Insurance and Billing

Insurance: The PACE program becomes the insurer for enrollees. Enrollees no longer use their Medicare and, if eligible Medicaid cards when accessing approved health services. The PACE program will provide each enrollee with a PACE insurance card. Clients do not pay premiums when enrolled in the PACE program.

Cost Share: Clients may have a cost share if their income assets exceed Oklahoma Medicaid limits. If a client is determined to be over in assets by Medicaid, they must pay a monthly “cost share” to PACE for services. The State Department of Human Services (DHS) determines the amount of cost share a client pays to PACE per month to cover costs of their care.

Billing: Participants are billed for services provided if services are not approved by the Interdisciplinary Team and/or deemed medically necessary by the Interdisciplinary team.

Vendors/ Professionals: Professionals that provide approved services to PACE enrollees can submit invoices /claims to the billing office using the criteria set forth in the providers contract. Questions regarding billing and payment can be directed to the billing department by calling the main number.

PACE participants may be fully and personally liable for the costs of unauthorized or out-of-network services.