Gold Open (Private Fee for Service)
Plan Overview
What Health Care Providers need to know about Private Fee-For-Service plans
Sample Identification Card
Payment Methodology
Service Area
Frequently Asked Questions
Terms and Conditions Manual
Medicare Billing Guidelines
Appeals and Grievances (coming soon)
Contact Information
Plan Overview
Gold Open is a Medicare Advantage (MA) Private Fee For Service (PFFS) plan offered by Geisinger Indemnity Insurance Company, an affiliate of Geisinger Health Plan. Three options are available, based on county of residence.
Gold Open provides medical services through eligible providers in the United States who are willing to furnish services to MA PFFS enrollees. To be eligible, providers must be state licensed, have a Medicare billing number or be eligible to obtain one. Institutional providers such as hospitals or skilled nursing facilities must be Medicare-certified health care facilities. If a provider does not want to provide services to Gold Open members, the member must seek care from another Medicare participating provider who is willing to furnish services.
Geisinger Gold Reserve is a Medicare Advantage Medical Savings Account plan. Members of Gold Reserve can go to any doctor or hospital that accepts Medicare and agrees to see them.
Geisinger Gold Reserve is available statewide.
From the enrollee's perspective, Gold Open offers the freedom to choose doctors and hospitals, the ability to see specialists without a referral and to travel without losing coverage. Members continue to pay the Medicare Part B premium and are responsible for the Gold Open premium and any cost sharing, such as copayments or coinsurance.
Physicians, hospitals and other health care providers or suppliers do not sign an agreement with Geisinger Indemnity Insurance Company or Geisinger Health Plan. Providers are considered "deemed" a Gold Open approved provider when:
- they know in advance of providing services to a Gold Open member that the member is enrolled in Gold Open, and
- render services based on this knowledge, and
- have reasonable access to our Terms and Conditions.
Federal health care providers, including the Veterans Administration are not eligible for reimbursement from Gold Open except when providing emergency care.
Enrollees must live in the the service area to join the plan. All health plans in the Medicare program agree to stay with the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare health plan leaves the program, enrollee will not lose Medicare coverage. If a plan decides not to continue, you will receive ample notification before a member’s coverage will end.
Please call Gold Open Customer Service for more information about this plan at (800) 498-9731, Monday through Friday 8 a.m to 5 p.m.
Advantages of Geisinger Gold Open
This is not an HMO, but a fee-for-service Medicare Advantage plan.
Providers are reimburseed at rates equivalent to the Medicare allowable rates, less any member cost-sharing amounts for covered services. Please refer to the Terms and Conditions and member cost sharing list for more information.
Physician, hospitals and other health care providers do not sign an agreement with the Geisinger Health Plan or Geisinger Indemnity Insurance Company, but, need to be licensed or certified by the state, acting within their scope of license or certification and not be sanctioned or have opted our of Medicare.
Precertification, prior authorization and referrals are not required.
Claims can be filed electronically. Gold Open adheres to federal prompt payment requirements and processes at least 95% of all clean claims in 30 or fewer days. If for some reason clean claims cannot be paid within 30 days, interest will be paid.
Full coverage for Gold Open members while traveling throughout the United States.
Local health plan.
Members have the Open of enrolling in our prescription drug coverage.
Free fitness center membership and health and wellness programs.
Residents of the following Pennsylvania counties are eligible to enroll in a Geisinger Gold Open plan:
Berks, Bradford, Carbon, Centre, Clearfield, Clinton, Columbia, Cumberland, Dauphin, Huntingdon, Lackawanna, Lancaster, Lebanon, Luzerne, Lycoming, Montour, Northumberland, Snyder, Sullivan, Tioga, Union, Wyoming, York, Adams, Blair, Cambria, Jefferson, Juniata, Lehigh, Mifflin, Monroe, Northampton, Perry, Pike, Potter, Schuylkill, Susquehanna, Wayne
Contact Geisinger Gold Open Customer Service Team
(800) 498-9731 or (570) 271-8771, Monday through Friday, 8 a.m. to 5 p.m.
Provider Network Management
Danville: (800) 876-5357
Harrisburg: (888) 281-5338
Scranton: (800) 350-6486
State College: (888) 669-4834
