HBIG injections - Medicare patient

[Guest guest]

ANYONE???? I am still investigating but thought some of you might have a

quick answer too. How (or IS?) this treatment covered by Medicare for

liver transplant patients requiring monthly infusions. If you have had

experience with this would appreciate your response. THanks much!!

Craycraft

Transplant Financial Coordinator

University of Kansas Medical Center

Fax

lcraycraft@...

>>> " Hogan, " 01/03/2007 1:00 PM

>>>

I have always been under the understanding that Medicare will not pay

if secondary if you don't follow the rules of the primary payer. This

is also for non transplant related medical care if you have an HMO

policy and go to a hospital that does not participate with that

particular HMO, then Medicare will either not cover it at all or cover

at 20%. This goes way back to my billing days....

Hogan

Transplant Financial Coordinator

Lahey Clinic

41 Mall Rd.

Burlington, MA 01805

phone

fax

Re: primary vs. medicare

Interesting, I wonder if this is national or regional policy that they

will pay even if a pt is out-of-network. I wonder if they mean that will

pay what they would have paid if pt would have stayed in-network ....

Chaney

" McCardell "

Sent by: TxFinancialCoordinators

01/03/2007 12:32 PM

Please respond to

TxFinancialCoordinators

To

, <TxFinancialCoordinators >

cc

Subject

Re: primary vs. medicare

I was told by Medicare yesterday on a similar case that

Medicare will always pay if the transplant is medically necessary

(aren't they all) even if the pt has a primary that will not pay

because

you are out-of-network.

So you may want to just call Medicare and verify your situation.

McCardell

Transplant Financial Coordinator

University of Utah Health Care

>>> <mailto:mafi%40med.umich.edu> mafi@... 01/03 10:35 AM

>>>

Hi Dana,

To maximize his coverage for transplant, we would redirect the patient

to the designated transplant center for his transplant care.

Medicare

will not pay if the patient electively goes out of network with his

EGHP.

Thanks.

Marcia

Marcia J. Fisher

Sr. Transplant Financial Coordinator

Michigan Transplant Center

This message is confidential, intended for the named recipient(s). If

you receive this message in error, please notify the sender by email

or

at , and delete this email. Thank you.

>>> Dana T

1/3/2007 11:35 AM >>>

hello all,

I have a patient who has a primary GHP but because we are not a

designated transplant center for this company he has no benefits

through

this plan. He has Medicare as 2ndry. Will Medicare automatically

become primary or does there need to be a denial from the primary?

Which brings me to the drugs, his prescription coverage is under the

GHP

(no Medicare part D coverage) so will the Medicare also pick up the

meds

for the 3 years? thanks for any input! Have a great day!

Dana Trujillo

Transplant Financial Coordinator

Sioux Valley Transplant Center

Sioux Falls, SD

__________________________________________________

[Guest guest]

Our facility does HBIG infusions and

Medicare covers those…..IF it is the IM injections, we are not using that

protocol so I do not know about that.

Our patients are on HBIG infusions

lifetime

Debbie Mast

Supervisor, Senior

Transplant Financial Coordinator

Member, TFCA

Heart Failure, Heart, Lung, Heart/Lung,

Liver, Kidney, Pancreas, Intestinal Transplant Programs

Phone: Fax:

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Craycraft

Sent: Wednesday, January 03, 2007

12:05 PM

To:

TxFinancialCoordinators

Subject:

HBIG injections - Medicare patient

ANYONE????

I am still investigating but thought some of you might have a

quick answer too. How (or IS?) this treatment covered by Medicare for

liver transplant patients requiring monthly infusions. If you have had

experience with this would appreciate your response. THanks much!!

Craycraft

Transplant Financial Coordinator

University of Kansas

Medical Center

Fax

lcraycraftkumc (DOT) edu

>>> " Hogan, " <.M.HoganLahey (DOT) Org>

01/03/2007 1:00 PM

>>>

I have always been under the understanding that Medicare will not pay

if secondary if you don't follow the rules of the primary payer. This

is also for non transplant related medical care if you have an HMO

policy and go to a hospital that does not participate with that

particular HMO, then Medicare will either not cover it at all or cover

at 20%. This goes way back to my billing days....

Hogan

Transplant Financial Coordinator

Lahey Clinic

41 Mall Rd.

Burlington, MA 01805

phone

fax

Re: primary vs. medicare

Interesting, I wonder if this is national or regional policy that they

will pay even if a pt is out-of-network. I wonder if they mean that will

pay what they would have paid if pt would have stayed in-network ....

Chaney

" McCardell " <.McCardellhsc (DOT) utah.edu>

Sent by: TxFinancialCoordinators

01/03/2007 12:32 PM

Please respond to

TxFinancialCoordinators

To

<mafi@....edu>, <TxFinancialCoordinators >

cc

Subject

Re: primary vs. medicare

I was told by Medicare yesterday on a similar case that

Medicare will always pay if the transplant is medically necessary

(aren't they all) even if the pt has a primary that will not pay

because

you are out-of-network.

So you may want to just call Medicare and verify your situation.

McCardell

Transplant Financial Coordinator

University of Utah Health Care

>>> <mailto:mafi%40med.umich.edu> mafi@....edu 01/03 10:35 AM

>>>

Hi Dana,

To maximize his coverage for transplant, we would redirect the patient

to the designated transplant center for his transplant care.

Medicare

will not pay if the patient electively goes out of network with his

EGHP.

Thanks.

Marcia

Marcia J. Fisher

Sr. Transplant Financial Coordinator

Michigan

Transplant Center

This message is confidential, intended for the named recipient(s). If

you receive this message in error, please notify the sender by email

or

at , and delete this email. Thank you.

>>> Dana T < <mailto:danartru%40yahoo.com> danartru>

1/3/2007 11:35 AM >>>

hello all,

I have a patient who has a primary GHP but because we are not a

designated transplant center for this company he has no benefits

through

this plan. He has Medicare as 2ndry. Will Medicare automatically

become primary or does there need to be a denial from the primary?

Which brings me to the drugs, his prescription coverage is under the

GHP

(no Medicare part D coverage) so will the Medicare also pick up the

meds

for the 3 years? thanks for any input! Have a great day!

Dana Trujillo

Transplant Financial Coordinator

Sioux Valley Transplant

Center

Sioux Falls, SD

__________________________________________________