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Medicare Benefits

Contact Info

Medicare Claims Analysts
252-522-7805
252-522-7165

Email:
pfs@lenoir.org

“Medical Necessity” is a term that has been used in recent years by Medicare and may not be familiar to you. “Medical Necessity” means that there are procedures and services physicians may prescribe for you that they may feel are necessary to manage your health. However, Medicare may not pay for certain services based up on their policies.

In the past, Medicare has covered most procedures. With the emergence of MRI, CT Scan, and other sophisticated and costly services  and procedures as the diagnostic methods of choice, it is important for you to know what procedures and services will be covered by asking your physicians and or Medicare. We also encourage you to discuss with your physicians other treatment options available to you that may give them the information that they need to treat you. If your physician orders a procedure or service that Medicare may not cover, you may be asked to sign an Advance Beneficiary Notice (ABN). The ABN informs you in advance that Medicare is not likely to pay for the procedure or service, and that you will be responsible for payment. By signing the ABN, you are indicating that you understand and agree to be personally and fully responsible for payment.

Medicare beneficiaries are responsible for deductibles and co-insurance. If you receive services as an outpatient or in outpatient observation, you will be billed for non-covered oral drugs and some injectable drugs that fall under the category of Self-Administered. Please refer to the online version of National Medicare Handbook at www.medicare.gov or call 1-800-633-4227 if you need more information.

Do You Have Any Options?

You can agree to be financially responsible for the procedure by signing the ABN form, or you can refuse the test or services. If you refuse the test or services, you will also be asked to sign a form indicating you’ve elected not to have the service. If you request the services and will not sign the ABN, you will still be responsible for payment. If you need services that are not covered by Medicare, you will be responsible for payment. You have the right to appeal a Medicare decision not in your favor. If you would like to appeal a Medicare decision, or have other Medicare questions, please contact the Medicare beneficiary hotline at 800-633-4227.

 
CAREER OPPORTUNITIES

Questions About Humana?

Dear Participant,

It has come to our attention that you may have recently received communication from Humana regarding UNC Lenoir Health Care's out-of-network status with its Medicare Advantage PPO plans.  We are concerned that information provided in that letter may have led to unnecessary anxiety or confusion for some members of our community.  Therefore, we are writing to you in an effort to clarify what out-of-network status with these plans means for participants.

 

First and foremost, it is important to note that all patients with Humana Medicare Advantage PPO plans may continue to be seen at UNC Lenoir Health Care. For many individuals, including those who have coverage through the North Carolina State Health Plan, no change should be apparent; your deductibles and copayments will not change, and benefits for in-network and out-of-network services are the same.

 

Participants in other versions of Humana's Medicare Advantage PPO plans may see increases in some copayments or deductibles, depending on the plan in which you are enrolled and the services you receive. As noted on Humana's website, "With a HumanaChoice (PPO) plan, you enjoy freedom to choose any doctor or hospital - but you pay less for services received from in network providers."

 

The following links may be helpful for those seeking to clarify the benefits offered by their plans:

Should you have further questions regarding your coverage, we would be happy to assist you.  Please call us at 252-522-7857 or 252-522-7676 Monday - Friday from 9:00 a.m. - 5:00 p.m.  Click on read more for Frequently Asked Questions.

We apologize for any concerns that information you have received from Humana may have caused. UNC Lenoir has been in continuous contact with Humana regarding our network status.  Our relationship with our patients and community is our highest priority, and we look forward to continuing to be of service to you and your family.

 

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New Year = New You! at the Minges Wellness Center

Special 2017 Minges Wellness Center Offer - New individuals who wish to join on Tuesday, January 10 between 8 am and 8 pm will NOT have to pay the $10 enrollment fee.  Membership is only $20 a month and no contract - ever. Call 252-522-7014 for more information.

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HealthLink - Fall 2016

Check out the latest edition of the Lenoir HealthLink! Download the PDF...

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Be Informed About Mental Health Crisis Resources in Lenoir County

Mental Health Crisis:

24/7 Crisis Services for Lenoir County are available by calling Eastpointe Access Center at 1-800-913-6109 or for TTY-888-819-5112.  Customer Service  Specialists will assist you in finding a crisis provider.

Mobile Crisis Teams are available 24 hours a day.  Professional counselors will speak with you and your family during a visit.  They have an average response time of 2 hours.  This service is provided by Easter Seals - UCP 800-913-6109.

The crisis center in Lenoir County is provided by, PORT Human Services, located at 2901 N. Heritage Street in Kinston.  252-233-2383.  Appointments are not needed for crisis assessment and referral services, Monday - Friday 8 a.m. to 5 p.m.

Suicide:

To be connected to a skilled, trained counselor at a crisis center in your area 24/7 call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255)

The 24/7 National Suicide Prevention Lifeline Network for Lenoir County is provided by REAL Crisis Intervention by calling 252-758-4357 for free couseling and extensive referral services.

Call 911 if there is a medical or life threatening emergency.

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Keep Your Employees Healthy!

Providing onsite flu vaccinations for your employees is one way to prevent absenteeism during the upcoming flu season. Schedule the UNC Lenoir Health Care corporate health nurses to come to your worksite and administer the vaccine to your employees while at work.  Contact Sonia Joyner, RN, MSN Corporate and Community Health coordinator at 252-522-7397 or sjoyner@lenoir.org to schedule your appointment today.  Costs include $25.00 for each flu vaccination ad fees associate with mileage costs and staff administration of vaccines.

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2017 Colorectal Cancer Screening Dates

This free clinic is for men & women age 40 and up who have never been screened for or had colorectal cancer. The clinic will be led by members of the WellAware team and the UNC Lenoir Gastro staff. Screening sponsored by the Lenoir Foundation. Call 252-522-7014 to complete required registration.

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Overcoming Fitness Fears

Have you always wanted to get in shape but were afraid to try? There are countless excuses for failing to exercise or eat right. However, one of the biggest obstacles is not knowing where to start and being scared to take that first step. Join Brittney for this informative talk.

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Life After Stroke Support Group

Stroke survivors and caregivers, please bring your own experiences to a discussion with other survivors on life after stroke, transition from hospital to home, and re-entering the communtiy. It's FREE.  If you have had a stroke, or are a caregiver of a loved one who is struggling with stroke issues and would like to come for encouragement, join us.  The quarterly support group is led by UNC Lenoir Health Care Stroke Coordinator, Dawn Becker, RN, who may be reached for more information at 252-522-7575. 

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Avoiding Holiday Hang-ups

This program is for people with diabetes and pre-diabetes.  Sandra will offer meal planning tips, exercise suggestions, and ideas on how you might deal with sickness and/or avoid sickness during the holidays.  All advice is designed to help you have an enjoyable Thanksgiving and Christmas.  For more information contact Sandra Midyette, RN, CDE, at 252-522-7616.

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Your Blood Pressure: Reaching the Target 2016 classes

A one hour basic hypertension educational class for anyone who has higher than normal blood pressure and needs to understand the condition better in order to have good blood pressure control.  Class size is limited and credit for attendance requires the participant to be present for the full session. Registration must be done by contacting Gail Carraway at 252-522-7014. Dates and Times - Jan 11 at 2 p.m., Feb 9 @ 10 a.m., March 7 @ 10 a.m., Apr 12 @ 10 a.m., May 24 @ 2 p.m., June 13 @ 2 p.m., July 13 @ 2 p.m., Aug 29 @ 10 a.m., Sept 14 @ 1 p.m., Oct 12 @ 1 p.m., Nov 9th @ 1 p.m. and Dec 7 @ 1 p.m.

 

 

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