Premier Radiology and Borgess Health Alliance accept two types of Medicare Advantage plans; contracted plans and deemed (PFFS*) plans. The contracted plans require that the hospital or physician group have a contract with them to qualify them as "in-network." They usually don't pay for "out-of-network" services unless it is a true emergency. Deemed plans have the option of going to any facility or physician that participates with original Medicare as long as that facility/physician chooses to see them. Borgess Health Alliance chooses to see all PFFS plans. The PFFS plans listed below are the ones that we commonly see in the Kalamazoo area. The contracted plans listed below are the ones that Borgess Health and Premier Radiology are contracted with.
| PFFS Plans (deemed) | Pay Rate | Bill to |
|---|---|---|
| BCBSM Medicare Advantage PFFS | 100% Medicare | P.O. Box 440 Southfield, MI 48037-0440 |
| Humana Gold Choice PFFS | 100% Medicare | P.O. Box 14601 Lexington, KY 40512-4601 |
| Medicare PLUS Blue PFFS | 100% Medicare | P.O. Box 440 Southfield, MI 48037-0440 |
| Secure Horizons Direct (by Pacificare) | 100% Medicare | P.O. Box 659787 San Antonio, TX 78265-9787 |
| Sterling Options I, II, III & IV PFFS | 100% Medicare | P.O. Box 69314 Harrisburg, PA 17106-9314 |
| Today's Options PFFS (by Pyramid) | 100% Medicare | 4888 Central Drive, Houston, TX 78279-5180 |
| Unicare Medicare Advantage PFFS | 100% Medicare | P.O. Box 795180 San Antonio, TX 78279-5180 |
| WellCare PFFS | 100% Medicare | P.O. Box 4438 Scranton, PA 18505 |
| Contracted Plans | Pay Rate | Bill to |
|---|---|---|
| BCN Advantage | Per Contract | Po. Box 38753 Grand Rapids, MI 49516 |
| Great Lakes Personal Care Plus PPO | Per Contract | P.O. Box 2127 Southfield, MI 48037-2127 |
| Humana Choice PPO Medicare | Per Contract | P.O. Box 14601 Lexington, KY 40512-4601 |
| Priority Health Medicare | Per Contract | P.O. Box 853923 Richardson, TX 75085-3923 |
| United Healthcare Medicare** | Per Contract | P.O. Box 659734 San Antonio, TX 78265-9734 |
| Medicare Plus Blue PPO | Per Contract | P.O. Box 440 Southfield, MI 49037-0440 |
*Note: PFFS* means Private Fee For Service.
**United Healthcare Medicare contract includes Evercare and Erickson Advantage.
Questions? Call 269.388.6350 or email us.