Terms and Conditions of Payment

With BlueMedicare PFFS, there is no signed agreement requirement since the plan is a non-network plan. Members have the freedom to seek services from any physician, hospital or other health care provider who is eligible to be paid under Medicare rules and who accepts the BlueMedicare PFFS Terms and Conditions of Payment (PDF).

N0TE: Having reasonable access to a PFFS plan's terms and conditions combined with providing services to a PFFS plan member represent acceptance of the plan's Terms and Conditions. The Centers for Medicare & Medicaid Services (CMS) consider there is reasonable access when a PFFS plan's terms and conditions' access information is printed on the member's insurance ID card and the terms and conditions are available on the plan's website, via fax and by phone.

If you do not want to accept the BlueMedicare PFFS Terms and Conditions of Payment...

If you know your patient has BlueMedicare PFFS coverage and you prefer not to accept our plan's Terms and Conditions of Payment - do not provide services to our member unless it is an emergency. Once you provide service you are considered a Deemed Provider.

BlueMedicare PFFS has a Medicare Advantage contract approved by the Centers for Medicare & Medicaid Services. Contracts are renewed annually and availability of coverage beyond the end of the current contract year is not guaranteed. A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. A doctor or hospital must agree to accept the plan's terms and conditions prior to providing health care services to a member, with the exception of emergencies. If a doctor or hospital does not agree to accept our payment terms and conditions, they may not provide health care services to the member, except in emergencies.