Providers Extracting Extra Money from SecureHorizons Members

[Josh]

ALLHEALTH:

I also have been having EverCare members telling me their PCP's are pushing them to move to other PCP's (basically wanting to get rid of them) with goofy excuses like "you should get a PCP closer to you".

What a CRAZY idea. Why should someone on Medicare and Medicaid have a PCP near them? That IS goofy.
- - - - - - - - - - - - - - - - - -

I believe it may have something to do with the fact that these are PPO plans and these specialist visit do not need to be pre authorized therefore charges are not predetermined before the visit.This same person who was charged 1400.00 for this OV with a skin cancer removal on SH PPO has gone back to Humana hmo and now is only being charged the 40.00 OV co pay from the same doctor for the same service like he was before he switched to SH 1/1/10

HMO's have much more control over costs and are usually to side more on including things in an office visit than a PPO. Even at that, someone in a PPO network can only charge up to the Medicare amounts if the doctor pars with Medicare (even if they don't par with the MA plan).