How We Reimburse

POMCO will negotiate customized fee schedules when necessary. A sampling of PPO fee reimbursements may be obtained by calling POMCO's Customer Service Department for more information.

 

POMCO as Secondary Payer

Participating Provider Organization (PPO) benefits do not always apply for every health plan administered by POMCO, when another health plan or Medicare is the primary payer and POMCO is secondary. A summary of how each plan considers POMCO secondary payer claims is included in the general information grid. If participating benefits do not apply, benefit reimbursement will be at the usual, customary and reasonable allowance, subject to plan deductible requirements. PPO providers may bill the patient for only coinsurance or deductible amounts. If POMCO, as secondary payer, considers the benefit payment at the PPO scheduled rate, the provider is not obligated to wait until POMCO has processed the claim to collect payment from the patient. The participating provider may collect a reasonable payment from the patient at the time of visit and refund any overpayment in accordance with the PPO agreement, once POMCO's explanation of Benefits is received. The patient is only responsible for any applicable plan co-payment and non-covered services.