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Doctors and Medical Services Providers
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Participating with Inclusive Health - Federal Option
To participate with Inclusive Health - Federal Option, providers must sign an amendment with MedCost, Inc. to be part of the Inclusive Health - Federal Option network through MedCost.
In early August, an amendment was sent to all MedCost participating providers, which included the Medicare reimbursement requirement dictated by the North Carolina legislature in establishing the risk pool. The amendment was accompanied by a letter of endorsement from the North Carolina Medical Society and the North Carolina Hospital Association who supported the passage of the risk pool by the legislature.
North Carolina General Statute section 58-50-190(d) limits reimbursement under Inclusive Health - Federal Option to Medicare reimbursement rates. For services for which Medicare has not established an allowed rate, Inclusive Health - Federal Option has established one. Providers do not have to participate in Medicare to participate in Inclusive Health - Federal Option. Providers rendering medical care to an insured shall accept payment of the amount established under this subsection, including any applicable deductible, coinsurance, or copayment amounts, as payment in full for services rendered.
There are advantages to both providers and their patients to providers participating with Inclusive Health - Federal Option. Patients who see a participating network provider will enjoy a significant savings in out-of-pocket coinsurance and deductible costs. All providers will be paid based on Medicare rates which for the PPO plans will be 80% for network versus 50% for non-network providers plus any patient coinsurance or copayment. There is no financial benefit to non-participation in regard to total payment for North Carolina providers. Under North Carolina law, payment to any providers rendering medical care to a risk pool patient cannot exceed the Medicare rates for services for which Medicare has established a rate, plus any applicable deductibles, coinsurance or copayments.
If you would like to request printed copies of our materials, please contact customer service at (866) 665-2117 or [email protected]
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