CALIFORNIA - Pacificare Health Systems

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Emergency Services
Urgently Needed Services
Out-of-area and routine travel renal dialysis
Call Customer Service Whenever You Need
Information
In addition to arranging health care services,
PacifiCare strives to provide the information
you need about your Secure Horizons Group
Retiree Medicare Advantage Plan when you
need it.
PacifiCare has specially trained Customer
Service Representatives who can answer your
questions about:
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Covered Services;
Making address or telephone number
changes;
Primary Care Physician selection or
changes;
Enrollment or Disenrollment;
Appeal and Grievance complaint rights;
Medical care when you are traveling;
The quality of care you are receiving;
Information concerning your Physician;
Questions about claims;
Welcome to the Secure Horizons Group
Retiree Medicare Advantage Plan
Any other questions or concerns regarding
your Secure Horizons Group Retiree
Medicare Advantage Plan.
Updating Your Membership Records
Your Secure Horizons Group Retiree MA Plan
membership record contains information
from your Election Form, including your
address and telephone number, as well as
your specific benefit plan coverage, Primary
Care Physician and the Contracting Medical
Group/IPA you selected upon enrollment.
These records are very important because
they identify you as an eligible Secure
Horizons Group Retiree Medicare Advantage
Plan Member and determine where and if you
are eligible to receive Covered Services.
Please report any changes in name, address
or phone number to Customer Service
immediately. You should also report any
changes in health insurance coverage you
have from your employer or your spouse’s
employer. Additionally, you should report any
liability claims (such as claims against another
driver in an auto accident), eligibility under
workers’ compensation, and MediCal or
Medicaid.
PacifiCare Is Interested in Your Comments
PacifiCare’s goal is to arrange the Covered
Services you need to stay as healthy and active
as you can. PacifiCare is interested in your
comments.
From time to time, PacifiCare will be asking
your thoughts on the Secure Horizons Group
Retiree Medicare Advantage Plan through
voluntary Member satisfaction surveys.
These surveys help PacifiCare measure the
performance of our Contracting Medical
Providers, as well as PacifiCare’s ability to
assist you with your health care coverage
concerns.
How to Submit a Claim
All Covered Services prescribed by PacifiCare
will be billed to either your Contracting
Medical Group/IPA or directly to the plan.
However, if you receive a bill for a Covered
Service or Emergency Service delivered by a
Non-Contracting Medical Provider and receive
a bill, please send the claim for determination
to:
PacifiCare of California
Claims Department
P.O. Box 489
Cypress, CA 90630
You are responsible for paying any applicable
Copayments or Coinsurance amounts directly
to the Provider at the time of service. If you
have any questions about any claims, please
call Customer Service.
Questions? Call the Customer Service Department at 1-800-228-2144,
(TDHI) 1-800-685-9355, Monday through Friday, 7:00 a.m. to 9:00 p.m.
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