Re: primary vs. medicare

[Guest guest]

Hi Dana,

If this patient has benefits for

transplant but chooses to use an out of network facility, Medicare will not

cover the transplant. If he had no transplant benefit, Medicare would pay

as primary with a denial from the primary plan.

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 Dana T

Sent: Wednesday, January 03, 2007

8:35 AM

To:

TxFinancialCoordinators

Subject:

primary vs. medicare

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]

thanks Debbie !! I guess I was on the wrong page with that one ! :)"Mast, Deborah" wrote: Hi Dana, If this patient has benefits for transplant but chooses to use an out of network facility, Medicare will not cover the transplant. If he had no transplant benefit, Medicare would pay as primary with a denial from the primary plan. 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 Dana TSent: Wednesday, January 03, 2007 8:35 AMTo: TxFinancialCoordinators Subject: primary vs. medicare 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]

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]

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

>>> 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]

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

>>> 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]

It's been my experience, if you do not follow the guidelines of your primary, Medicare will deny. In the case of a plan with NO out of network transplant benefits, Medicare will deny. In the case with out of network transplant benefits, Medicare will pay. I haven't had Medicare deny any of ours that use their out of network benefits. If they have NO out of network transplant benefits, I redirect to a network center.

Kreci Transplant Financial Coordinator Southwest Florida Regional Medical Center 2727 Winkler Ave Fort Myers, FL 33910

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-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of McCardellSent: Wednesday, January 03, 2007 1:01 PMTo: mafi@...; TxFinancialCoordinators Subject: Re: primary vs. medicare

I was told by Medicare yesterday on a similar case thatMedicare will always pay if the transplant is medically necessary(aren't they all) even if the pt has a primary that will not pay becauseyou are out-of-network.So you may want to just call Medicare and verify your situation. McCardellTransplant Financial CoordinatorUniversity of Utah Health Care >>> mafi@....edu 01/03 10:35 AM >>>Hi Dana, To maximize his coverage for transplant, we would redirect the patientto the designated transplant center for his transplant care. Medicarewill not pay if the patient electively goes out of network with hisEGHP. Thanks. Marcia Marcia J. Fisher Sr. Transplant Financial CoordinatorMichigan Transplant Center This message is confidential, intended for the named recipient(s). Ifyou receive this message in error, please notify the sender by emailorat , and delete this email. Thank you. >>> Dana T <danartru> 1/3/2007 11:35 AM >>>hello all,I have a patient who has a primary GHP but because we are not adesignated transplant center for this company he has no benefitsthroughthis plan. He has Medicare as 2ndry. Will Medicare automaticallybecome primary or does there need to be a denial from the primary? Which brings me to the drugs, his prescription coverage is under theGHP(no Medicare part D coverage) so will the Medicare also pick up themedsfor the 3 years? thanks for any input! Have a great day! Dana TrujilloTransplant Financial CoordinatorSioux Valley Transplant CenterSioux Falls, SD__________________________________________________