PHYSICIANS UNITED PLAN, INC.


    Company Information

  • Company Demographic Information
    Name of Company:
    PHYSICIANS UNITED PLAN, INC.
    Case Number:2014 CA 1472
    Guaranty Association:
    None
    Type of Coverage:
    Health Maintenance Organization
    State of Domicile:
    Florida
    Status of Receivership:
    Liquidation
    Important Receivership Dates
    Date of Rehabilitation:
    June 09, 2014
    Date of Liquidation:
    July 01, 2014
    Policy Cancellation Date:July 01, 2014
    Claims Filing Deadline:
    June 09, 2015
    Objection Deadline:
    See Below


  • Notice of Receivership

    ​On June 9, 2014, Physicians United Plan, Inc. (“PUP”) was ordered into receivership for purposes of rehabilitation by Judge Charles A. Francis of the Second Judicial Circuit Court in Leon County, Florida. The Florida Department of Financial Services is the court appointed Receiver of PUP. PUP was ordered liquidated effective July 1, 2014.


  • Background Information

    PUP was a health maintenance organization that obtained its Florida license in 2005 and began operations in January 2006. Headquartered in Orlando, Florida, PUP was a Medicare Advantage Prescription Drug HMO of approximately 50,000 Medicare subscribers. Medicare premiums and contracts are administered through a federal agency, the Centers for Medicare and Medicaid Services ("CMS").

    As a result of the liquidation of Physicians United Plan, Inc. (PUP) and termination of its contract with CMS, CMS retroactively enrolled all PUP members into Original Medicare Fee-for-Service (FFS) and a Prescription Drug Plan (PDP) effective June 1, 2014


  • Special Election Period

    As a result of the receivership of PUP, all beneficiaries enrolled in PUP had a Special Election Period until August 31, 2014 to enroll in a plan of their choosing. All dual eligible or those eligible for the Low Income Subsidy could have enrolled in another plan at any time. A beneficiary who selected another Medicare Advantage or Medicare Advantage-Prescription Drug plan was covered under the new plan effective the first day of the next month after they enrolled.


  • JULY 1, 2014 LIQUIDATION OF PUP HEALTH PLAN, INC.

    ​PUP was ordered liquidated effective 12:01 a.m. on July 1, 2014.


  • JULY 13, 2018, Notices of Determination Mailed

    The Division sent 53 Notices of Determination (NODs) to medical providers and other claimants with Class 2 through Class 8 claims. The NODs were sent via the US Postal Service. These NODs inform the claimants of the evaluation and recommendation made on their filed claim. The process by which an objection to class or amount may be filed is described in the NOD. The Objection filing deadline is September 21, 2018.


  • January 11, 2019, NODs mailed for PUP

    ​The Division sent 28 Notices of Determination (NODs) to medical providers and other claimants. The NODs were sent via the US Postal Service. These NODs inform the claimants of the evaluation and recommendation made on their filed claim. The process by which an objection to class or amount may be filed is described in the NOD. The Objection filing deadline is March 12, 2019.


  • Fourth interim claims report Notices of Determination mailed, objection filing deadline established

    ​14 Notices of Determination (NODs) mailed to claimants on April 11, 2019.  The Objection filing deadline is June 10, 2019.


  • September 9, 2019, NODs mailed for PUP

    ​On September 9, 2019, the Department mailed 3 Notices of Determination (NODs) to medical providers and another claimant.  The NODs were sent via the US Postal Service.  These NODs inform the claimants of the evaluation and recommendation made on their filed claim.  The process by which an objection to class or amount may be filed is described in the NOD.  The Objection Filing Deadline is November 8, 2019.


  • September 16, 2020

    ​On September 16, 2020 the Department mailed 12 Notices of Determination (NODs) to the remaining claimants.  The NODs were sent via the US Postal Service.  These NODs inform the claimants of the evaluation and recommendation made on their filed claim.  The process by which an objection to class or amount may be filed is described in the NOD.  The Objection Filing Deadline is October 26, 2020.



  • Claims Information

  • General Information

    ​On September 22, 2017, the order approving the 1st Interim Claims Report was signed by the judge assigned to the Physicians United Plan, Inc. receivership. Notices of Determination (NODs) were mailed to all evaluated claims in classes 2-8 on October 17, 2017. Each NOD has a claims evaluation code listed on it that provides the basis of how the claim was evaluated. For a list of evaluation codes and their descriptions, please click here.


  • Important Information for Medical Fee-For-Service Providers - Updated August 25, 2016

    The Receiver entered into a contract with a third-party administrator, MED3000 Health Solutions Southeast, to handle the processing of PUP unpaid claims.

    On August 25, 2016, the Receiver sent notices with claim filing instructions to all known Medical Fee-For-Service Providers who may have claims unpaid by PUP. These notices were sent by email to the email on file with the NPPES database or by regular mail if no email was available. If you have not received a notice, please contact MED3000 Health Solutions Southeast by email, fl-customerservice@mckesson.com or by phone at (844) 636-7501. Always include the provider name, tax ID and the NPI in your inquiry.

    The Claim Filing Deadline for all Medical Providers was October 31, 2016


  • Court Orderded Claims Filing Bar Date established

    No new claims will be accepted by the Receiver effective March 29, 2019.  See Related Documents to review Motion and Order.


  • I am owed money for services provided before PUP was ordered into receivership. What is the procedure for payment of these claims?

    On August 26, 2016, the Department sent approximately 17,890 Provider Notices regarding claim filing instructions.  The majority were sent by regular postal mail and the remainder were sent via email message instructing medical providers to submit their outstanding claims against Physicians United Plan, Inc. (PUP). The deadline to submit outstanding claims is October 31, 2016,


  • I have provided services after the company was placed into receivership to a member of PUP. Who is responsible for paying these bills?

    ​The company, Physicians United Plan, Inc. is responsible for paying services provided under the terms of its member agreements for claims occurring before June 1, 2014.  Under Section 641.3154, Florida Statutes, HMO members/subscribers are not liable to any provider of health care services for any services covered by the HMO.


  • Can Providers seek payment from former members/subscribers for debt owed by PUP for medical services?

    ​No.  Under Section 641.3154, Florida Statutes, HMO subscribers are not liable to any provider of health care services for any services covered by the HMO. Additionally, health care providers and their representatives are prohibited from attempting to collect payment from the HMO subscribers for such services.  If you are contacted by a health care provider for such payment, you should inform the provider of this law. 


  • Claim Evaluation Codes

    Claim Evaluation Codes can be found here on the Division's website.



  • Contact Information

  • Contact Information

    ​For Medicare information: If you need more information regarding your retroactive Medicare enrollment, Medicare in general, other Medicare Advantage plans, or coverage options from 12:01 a.m. on June 1, 2014, please visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227). Please also call this number if you have not received a letter from CMS but think you should have. TTY users should call 1-877-486-2048. A Customer Service Representative will be able to answer your Medicare questions. For Medicare Supplement information: If you need information regarding Medicare Supplement options, please contact the Department of Financial Services at 1-877-693-5236 (Florida only) or 850- 413-3089. For Receivership information: For additional information about the PUP Receivership, or about the receivership process in general, please contact the Receiver by calling the Florida Department of Financial Services at 1-800-882-3054 (Florida only) or 850-413-3081 or use the "Contact Us" form found on the Receiver's website at www.myfloridacfo.com/division/receiver.



  • Frequently Asked Questions

  • Important Update for Medical Fee-For-Service Providers - August 25, 2016

    The Receiver entered into a contract with a third-party administrator, MED3000 Health Solutions Southeast, to handle the processing of PUP unpaid claims. 

    On August 25, 2016, the Receiver sent notices with claim filing instructions to all known Medical Fee-For-Service Providers who may have claims unpaid by PUP. These notices were sent by email to the email on file with the NPPES database or by regular mail if no email was available. If you have not received a notice, please contact MED3000 Health Solutions Southeast by email, fl-customerservice@mckesson.com or by phone at (844) 636-7501. Always include the provider name, tax ID and the NPI in your inquiry. 

    The Claim Filing Deadline for all Medical Providers is October 31, 2016 

    Note: The filing proof-of-claim and deadline waiver applied to Medical Providers only. All other claimants must have submitted the proof-of-claim form and supporting documentation by the June 9, 2015 deadline.


  • Do I have health care coverage now?

    ​YES. CMS retroactively enrolled all PUP members into Original Medicare Fee-for-Service (FFS) and a Prescription Drug Plan (PDP) effective June 1, 2014. CMS mailed each PUP member a separate letter regarding this retroactive enrollment and the member's options for continued health care coverage from July 1, 2014. If you did not receive the letter from CMS or have any questions about your continued health care coverage, you should call 1-800-MEDICARE (1-800-633-4227).

    REMEMBER: Benefits received under PUP may not be the same as those received under Original Medicare FFS. You may find that you are responsible for paying for a portion or all of the services you obtained starting June 1, 2014, while under Original Medicare FFS until you obtain a replacement Medicare Advantage plan or purchase a Medicare Supplement. Again, please call 1-800-MEDICARE (1-800-633-4227) to discuss your options with CMS.


  • Can Providers seek payment from PUP members for debt owed by PUP for medical services?

    ​No. Under Section 641.3154, Florida Statutes, HMO members are not liable to any provider of health care services for any services covered by the HMO. Additionally, health care providers and their representatives are prohibited from attempting to collect payment from the HMO members for such services. If you are contacted by a health care provider for such payment, you should inform the provider of this law. You may also want to send a letter regarding this problem, with a copy of any bills you receive from such providers, to the Receiver of Physicians United Plan, Inc., at 325 John Knox Road, Atrium Building, Suite 101, Tallahassee, FL 32303. If the provider or his representatives continue to pressure you for payment, please contact the Receiver at 1-800-882-3054 (Florida only) or 850-413-3081. Although the Receiver cannot represent you against the provider, we can assist you in informing the provider of the relevant laws.

     PLEASE NOTE, HOWEVER:  Benefits received under PUP may not be the same as those received under Original Medicare FFS. So while you should not be billed for services prior to June 1, 2014, for which PUP would have paid, you may find that you are responsible for paying for a portion or all of the services you obtained starting June 1, 2014, while under Original Medicare FFS until you obtain a replacement Medicare Advantage plan or purchase a Medicare Supplement. Again, please call 1-800-MEDICARE (1-800-633-4227) to discuss your options with CMS.


  • Why is additional premium being deducted from my social security check?

    ​PUP provided Monthly Medicare Part B rebates on some of their health plans. Once CMS retroactively disenrolled the PUP members and placed them in Original Medicare FFS as of 6/1/14, the PUP members were no longer eligible for those rebates.  Thus CMS will deduct those premium payments from monthly benefit checks beginning in June 2014.


  • Can I be billed for services filed under Original Medicare Fee For Service (FFS) beginning 06/01/2014?

    ​Yes.  Under Original Medicare FFS, members are responsible for 20% coinsurance.  Additionally, certain services are not covered under Original Medicare FFS (such as preventative dental services, routine eye exams, - glasses and transportation).  For further questions regarding coverage under Original Medicare FFS, please call 1-800-MEDICARE (1-800-633-4227).

    For additional information about the PUP Receivership, or about the receivership process in general, please contact the Receiver by calling the Florida Department of Financial Services at 1-800-882-3054 (Florida only) or 850-413-3081 or use the "Contact Us" form found on the Receiver's website at www.myfloridacfo.com/division/receiver.



  • Policy and Coverage Information

  • POLICY CANCELLATION

    ​By Court Order, effective at 12:01 a.m. on July 1, 2014, PUP was ordered liquidated. As a result of the impending of Physicians United Plan, Inc. (PUP) and termination of its contract with CMS, CMS retroactively enrolled all PUP members into Original Medicare Fee-for-Service (FFS) and a Prescription Drug Plan (PDP) effective June 1, 2014. You should very carefully read any letters you receive from the Receiver or CMS. These letters will provide you with extremely important information regarding the continuation of your health care coverage, including arrangements made for continued prescription drug coverage, and will explain your other Medicare options.

    Beneficiaries currently in the hospital or receiving treatments such as chemotherapy, dialysis, or organ transplantation are able to continue with such care. Remember, you will need to closely read the information and follow any instructions which are provided in letters you receive from CMS regarding your continued health care and prescription drug coverage after June 1, 2014.


  • SPECIAL ELECTION PERIOD

    As a result of the receivership of PUP, all beneficiaries enrolled in PUP have a Special Election Period until August 31, 2014 to enroll in a plan of their choosing. All dual eligible or those eligible for the Low Income Subsidy can enroll in another plan at any time. A beneficiary that selects another Medicare Advantage or Medicare Advantage-Prescription Drug plan will be covered under the new plan effective the first day of the next month after they enroll. Please contact 1-800-MEDICARE (1- 800-633-4227) for more information regarding these matters and/or to make a new plan selection.

    A few more points/reminders about your health care coverage from June 1, 2014:

    • As a result of the liquidation of Physicians United Plan, Inc. (PUP) and termination of its contract with CMS, CMS has retroactively enrolled all PUP members into Original Medicare FFS and a Prescription Drug Plan effective June 1, 2014.

    • If you have any difficulty in obtaining prescriptions, please ask your pharmacist to assist you by doing an "electronic lookup" for your name/new pharmacy plan on the Medicare system to which they have access.

    • The Receiver emailed a notice to all of PUP's medical providers which informed them of the retroactive enrollment and the Special Election Period. This notice:

    o Advised providers who have delivered services to members on or after June 1, 2014 to submit claims for those services to CMS under Medicare Fee-for-Service.

    o Advised providers who were reluctant to provide health services to PUP members to continue to see those individuals and submit the claims for such services to CMS under Original Medicare for payment.



  • Provider Information

  • August 25, 2016 - Important Claim Information Update for Medical Fee-For-Service Providers

    The Receiver entered into a contract with a third-party administrator, MED3000 Health Solutions Southeast, to handle the processing of PUP unpaid Provider claims. 

    On August 25, 2016, the Receiver sent notices with claim filing instructions to all known Medical Fee-For-Service Providers who may have claims unpaid by PUP. These notices were sent by email to the email on file with the NPPES database or by regular mail if no email was available. If you have not received a notice, please contact MED3000 Health Solutions Southeast by email, fl-customerservice@mckesson.com or by phone at (844) 636-7501. Always include the provider name, tax ID and the NPI in your inquiry. 

    The Claim Filing Deadline for all Medical Providers is October 31, 2016


  • As of August 18, 2014

    ​As a result of the liquidation of Physicians United Plan, Inc. (PUP) and termination of its contract with CMS, CMS retroactively enrolled all PUP members into Original Medicare FFS and a Prescription Drug Plan effective June 1, 2014.

    Providers who have delivered services to members on or after June 1, 2014 should submit claims under Medicare Fee for Service.

    Providers with any questions regarding this retroactive enrollment for billing should contact Medicare directly at 1-800-MEDICARE (1-800-633-4227).



  • Financial Statements

  • The following documents are provided as Adobe Acrobat PDF files and are best viewed using the free Adobe Acrobat reader software.

    DateTitleSize
    03/31/2021Financial Statement293K
    12/31/2020Financial Statement584K
    09/30/2020Financial Statement 676K
    06/30/2020Financial Statement199K
    03/31/2020Financial Statement131K
    12/31/2019Financial Statement289K
    09/30/2019Financial Statement291K
    06/30/2019Financial Statement1,921K
    03/31/2019Financial Statement289K
    12/31/2018Financial Statement281K
    09/30/2018Financial Statement274K
    06/30/2018Financial Statement649K
    03/31/2018Financial Statement158K
    12/31/2017Financial Statement629K
    09/30/2017Financial Statement620K
    06/30/2017Financial Statement618K
    03/31/2017Financial Statement639K
    12/31/2016Financial Statement668K
    09/30/2016Financial Statement80K
    06/30/2016Financial Statement75K
    03/31/2016Financial Statement82K
    12/31/2015Financial Statement76K
    09/30/2015Financial Statement76K
    06/30/2015Financial Statement170K
    03/31/2015Financial Statement170K
    12/31/2014Financial Statement79K
    09/30/2014Financial Statement200K
    03/31/2014NAIC Quarterly Statement383K

     



  • The following documents are provided as Adobe Acrobat PDF files and are best viewed using the free Adobe Acrobat reader software.

    Court Documents

    DateTitleSize
    09/10/2020Order Approving Receiver's Motion for Approval of Sixth Interim Claims Report and Recommendations on Claims534K
    09/09/2020Receiver's Motion for Approval of Sixth Interim Claims Report and Recommendation on Claims306K
    08/28/2019ORDER approving DFS's 5th Interim Claims Report and Recommendation on Claims 08.28.19111K
    08/27/2019Motion For Court Approval of 5th Interim Claims Report 08.27.192,902K
    03/29/2019Order Granting Department's Motion for Court to Set Claims Bar Date479K
    03/22/2019Department's Motion for Court to Set Claims Bar Date687K
    03/18/2019Motion for Court Approval of Fourth Interim Claims Report 03.18.192,690K
    03/18/2019Order Approving DFS 4th Interim Claims Report and Recommendation on Claims 03.18.191,108K
    12/19/2018Receiver's Motion for Approval of Third Interim Claims Report and Recommendation on Claims2,718K
    12/19/2018Order Approving Receiver's Third Interim Claims Report and Recommendation on Claims1,113K
    06/25/2018ORDER APPROVING DEPARTMENT'S SECOND INTERIM CLAIMS REPORT AND RECOMMENDATION ON CLAIMS 6.25.18625K
    06/22/2018Motion for Court Approval of Second Interim Claims Report 6.22.18392K
    09/22/2017Order Approving Department's First Interim Claims Report and Recommendation on Claims76K
    09/21/2017Department's Motion for Court Approval of First Interim Claims Report100K
    05/14/2015Order Approving Procedure of Deeming Medical Provider Claims as Filed397K
    05/13/2015Receiver's Motion for an Order Approving Procedure of Deeming Medical Provider Claims as Filed19K
    06/09/2014Consent Order Appointing the Florida Department of Financial Services as Receiver For Purposes of Immediate Rehabilitation and Automatic Liquidation Effective July 1, 2014, Injunction, and Notice of Automatic Stay2,366K
    06/05/2014Petition For Order Appointing the Florida Department of Financial Services as Receiver For Purposes of Immediate Rehabilitation and Automatic Liquidation Effective July 1, 2014, Injunction, and Notice of Automatic Stay2,506K

     

    Notices

    DateTitleSize
    08/25/2016Notice to Capitated and PBM Providers70K
    08/25/2016Notice to MSO Providers70K
    05/13/2016Seventh Notice to Medical Providers89K
    05/27/2015Notice to Providers130K
    05/27/2015Sixth Notice to Medical Providers130K
    08/07/2014Notice to Agents (Spanish Version)55K
    08/07/2014Notice to Agents (English Version)74K
    07/24/2014Fifth Notice to Medical Providers77K
    06/26/2014Fourth Notice to Medical Providers231K
    06/25/2014Third Notice to Medical Providers92K
    06/20/2014Notice to Members (English Version)87K
    06/20/2014Notice to Members (Spanish Version)101K
    06/19/2014Second Notice to Medical Providers74K
    06/13/2014First Notice to Medical Providers49K

     



DIVISION DIRECTOR

Toma Wilkerson


Division of Rehabilitation and Liquidation
325 John Knox Road
Atrium Building, Suite 101
Tallahassee, FL 32303

1-800-882-3054

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