Guest guest Posted July 30, 2007 Report Share Posted July 30, 2007 Since the immunosuppressants are a Medicare allowable under Part B, would the patient’s BC medical policy cover part or all of the 20%? Barbara Barbara Cochrane, MSN, RN Transplant Financial Coordinator Mercy Medical Center—Des Moines Fax: bcochrane@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Aguiar, J. Sent: Friday, July 27, 2007 2:36 PM To: TxFinancialCoordinators Subject: RE: Coverage of immunos If there is no Rx coverage thru the BC, then her immunos would be thru Part B (@ 80%) & the rest of her drugs thru Humana. However, she will be responsible for the 20% Part B doesn't cover & no, that can't be balance billed into Humana. So, make sure your pt knows she will have significant out of pocket costs for the immunos because of the way her BC is structured. J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Dana T Sent: Friday, July 27, 2007 12:29 PM To: TxFinancialCoordinators Subject: RE: Coverage of immunos ok..last question and then I think I have my head on straight...my patient says she doesn't have prescription coverage through BCBS..she only has her Humana part D...will part B then pay for immuno drugs even though Medicare isn't primary ?? thanks for all the help!! I would be lost without everyone's input as I have no one in my hospital who has any idea what I do !! " Aguiar, J. " <Aguiar.Mayo (DOT) Edu> wrote: No, you're not off base-while the pt has other ins, the immunos would fall under the commercial plan BUT when the day comes that Medicare is primary, then coverage for the immunos will be under Part B, because the pt had Part A @ the time of tx, vs. getting them under the Part D plan. Hope this helps, J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Dana T Sent: Friday, July 27, 2007 11:17 AM To: TxFinancialCoordinators Subject: RE: DX start date after age 65 thanks that does help but I still have another question about this..if the BCBS is now the primary doesn't the drug coverage go through them? In some way I have become confused thinking that Medicare B only pays for the immuno drugs if Medicare is primary at the time of transplant otherwise they need to be paid through the GHP coverage. Am I totally off base on that ?? this is my 1st situation like this and I think I've just got myself confused on who pays what when... thanks again ! " Aguiar, J. " <Aguiar.Mayo (DOT) Edu> wrote: Dana, the Part B piece comes because she has Medicare part A @ the time of tx, so regardless of whether Medicare is primary or 2ndy, her coverage for immunos, as far as Medicare & the Part D plans are concerned, will always come thru Part B. The Part D plan only picks up immunos when the pt didn't have at least Medicare Part A @ the time of tx so there was no Part B coverage available for the immunos. Hope this helps, J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Dana T Sent: Friday, July 27, 2007 10:53 AM To: TxFinancialCoordinators Subject: Re: DX start date after age 65 Hi all, I kind of have the same situation I am confused about..my patient is 70 years old and her husband started working for a grocery store and she now has BCBS since 2/1/2007 and they say the BCBS is primary and her Medicare is 2ndry. She has a Humana part D plan and when I called to confirm the drug coverage they told me her Part B would be paying for them. WIll part B still pay for immuno drugs is she has the BCBS as primary?? it goes back to the response below where they think Medicare is primary due to age. If that is the case why does BCBS think they are primary?? thanks !! Dana Trujillo Financial Coordinator Sanford Transplant Center Sioux Falls, SD Patti Montemayor <PMontemayorSWMail (DOT) SW.Org> wrote: i love your eloquence, i have wanted to say that but was afraid people would think me odd, so, what else is new. i believe her medicare is primary because of age. . . . Patti Montemayor, RN CCTC Transplant Coordinator and White Hospital 254/724-8448 >>> kimmonykricketsbcglobal (DOT) net 7/27/2007 11:47 AM >>> Hello. I am having a brain fart. We have a patient who has Medicare and a GHI. She is 70 years old and just started dialysis Feb of 2007. Does Medicare become secondary because of a new COB period? or does Medicare stay primary because she is over age 65? Any help will be great!! Thanks Kim Transplant Financial Coordinator Ready for the edge of your seat? Check out tonight's top picks on Yahoo! TV. Pinpoint customers who are looking for what you sell. Shape Yahoo! in your own image. Join our Network Research Panel today! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2007 Report Share Posted July 30, 2007 Since the immunosuppressants are a Medicare allowable under Part B, would the patient’s BC medical policy cover part or all of the 20%? Barbara Barbara Cochrane, MSN, RN Transplant Financial Coordinator Mercy Medical Center—Des Moines Fax: bcochrane@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Aguiar, J. Sent: Friday, July 27, 2007 2:36 PM To: TxFinancialCoordinators Subject: RE: Coverage of immunos If there is no Rx coverage thru the BC, then her immunos would be thru Part B (@ 80%) & the rest of her drugs thru Humana. However, she will be responsible for the 20% Part B doesn't cover & no, that can't be balance billed into Humana. So, make sure your pt knows she will have significant out of pocket costs for the immunos because of the way her BC is structured. J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Dana T Sent: Friday, July 27, 2007 12:29 PM To: TxFinancialCoordinators Subject: RE: Coverage of immunos ok..last question and then I think I have my head on straight...my patient says she doesn't have prescription coverage through BCBS..she only has her Humana part D...will part B then pay for immuno drugs even though Medicare isn't primary ?? thanks for all the help!! I would be lost without everyone's input as I have no one in my hospital who has any idea what I do !! " Aguiar, J. " <Aguiar.Mayo (DOT) Edu> wrote: No, you're not off base-while the pt has other ins, the immunos would fall under the commercial plan BUT when the day comes that Medicare is primary, then coverage for the immunos will be under Part B, because the pt had Part A @ the time of tx, vs. getting them under the Part D plan. Hope this helps, J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Dana T Sent: Friday, July 27, 2007 11:17 AM To: TxFinancialCoordinators Subject: RE: DX start date after age 65 thanks that does help but I still have another question about this..if the BCBS is now the primary doesn't the drug coverage go through them? In some way I have become confused thinking that Medicare B only pays for the immuno drugs if Medicare is primary at the time of transplant otherwise they need to be paid through the GHP coverage. Am I totally off base on that ?? this is my 1st situation like this and I think I've just got myself confused on who pays what when... thanks again ! " Aguiar, J. " <Aguiar.Mayo (DOT) Edu> wrote: Dana, the Part B piece comes because she has Medicare part A @ the time of tx, so regardless of whether Medicare is primary or 2ndy, her coverage for immunos, as far as Medicare & the Part D plans are concerned, will always come thru Part B. The Part D plan only picks up immunos when the pt didn't have at least Medicare Part A @ the time of tx so there was no Part B coverage available for the immunos. Hope this helps, J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Dana T Sent: Friday, July 27, 2007 10:53 AM To: TxFinancialCoordinators Subject: Re: DX start date after age 65 Hi all, I kind of have the same situation I am confused about..my patient is 70 years old and her husband started working for a grocery store and she now has BCBS since 2/1/2007 and they say the BCBS is primary and her Medicare is 2ndry. She has a Humana part D plan and when I called to confirm the drug coverage they told me her Part B would be paying for them. WIll part B still pay for immuno drugs is she has the BCBS as primary?? it goes back to the response below where they think Medicare is primary due to age. If that is the case why does BCBS think they are primary?? thanks !! Dana Trujillo Financial Coordinator Sanford Transplant Center Sioux Falls, SD Patti Montemayor <PMontemayorSWMail (DOT) SW.Org> wrote: i love your eloquence, i have wanted to say that but was afraid people would think me odd, so, what else is new. i believe her medicare is primary because of age. . . . Patti Montemayor, RN CCTC Transplant Coordinator and White Hospital 254/724-8448 >>> kimmonykricketsbcglobal (DOT) net 7/27/2007 11:47 AM >>> Hello. I am having a brain fart. We have a patient who has Medicare and a GHI. She is 70 years old and just started dialysis Feb of 2007. Does Medicare become secondary because of a new COB period? or does Medicare stay primary because she is over age 65? Any help will be great!! Thanks Kim Transplant Financial Coordinator Ready for the edge of your seat? Check out tonight's top picks on Yahoo! TV. Pinpoint customers who are looking for what you sell. Shape Yahoo! in your own image. Join our Network Research Panel today! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2007 Report Share Posted July 30, 2007 Yes the BC will cover the 20%. Hogan Transplant Financial Coordinator Lahey Clinic 41 Mall Rd. Burlington, MA 01805 phone fax -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Cochrane, Barbara ESent: Monday, July 30, 2007 4:33 PMTo: TxFinancialCoordinators Subject: RE: Coverage of immunos Since the immunosuppressants are a Medicare allowable under Part B, would the patient’s BC medical policy cover part or all of the 20%? Barbara Barbara Cochrane, MSN, RN Transplant Financial Coordinator Mercy Medical Center—Des Moines Fax: bcochranemercydesmoines (DOT) org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Aguiar, J.Sent: Friday, July 27, 2007 2:36 PMTo: TxFinancialCoordinators Subject: RE: Coverage of immunos If there is no Rx coverage thru the BC, then her immunos would be thru Part B (@ 80%) & the rest of her drugs thru Humana. However, she will be responsible for the 20% Part B doesn't cover & no, that can't be balance billed into Humana. So, make sure your pt knows she will have significant out of pocket costs for the immunos because of the way her BC is structured. J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Dana TSent: Friday, July 27, 2007 12:29 PMTo: TxFinancialCoordinators Subject: RE: Coverage of immunos ok..last question and then I think I have my head on straight...my patient says she doesn't have prescription coverage through BCBS..she only has her Humana part D...will part B then pay for immuno drugs even though Medicare isn't primary ?? thanks for all the help!! I would be lost without everyone's input as I have no one in my hospital who has any idea what I do !! "Aguiar, J." <Aguiar.Mayo (DOT) Edu> wrote: No, you're not off base-while the pt has other ins, the immunos would fall under the commercial plan BUT when the day comes that Medicare is primary, then coverage for the immunos will be under Part B, because the pt had Part A @ the time of tx, vs. getting them under the Part D plan. Hope this helps, J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Dana TSent: Friday, July 27, 2007 11:17 AMTo: TxFinancialCoordinators Subject: RE: DX start date after age 65 thanks that does help but I still have another question about this..if the BCBS is now the primary doesn't the drug coverage go through them? In some way I have become confused thinking that Medicare B only pays for the immuno drugs if Medicare is primary at the time of transplant otherwise they need to be paid through the GHP coverage. Am I totally off base on that ?? this is my 1st situation like this and I think I've just got myself confused on who pays what when... thanks again ! "Aguiar, J." <Aguiar.Mayo (DOT) Edu> wrote: Dana, the Part B piece comes because she has Medicare part A @ the time of tx, so regardless of whether Medicare is primary or 2ndy, her coverage for immunos, as far as Medicare & the Part D plans are concerned, will always come thru Part B. The Part D plan only picks up immunos when the pt didn't have at least Medicare Part A @ the time of tx so there was no Part B coverage available for the immunos. Hope this helps, J. Aguiar Mayo Clinic Arizona From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Dana TSent: Friday, July 27, 2007 10:53 AMTo: TxFinancialCoordinators Subject: Re: DX start date after age 65 Hi all, I kind of have the same situation I am confused about..my patient is 70 years old and her husband started working for a grocery store and she now has BCBS since 2/1/2007 and they say the BCBS is primary and her Medicare is 2ndry. She has a Humana part D plan and when I called to confirm the drug coverage they told me her Part B would be paying for them. WIll part B still pay for immuno drugs is she has the BCBS as primary?? it goes back to the response below where they think Medicare is primary due to age. If that is the case why does BCBS think they are primary?? thanks !! Dana Trujillo Financial Coordinator Sanford Transplant Center Sioux Falls, SDPatti Montemayor <PMontemayorSWMail (DOT) SW.Org> wrote: i love your eloquence, i have wanted to say that but was afraid peoplewould think me odd, so, what else is new.i believe her medicare is primary because of age. . . . Patti Montemayor, RN CCTCTransplant Coordinator and White Hospital254/724-8448>>> kimmonykricketsbcglobal (DOT) net 7/27/2007 11:47 AM >>>Hello. I am having a brain fart.We have a patient who has Medicare and a GHI.She is 70 years old and just started dialysis Feb of 2007.Does Medicare become secondary because of a new COB period? or does Medicare stay primary because she is over age 65?Any help will be great!!ThanksKim Transplant Financial Coordinator Ready for the edge of your seat? Check out tonight's top picks on Yahoo! TV. Pinpoint customers who are looking for what you sell. Shape Yahoo! in your own image. Join our Network Research Panel today! See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities. THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.