August 2007

Dear Medicare/ Medicare Advantage Plan Patient:

The physicians of Raleigh Medical Group, P.A., which also includes Cary Medical Group physicians, participate with Medicare Part B at this time. This means that we are in agreement with CMS (Medicare) by contract to provide services to you and to file a claim for such services to CMS on your behalf. This contractual arrangement acknowledges that the above physicians will accept payment of the current year Medicare Physician Fee Schedule as payment for services rendered, leaving you with only a balance due for deductible, co-insurance or in some cases, full charges for non-covered services. This is the manner in which our practice has operated with CMS over the past several years under our contract with the traditional Medicare Part B.

The Medicare Modernization Act (MMA) introduced a new way for Medicare patients to be insured under Part B benefits in 2005. They call these plans Medicare Advantage Plans. They are plans that allow for private insurers to contract with Medicare to administer your Part B benefits based on a contract between you and this new insurer. Examples include Humana Gold, Secure Horizons, United Healthcare Medicare Complete, Aetna Golden and Pacificare. You pay these companies and not Medicare Part B to provide physician health coverage for you.

The physicians of Raleigh Medical Group and Cary Medical Group do not contract with these plans. The plans are sold to you as HMO’s (Health Maintenance Organizations), PPO’s (Preferred Provider Organizations) and FFS (Fee For Service) plans. This means that while we do contract with traditional Medicare Part B, we do not accept the payment terms of any of the above plans.
If you have an HMO plan, our physicians can not get paid for services provided to you. You must choose a physician who is listed as “in-network” and we are not. You may contact your insurer to get a list of the physicians who are covered to treat you and receive payment. This is your only option.

If you have a PPO, our physicians may get some payment but the payment will be reduced because we are again, not “in-network”. This means that you may be responsible for a higher
deductible and coinsurance. You may contact your insurer to get a list of physicians who are covered by the plan and if you choose one of those physicians, the amount you have to pay out will be less than if you continue with one of our physicians.

If you have a FFS, we again, do not participate with those plans but your cost for covered services will be similar to those of the traditional Medicare Part B.

We will file a claim for you in all of these instances but depending on the type of plan you have elected to purchase, there could be considerable cost to you. If you have questions, please feel free to contact our Billing Department. Raleigh Office patients may call 919-782-1806. Cary office patients may call 919-859-5955. Gastroenterology patients may call 919-341-3645.

Please allow our Check-In staff to make a copy of your current insurance card when you visit, so that we may stay informed of how your benefits will pay for care delivered at Raleigh and Cary Medical Groups.

Sincerely,

Cynthia R. Cox
Executive Director
Raleigh Medical Group, P.A.
Cary Medical Group