As a member of a Peoples Health Medicare health plan, you are our priority. Our commitment is to take care of your health. This means much more than ensuring you have access to healthcare providers. It's about providing you with the resources and tools you need to manage and maintain a healthy lifestyle.
Use the tabs on the left-hand side of this page to learn more about common topics our members are interested in.
We will also post on this page plan or general informational updates that may affect you as a Peoples Health plan member.
Medicare Coverage Updates for Cancer Treatment
Medicare has retroactively revised the coverage rules for two healthcare benefits related to cancer treatment.
Scans for Solid Tumors
Previously, Medicare required the gathering of specific information before covering any fluorodeoxyglucose positron emission tomography scans for cancer treatment. Effective June 11, 2013, however, Medicare no longer requires the data collection in order to cover three scans for use in guiding anti-tumor treatment after initial anti-cancer therapy.
Drugs for Vomiting and Nausea
Medicare previously covered the oral three-drug combination of aprepitant, a 5HT3 antagonist and dexamethasone during or after treatment with a defined list of chemotherapy agents considered “highly” likely to cause vomiting and nausea. Effective May 29, 2013, Medicare expanded coverage to include the following chemotherapy agents, which are only “moderately” likely to cause nausea and vomiting:
You can find more details about these coverage changes by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048. If you have received either of these treatments on or after the effective dates and would like to seek reimbursement, contact Member Services.
Medicare Coverage Updates
Medicare has revised the coverage rules for several healthcare procedures. To be covered, procedures generally must be received through a provider in your Peoples Health plan’s network.
Effective September 24, 2013, facilities providing this procedure are no longer required to be certified. This is because Medicare has determined that the requirement for certification does not affect the results of the procedures.
Medicare considers bariatric surgery to be reasonable and necessary for the treatment of patients who have a body mass index greater than or equal to 35, at least one health condition stemming from morbid obesity, and an unsuccessful attempt with another medical treatment for obesity.
Permanent Cardiac Pacemakers
Effective August 13, 2013, pacemakers are now covered for certain conditions. These self-contained, battery-operated devices stimulate the heart electronically. Single-chamber pacemakers generally target the right atrium or ventricle, while dual-chamber models target both the right atrium and ventricle.
Medicare considers both types of permanent cardiac pacemakers to be reasonable and necessary for:
- Documented irreversible symptomatic bradycardia due to sinus node dysfunction
- Documented irreversible symptomatic bradycardia due to second- and/or third-degree atrioventricular block
Symptoms of bradycardia include those that can be directly attributed to a heart rate slower than 60 beats per minute (for example seizures, dizziness or confusion).
Scans for Dementia and Neurodegenerative Disease
Medicare has found that a type of imaging called beta amyloid positron emission tomography may be promising for certain cases of dementia or neurodegenerative disease.
Effective September 27, 2013, one scan per patient is now covered for the following purposes, when done under specific research scenarios:
- To develop better treatment or prevention for Alzheimer’s disease
- To identify subpopulations at risk for developing Alzheimer’s disease
- When the patient is enrolled in an approved clinical study, to resolve clinically difficult differential diagnoses where the use of this imaging technology appears to improve health in specific ways
If you have received any of these treatments on or after the effective dates and would like to seek reimbursement,contact Member Services. You can find more information about these coverage changes by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
Coverage Update: Vision Care
Medicare has expanded its coverage for an eye
disease that can cause loss of vision. Medicare
now covers ocular photodynamic therapy with
verteporfin to treat “wet” macular degeneration.
If you have received this treatment since April 3,
2013, and would like to seek reimbursement,
contact Member Services.
Coverage Update: Wound Care
The Centers for Medicare & Medicaid Services has announced that it now covers autologous platelet-rich plasma (PRP) for the treatment of diabetic, venous and pressure wounds that are both chronic and nonhealing. The PRP must be provided through a clinical research study that meets specific requirements and is designed to assess the health outcomes of this treatment for these three types of wounds. If you have received PRP since August 2, 2012, and would like to seek reimbursement, contact Member Services.
Do Your Part to Prevent Fraud
Each year, Medicare loses billions of dollars to fraud, which raises costs for everyone. So check out these tips on how to keep from becoming a victim, and share the information with your friends.
Question Free Medical Supplies
Medicare does not sell or mail medical supplies. If you receive medical supplies that you or your doctor did not order, you might be the target of a fraud scheme. Take action to protect your Medicare benefits:
- Refuse medical supplies you did not order
- Return unordered medical supplies that are shipped to your home
- Call us to report companies that send you these items
Report Services Not Provided
You are one of the first lines of defense against Medicare fraud. Do your part and report services or items that you have been billed for, but did not receive. Review your plan statement and be on the lookout for this scheme:
- Make sure you received the services or items billed
- Check the number of services billed
- Ensure the same service has not been billed more than once
Prevent Identity Theft
Identity theft can lead to higher healthcare costs for everyone enrolled in Medicare. Current fraud schemes to be on the lookout for include:
- People using your Medicare or health plan member number for reimbursements of services you never received
- People calling you to ask for your Medicare or health plan numbers
- People trying to bribe you to use a doctor you don’t know to get services you may not need
Protect Medicare for Future Generations
Did you know that reducing Medicare fraud is one step toward making sure your grandchildren will have Medicare when they need it? You can do your part by being on the lookout for fraudulent schemes such as:
- People going door to door to sell you healthcare items or services (only your doctor knows what you need)
- People calling you to ask for your Medicare or health plan numbers
- People offering you money or other incentives
Protect Your Identity and Your Benefits
Never give out your Social Security, Medicare, health plan, or banking information to someone you don’t know. Carefully review your Explanation of Benefits to ensure all the information is correct. Know that free services do not require you to give your plan or Medicare number to anyone.
Compliance and Fraud, Waste and Abuse Hotline
To report potential violations of the law, call the toll-free Peoples Health Compliance Hotline at
. You may choose to remain anonymous. We have a nonretaliation policy toward all callers.