Important Update for Medical Fee-For-Service Providers - August 25, 2016:
The Receiver entered into a contract with a third-party administrator, MED3000 Health Solutions Southeast, to handle the processing of PUP unpaid claims
On August 25, 2016, the Receiver sent notices with claim filing instructions to all known Medical Fee-For-Service Providers who may have claims unpaid by PUP. These notices were sent by email to the email on file with the NPPES database or by regular mail if no email was available. If you have not received a notice, please contact MED3000 Health Solutions Southeast by email, email@example.com or by phone at (844) 636-7501. Always include the provider name, tax ID and the NPI in your inquiry.
The Claim Filing Deadline for all Medical Providers is October 31, 2016
Note: The filing proof-of-claim and deadline waiver applied to Medical Providers only. All other claimants must have submitted the proof-of-claim form and supporting documentation by the June 9, 2015 deadline.
Do I have health care coverage now?
YES. CMS retroactively enrolled all PUP members into Original Medicare Fee-for-Service (FFS) and a Prescription Drug Plan (PDP) effective June 1, 2014. CMS mailed each PUP member a separate letter regarding this retroactive enrollment and the member’s options for continued health care coverage from July 1, 2014. If you did not receive the letter from CMS or have any questions about your continued health care coverage, you should call 1-800-MEDICARE (1-800-633-4227).
REMEMBER: Benefits received under PUP may not be the same as those received under Original Medicare FFS. You may find that you are responsible for paying for a portion or all of the services you obtained starting June 1, 2014, while under Original Medicare FFS until you obtain a replacement Medicare Advantage plan or purchase a Medicare Supplement. Again, please call 1-800-MEDICARE (1-800-633-4227) to discuss your options with CMS.
Can Providers seek payment from PUP members for debt owed by PUP for medical services?
No. Under Section 641.3154, Florida Statutes, HMO members are not liable to any provider of health care services for any services covered by the HMO. Additionally, health care providers and their representatives are prohibited from attempting to collect payment from the HMO members for such services. If you are contacted by a health care provider for such payment, you should inform the provider of this law. You may also want to send a letter regarding this problem, with a copy of any bills you receive from such providers, to the Receiver of Physicians United Plan, Inc., at 2020 Capital Circle SE, Suite 310, Tallahassee, FL 32301. If the provider or his representatives continue to pressure you for payment, please contact the Receiver at 1-800-882-3054 (Florida only) or 850-413-3081. Although the Receiver cannot represent you against the provider, we can assist you in informing the provider of the relevant laws.
PLEASE NOTE, HOWEVER: Benefits received under PUP may not be the same as those received under Original Medicare FFS. So while you should not be billed for services prior to June 1, 2014, for which PUP would have paid, you may find that you are responsible for paying for a portion or all of the services you obtained starting June 1, 2014, while under Original Medicare FFS until you obtain a replacement Medicare Advantage plan or purchase a Medicare Supplement. Again, please call 1-800-MEDICARE (1-800-633-4227) to discuss your options with CMS.
Why is additional premium being deducted from my social security check?
PUP provided Monthly Medicare Part B rebates on some of their health plans. Once CMS retroactively disenrolled the PUP members and placed them in Original Medicare FFS as of 6/1/14, the PUP members were no longer eligible for those rebates. Thus CMS will deduct those premium payments from monthly benefit checks beginning in June 2014.
Can I be billed for services filed under Original Medicare Fee For Service (FFS) beginning 06/01/2014?
Yes. Under Original Medicare FFS, members are responsible for 20% coinsurance. Additionally, certain services are not covered under Original Medicare FFS (such as preventative dental services, routine eye exams, - glasses and transportation). For further questions regarding coverage under Original Medicare FFS, please call 1-800-MEDICARE (1-800-633-4227).
For additional information about the PUP Receivership, or about the receivership process in general, please contact the Receiver by calling the Florida Department of Financial Services at 1-800-882-3054 (Florida only) or 850-413-3081 or use the "Contact Us" form found on the Receiver’s website at www.myfloridacfo.com/division/receiver.