|
IBC and Holy Redeemer Health System Contract Dispute
Holy Redeemer Health System will be terminating their contract with IBC effective January 1, 2004, unless some agreement is reached in the meantime. If this contract termination takes place, all Holy Redeemer facilities including their hospital, skilled nursing facilities and home health agencies will become non-participating providers as of January 1, 2004. All IBC products including the Keystone, Medicare, Personal Choice and Traditional plans will be affected by this change. The only exception will be made for services that were pre-authorized prior to January 1, 2004. The following is a summary of how coverage will be affected for the various plans:
- Keystone HMO & Keystone 65: Any non-emergency services provided at Holy Redeemer without a referral or prior approval will NOT be covered.
- Keystone POS & Keystone 65 Choice: Any non-emergency services provided at Holy Redeemer without a referral or prior approval will be subject to the deductibles, coinsurance and benefit maximums associated with the self-referred portion of the benefit plan.
- Personal Choice & Personal Choice 65: Any non-emergency services provided at Holy Redeemer will be subject to the deductibles, coinsurance, benefit limitations and precertification requirements associated with the out-of-network portion of the benefit plan.
- Traditional Coverage: Under the terms of the contract, members will be reimbursed for
$100 for the first day of a Holy Redeemer inpatient admission and $50 for each subsequent day. Coverage for outpatient services will be limited to 75% of the allowable expenses for covered services. Remaining balances can be submitted to Major Medical if this coverage is available.
New ID cards bearing non-social security based identification numbers were issued for members in NEW Personal Choice and Traditional groups in September 2003. Existing Personal Choice and Traditional members are receiving new ID cards when benefit or administrative changes are being made during their renewal. Keystone members will be receiving new cards early in 2005.
Benefit Enhancements have been made to some IBC products as follows:
- Durable Medical Equipment will be replaced or repaired when deemed medically necessary (HMO/POS)
- Clinical Trial routine costs will be covered (HMO, POS PPO)
- Prosthetic Devices repair and replacement is covered when deemed medically necessary (HMO, POS, PPO)
- Precertification Requirements no longer apply to outpatient hospice and respite care, physical and occupation therapies, spinal manipulations or restorative therapies (POS/PPO)
|
