This survey is for physicians currently designated as Tier 1 in Horizon's OMNIA plans. Tier 2 physicians, please take our Tier 2 survey.

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* 1. Explain why you believe that you have been assigned to Tier 1.

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* 2. Has your Tier status been changed by Horizon at any time?

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* 3. Have you contacted Horizon for information regarding your Tier designation?

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* 4. If you answered yes to question #3, how helpful was the response?

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* 5. Has Horizon contacted you about:

  Yes No
Seeking privileges at a Tier 1 hospital?
Using Tier 1 hospitals more often?
Discontinuing privileges at a Tier 2 hospital?
Using Tier 2 hospitals less often?
Advising your patients of the difference in deductibles and co-pays, when using a Tier 1 versus a Tier 2 hospital?

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* 6. How has your Tier assignment:

  Significant increase Some increase No change Some decrease Significant decrease
How has your Tier 1 assignment affected your revenue?
How has your Tier 1 assignment affected your patient population?

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* 7. Have you:

  Yes No
Sought privileges at a hospital due to its Tier 1 designation?
Used a hospital more often due to its Tier 1 designation?
Discontinued privileges at a hospital due to its Tier 2 designation?
Used a hospital less often due to its Tier 2 designation?

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* 8. Have you been invited by Horizon to participate in its new Medicare Advantage program?

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* 9. Describe any information you received from Horizon about participation in the Medicare Advantage Program:

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* 10. Contact Information:

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