFS plan and, if it is negative,
the enrollee must find another health care professional who agrees
to be deemed. The exception is emergency care.
- Several plans contain Part D prescription coverage but a number
of plans do not include drug coverage and these MA-Only Plans
can be sold throughout the year after "lock-in".
- We pay a 5% bonus on the portion of reimbursement based on the
Interim Rate Letter.
How to find online 2007 PFFS materials, such as Terms and Conditions,
Reimbursement Guide, and Quick Reference:
- Go to: UnitedHealthcare
Online
- On the top menu: click on "Tools and Resources".
- On the left menu: click on "Products and Services".
- On the left menu, below "Products and Services": click
on "Medicare".
(Or click here: UnitedHealthcare
Online Medicare)
- On the main part of the page, under "Secure Horizons":
click on "MedicareDirect Private Fee for Service
(PFFS) Plans".
(Or click here: MedicareDirect
Private Fee for Service (PFFS) Plans)
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