Subject to all the terms of the Medicare contract between MHP and the Centers for Medicare and Medicaid Services (CMS), all Mercy MedicareADVANTAGE members are entitled to the medical care, services, supplies and other medically necessary benefits covered under original Medicare (except hospice) and set forth in the member’s schedule of benefits and limitations.
These services and benefits are only available if they are:
Medically necessary; and
When indicated, prior authorization from MHP has been received.
Members are generally responsible for a nominal flat fee co-payment per physician office visit or coinsurance if accessing an out of network provider under the Mercy MedicareADVANTAGE PPO plan. Preventive services are covered at either a nominal or zero dollar co-payments. Members, based on benefit package selection, may be responsible for deductibles, co-insurance, and/or co-payments for other services.
Specific benefits are available in the member’s Evidence of Coverage, by calling Provider Relations at 314-214-8137 or 800-596-4315, or by accessing the Member’s Benefits through the Provider Connection, the secure provider portal at mercyhealthplans.com.