Fox Insurance Co. Terminated as a Medicare Provider

by Mary Jane Stern

After an ongoing audit, on March 09, 2010, Medicare announced they terminated their contract with Fox Insurance Company effective immediately:

“The Centers for Medicare & Medicaid Services (CMS) today terminated its contract with Fox Insurance Company.   After an onsite review of the plan and its services, CMS determined that the plan’s significant deficiencies – not meeting Medicare’s requirements to provide enrollees with prescription drugs according to recognized standards of care – jeopardized the health and safety of Fox enrollees.  CMS found that Fox committed a series of violations, including improperly denying its enrollees coverage of critical HIV, cancer, and seizure medications. The termination of the contract is effective immediately.”

On February 26, 2010, Fox issued the following statement:

“We take our oversight role of Medicare prescription drug plans seriously,” said Blum.   “We review and take action on all complaints received about Medicare health and drug plans and will take appropriate and immediate actions wherever necessary.”

You can read the full press release at http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3634

Fox had 123,000 Medicare beneficiaries and their plan was available in

Arkansas, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland, Missouri, North Carolina, New Jersey, New York, Nevada, Ohio, Pennsylvania, South Carolina, Texas and West Virginia.

If you are a beneficiary, you should have received the Department of Health & Human Services Centers for Medicare & Medicaid Services notice explaining the change in coverage that became Effective March 1, 2010.  In this notice, Medicare advises Fox members that they are temporarily moved to the Limited Income Newly Eligible Transition (LI-NET) program run by Humana.  Call Medicare if you have not received your notice 1-800-MEDICARE (1-800-633-4227).

You have the option now to join another Medicare Part D drug plan on your own or if you don’t do anything Medicare will automatically enroll you in another plan, effective May 1, 2010.

Ready to enroll in another plan on your own? Visit Q1Medicare.com. This site is amazing and provides all kinds of information regarding Medicare Part D Plans. If you are prescribed several medications or just one, they have a great search called Find A Drug Across All Plans. All you have to do is select your state and enter a drug name.  What you get is a listing of all the plans and the co-pay/tier level for that drug and even the monthly premium.  This is a great tool.

If you feel your Part D provider is not meeting the Medicare requirements to provide you with prescription drugs according to recognized standards of care or that might jeopardize your health and safety, CMS encourages you to contact 1-800-MEDICARE (1-800-633-4227) or the State Health Insurance Assistance Program (SHIP) to help get them resolved. Medicare enrollees, their families and their caregivers can contact a SHIP near them by visiting: http://www.medicare.gov/Contacts/staticpages/ships.aspx.