PacifiCare boosting fees for Nevada Secure Horizons customers

Jace Radke

Friday, Sept. 15, 2000 | 11:13 a.m.

PacifiCare Health Systems Inc.'s Secure Horizons, the nation's largest Medicare health maintenance organization, wants to charge higher fees for 31,000 Southern Nevadans to help offset rising costs and what Horizon officials say is insufficient federal funding for Medicare.

The Santa Ana, Calif., company said the changes, set to start in 2001, are pending approval by the federal Health Care Financing Administration, But PacifiCare officials don't foresee any snags in getting the new higher co-payment rates approved.

The new co-payments will mainly hit Secure Horizons members in prescriptions, a health club benefit and urgent and emergency care. Urgent care co-payments will be raised from $10 to $20, and emergency room co-pays will jump from $35 to $50, Horizons spokeswoman Lori Nelson said.

Prescription co-payments have been increased between $2 to $5 depending on the type of drug. Members will also no longer receive free health club benefits and will instead have to pay a rate of $15 a month to use 24 Hour Fitness centers.

"I think the loss of the health club benefit is what will bother people the most," Nelson said. "But I think that was a trade-off in order to keep the premium at zero."

Along with prescription drug coverage without charging a monthly premium, other hospital co-payments and expensive benefits not covered by Medicare are unchanged from the provider's 2000 plan.

Dr. Brad Coats, president of PacifiCare of Nevada, said the price increases are part of the challenges created by the government's Medicare program.

"Medical inflation is a significant factor in designing our 2001 Secure Horizons benefit package and until more dollars are put back into the program by Congress, we're asking consumers to help us cover more of the cost," Coats said. "This is a problem Washington can fix if legislators truly want consumers to have more choice in Medicare now and in the future."

Officials of Sierra Health Services Inc. of Las Vegas, the largest medical insurer in Nevada, said Sierra's 2001 benefit packages will not see any major co-payment increases, except in the area of prescription drugs where there may be slight increases.

Jace Radke

is a reporter for the Las Vegas Sun. He can be reached at (702) 259-2318 or by e-mail at jace@lasvegassun.com.