PHYSICIANS UNITED PLAN, INC.
Company Information
| Company Demographic Information | |
| Name of Company: | PHYSICIANS UNITED PLAN, INC. |
|---|---|
| Case Number: | 2014 CA 1472 |
| Guaranty Association: | None |
| Type of Coverage: | Health Maintenance Organization |
| State of Domicile: | Florida |
| Status of Receivership: | Liquidation |
| Important Receivership Dates | |
| Date of Rehabilitation: | June 09, 2014 |
| Date of Liquidation: | July 01, 2014 |
| Policy Cancellation Date: | July 01, 2014 |
| Claims Filing Deadline: | June 09, 2015 |
| Objection Deadline: | See Below |
Notice of Receivership
On June 9, 2014, Physicians United Plan, Inc. (“PUP”) was ordered into receivership for purposes of rehabilitation by Judge Charles A. Francis of the Second Judicial Circuit Court in Leon County, Florida. The Florida Department of Financial Services is the court appointed Receiver of PUP. PUP was ordered liquidated effective July 1, 2014.
Background Information
PUP was a health maintenance organization that obtained its Florida license in 2005 and began operations in January 2006. Headquartered in Orlando, Florida, PUP was a Medicare Advantage Prescription Drug HMO of approximately 50,000 Medicare subscribers. Medicare premiums and contracts are administered through a federal agency, the Centers for Medicare and Medicaid Services ("CMS").
As a result of the liquidation of Physicians United Plan, Inc. (PUP) and termination of its contract with CMS, CMS retroactively enrolled all PUP members into Original Medicare Fee-for-Service (FFS) and a Prescription Drug Plan (PDP) effective June 1, 2014
Special Election Period
JULY 1, 2014 LIQUIDATION OF PUP HEALTH PLAN, INC.
PUP was ordered liquidated effective 12:01 a.m. on July 1, 2014.
JULY 13, 2018, Notices of Determination Mailed
January 11, 2019, NODs mailed for PUP
The Division sent 28 Notices of Determination (NODs) to medical providers and other claimants. The NODs were sent via the US Postal Service. These NODs inform the claimants of the evaluation and recommendation made on their filed claim. The process by which an objection to class or amount may be filed is described in the NOD. The Objection filing deadline is March 12, 2019.
Fourth interim claims report Notices of Determination mailed, objection filing deadline established
14 Notices of Determination (NODs) mailed to claimants on April 11, 2019. The Objection filing deadline is June 10, 2019.
September 9, 2019, NODs mailed for PUP
On September 9, 2019, the Department mailed 3 Notices of Determination (NODs) to medical providers and another claimant. The NODs were sent via the US Postal Service. These NODs inform the claimants of the evaluation and recommendation made on their filed claim. The process by which an objection to class or amount may be filed is described in the NOD. The Objection Filing Deadline is November 8, 2019.
September 16, 2020
On September 16, 2020 the Department mailed 12 Notices of Determination (NODs) to the remaining claimants. The NODs were sent via the US Postal Service. These NODs inform the claimants of the evaluation and recommendation made on their filed claim. The process by which an objection to class or amount may be filed is described in the NOD. The Objection Filing Deadline is October 26, 2020.
Claims Information
General Information
On September 22, 2017, the order approving the 1st Interim Claims Report was signed by the judge assigned to the Physicians United Plan, Inc. receivership. Notices of Determination (NODs) were mailed to all evaluated claims in classes 2-8 on October 17, 2017. Each NOD has a claims evaluation code listed on it that provides the basis of how the claim was evaluated. For a list of evaluation codes and their descriptions, please click here.
Important Information for Medical Fee-For-Service Providers - Updated 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, fl-customerservice@mckesson.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 was October 31, 2016
Court Orderded Claims Filing Bar Date established
No new claims will be accepted by the Receiver effective March 29, 2019. See
Related Documents to review Motion and Order.
I am owed money for services provided before PUP was ordered into receivership. What is the procedure for payment of these claims?
I have provided services after the company was placed into receivership to a member of PUP. Who is responsible for paying these bills?
The company, Physicians United Plan, Inc. is responsible for paying services provided under the terms of its member agreements for claims occurring before June 1, 2014. Under Section 641.3154, Florida Statutes, HMO members/subscribers are not liable to any provider of health care services for any services covered by the HMO.
Can Providers seek payment from former members/subscribers for debt owed by PUP for medical services?
No. Under Section 641.3154, Florida Statutes, HMO subscribers 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 subscribers for such services. If you are contacted by a health care provider for such payment, you should inform the provider of this law.
Claim Evaluation Codes
Claim Evaluation Codes can be found here on the Division's website.
Contact Information
Contact Information
Frequently Asked Questions
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, fl-customerservice@mckesson.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 325 John Knox Road, Atrium Building, Suite 101, Tallahassee, FL 32303. 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.
Policy and Coverage Information
POLICY CANCELLATION
By Court Order, effective at 12:01 a.m. on July 1, 2014, PUP was ordered liquidated. As a result of the impending of Physicians United Plan, Inc. (PUP) and termination of its contract with CMS, CMS retroactively enrolled all PUP members into Original Medicare Fee-for-Service (FFS) and a Prescription Drug Plan (PDP) effective June 1, 2014. You should very carefully read any letters you receive from the Receiver or CMS. These letters will provide you with extremely important information regarding the continuation of your health care coverage, including arrangements made for continued prescription drug coverage, and will explain your other Medicare options.
Beneficiaries currently in the hospital or receiving treatments such as chemotherapy, dialysis, or organ transplantation are able to continue with such care. Remember, you will need to closely read the information and follow any instructions which are provided in letters you receive from CMS regarding your continued health care and prescription drug coverage after June 1, 2014.
SPECIAL ELECTION PERIOD
As a result of the receivership of PUP, all beneficiaries enrolled in PUP have a Special Election Period until August 31, 2014 to enroll in a plan of their choosing. All dual eligible or those eligible for the Low Income Subsidy can enroll in another plan at any time. A beneficiary that selects another Medicare Advantage or Medicare Advantage-Prescription Drug plan will be covered under the new plan effective the first day of the next month after they enroll. Please contact 1-800-MEDICARE (1- 800-633-4227) for more information regarding these matters and/or to make a new plan selection.
A few more points/reminders about your health care coverage from June 1, 2014:
• As a result of the liquidation of Physicians United Plan, Inc. (PUP) and termination of its contract with CMS, CMS has retroactively enrolled all PUP members into Original Medicare FFS and a Prescription Drug Plan effective June 1, 2014.
• If you have any difficulty in obtaining prescriptions, please ask your pharmacist to assist you by doing an "electronic lookup" for your name/new pharmacy plan on the Medicare system to which they have access.
• The Receiver emailed a notice to all of PUP's medical providers which informed them of the retroactive enrollment and the Special Election Period. This notice:
o Advised providers who have delivered services to members on or after June 1, 2014 to submit claims for those services to CMS under Medicare Fee-for-Service.
o Advised providers who were reluctant to provide health services to PUP members to continue to see those individuals and submit the claims for such services to CMS under Original Medicare for payment.
Provider Information
August 25, 2016 - Important Claim Information Update for Medical Fee-For-Service Providers
The Receiver entered into a contract with a third-party administrator, MED3000 Health Solutions Southeast, to handle the processing of PUP unpaid Provider 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, fl-customerservice@mckesson.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
As of August 18, 2014
As a result of the liquidation of Physicians United Plan, Inc. (PUP) and termination of its contract with CMS, CMS retroactively enrolled all PUP members into Original Medicare FFS and a Prescription Drug Plan effective June 1, 2014.
Providers who have delivered services to members on or after June 1, 2014 should submit claims under Medicare Fee for Service.
Providers with any questions regarding this retroactive enrollment for billing should contact Medicare directly at 1-800-MEDICARE (1-800-633-4227).
Financial Statements
The following documents are provided as Adobe Acrobat PDF files and are best viewed using the free Adobe Acrobat reader software.
Related Documents
The following documents are provided as Adobe Acrobat PDF files and are best viewed using the free Adobe Acrobat reader software.
Court Documents
Notices
| Date | Title | Size |
|---|---|---|
| 08/25/2016 | Notice to Capitated and PBM Providers | 70K |
| 08/25/2016 | Notice to MSO Providers | 70K |
| 05/13/2016 | Seventh Notice to Medical Providers | 89K |
| 05/27/2015 | Notice to Providers | 130K |
| 05/27/2015 | Sixth Notice to Medical Providers | 130K |
| 08/07/2014 | Notice to Agents (Spanish Version) | 55K |
| 08/07/2014 | Notice to Agents (English Version) | 74K |
| 07/24/2014 | Fifth Notice to Medical Providers | 77K |
| 06/26/2014 | Fourth Notice to Medical Providers | 231K |
| 06/25/2014 | Third Notice to Medical Providers | 92K |
| 06/20/2014 | Notice to Members (English Version) | 87K |
| 06/20/2014 | Notice to Members (Spanish Version) | 101K |
| 06/19/2014 | Second Notice to Medical Providers | 74K |
| 06/13/2014 | First Notice to Medical Providers | 49K |
Other
| Date | Title | Size |
|---|---|---|
| 02/18/2022 | Insolvency Report | 950K |