MEDICARE HMOs: PacifiCare To Re-enter Some TX Counties
Just months after pulling out of 12 Texas counties, PacifiCare of Texas is re-establishing its Secure Horizons plan in two counties south of San Antonio. The San Antonio Express- News reports that PacifiCare will continue to offer the service in Medina and Wilson counties, but is sticking with its original withdrawal plan in the 10 other counties. With the help of Reps. Ciro Rodriguez (D-TX) and Henry Bonilla (R-TX), PacifiCare was able to work out a deal with the federal government allowing the HMO "to drop one ZIP code -- 78850 in Medina County -- to make the rest of the area profitable for the company." PacifiCare's retreat from that ZIP code will leave "about 200 Secure Horizons members" without a Medicare HMO, forcing them to return to the traditional Medicare program. PacifiCare President Pat Feyen said that area was not profitable because "doctors were under a fee-for-service contract instead of capitated contracts." However, Feyen said his company will see a 5% to 6% increase in Medicare reimbursement rates for HMO enrollees in Wilson and Medina counties next year (Poling, 11/18).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.