Blue Medicare Private Fee-for-Service  

HCSC Insurance Services Company (HISC) is approved by the Centers for Medicare and Medicaid Services to offer Blue Medicare PFFS^SM (Private Fee-For-Service) and is available to local and national employer groups headquartered in Illinois, New Mexico, Oklahoma and Texas.

Blue Medicare PFFS is a private fee-for-service Medicare Advantage health plan.  This means Medicare-eligible retirees who join a group plan have the freedom to choose any licensed doctor or hospital that participates in Medicare and is willing to accept the Plan’s terms, conditions and payment rates. They can see specialists without referral, and travel without losing coverage within the U.S.

Private Fee-For-Service members may go to any Medicare-approved doctor, ancillary provider, or hospital that accepts the plan’s terms and conditions of participation. Acceptance is “deemed” to occur where the provider is aware, in advance of furnishing services, that the member is enrolled in a PFFS product and when the provider has reasonable access to the Terms and Conditions of participation.

The Medicare Advantage organization, rather than the Medicare program, pays physicians and providers on a fee-for-services basis for services rendered to such members. Members are responsible for cost-sharing, as specified in the plan, and balance billing of members will not be permitted.

Related Links
PFFS Payment Dispute Decision Request Form