question

[Guest guest]

Hello Group,

This may be a strange question but anyhow has anyone had any bruise look under a toe nail? I have one and haven't droped anything on my foot. Just thought it was kind of strange. It don't hurt unless I do bump something on it??? Makes me wonder if being on my feet all day at work and the slight swelling I still get has somehting to do with it. Just another stange thing happening in my body

Shelia

[Guest guest]

If the pt has a benefit and chooses not to use it by going out of network, I do

not believe medicare will pay as primary...

Sent from my GoodLink synchronized handheld (www.good.com)

question

pt has commercial insurance thru part time employment (primary

insurance)

has medicare and medicaid also.

pt worked up at a hospital that commerical insurance will not pay

because out of network. (found out too late)

Could that hospital accept the denial from commercial insurance but

then bill medicare and medicaid with no problems? or can medicare deny

too? thanks

Patti Montemayor, RN CCTC

Transplant Coordinator

and White Hospital

254/724-8448

[Guest guest]

If Commercial Insurance denies the

transplant, Medicare will not pay primary. If the patient plan has out of

network and paid at out of network benefit level, Medicare will pay up to Medicare

liability.

Austria

Specialty Contracting

Methodist Health System

1441 North Beckley Avenue

Dallas,Texas 75203

Phone:

Fax:

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Mast, Deborah

Sent: Friday, July 27, 2007 4:22

PM

To:

TxFinancialCoordinators ;

TxFinancialCoordinators

Subject: RE:

question

If the pt has a benefit and chooses not to use it by

going out of network, I do not believe medicare will pay as primary...

Sent from my GoodLink synchronized handheld (www.good.com)

question

pt has commercial insurance thru part time employment (primary

insurance)

has medicare and medicaid also.

pt worked up at a hospital that commerical insurance will not pay

because out of network. (found out too late)

Could that hospital accept the denial from commercial insurance but

then bill medicare and medicaid with no problems? or can medicare deny

too? thanks

Patti Montemayor, RN CCTC

Transplant Coordinator

and White Hospital

254/724-8448

***********************************************************************

This electronic transmission contains information from Methodist Health

System and should be considered confidential and privileged. The

information contained in the above messages is intended only for the

use of the individual(s) and entity(ies) named above. If you are not

the intended recipient, be aware that any disclosure, copying,

distribution, or use of this information is prohibited. If you receive

this transmission in error, please notify the sender immediately by

return e-mail. Methodist Health System, its subsidiaries and

affiliates hereby claim all applicable privileges related to the

transmission of this communication.

[Guest guest]

thats what I kind of wondered, now i have an opionion from both sides of

the fence, can anybody else add something?

Patti Montemayor, RN CCTC

Transplant Coordinator

and White Hospital

254/724-8448

>>> DMast@... 7/27/2007 4:21 PM >>>

If the pt has a benefit and chooses not to use it by going out of

network, I do not believe medicare will pay as primary...

Sent from my GoodLink synchronized handheld (www.good.com)

question

pt has commercial insurance thru part time employment (primary

insurance)

has medicare and medicaid also.

pt worked up at a hospital that commerical insurance will not pay

because out of network. (found out too late)

Could that hospital accept the denial from commercial insurance but

then bill medicare and medicaid with no problems? or can medicare deny

too? thanks

Patti Montemayor, RN CCTC

Transplant Coordinator

and White Hospital

254/724-8448

[Guest guest]

Medicare will see that partial payment or no payment was made and will know pt went out of network so they are not required to pay. Stoops , LCSW, MPA, MSHA, CCMProgram Operations ManagerThe Clarian Transplant Centerswatson@... office fax questionpt has commercial insurance thru part time employment (primaryinsurance)has medicare and medicaid also.pt worked up at a hospital that commerical insurance will not paybecause out of network. (found out too late)Could that hospital accept the denial from commercial insurance butthen bill medicare and medicaid with no problems? or can medicare denytoo? thanksPatti Montemayor, RN CCTCTransplant Coordinator and White Hospital254/724-8448

[Guest guest]

Thanks everyone for

correcting me… I was thinking more along the lines that the claim would

process as ‘out of network’, but misread that there weren’t

ANY out of network benefits.  My apologies!

I would wonder at

this point then, if Medicare denies as well as the commercial, would then

Medicaid pay ultimately?

The commercial

insurance is not willing to retrospectively review for an out of network referral? 

Was the patient evaluated urgently as an inpatient, or was it outpatient?  Is

there another transplant center the patient should have used to stay in network—if

not, what does that commercial insurance expect the patient to do to obtain transplant

services!?

Meredith Gray

Transplant Financial Coordinator

Continuity of Care and Case Management/ Box 602

Strong

Memorial Hospital

(fax)

5-1616 ID# 6541 (pager)

This message

contains information which may be confidential and privileged. Unless you are

the addressee (or authorized to receive for the addressee), you may not use, copy

or disclose to anyone the message or any information contained in the message

(including attachments). If you have received the message in error, please

advise sender by reply email and delete the message. Thank you!

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Austria,

Sent: Friday, July 27, 2007 5:25

PM

To: TxFinancialCoordinators

Subject: RE:

question

If Commercial Insurance denies the transplant, Medicare will not

pay primary. If the patient plan has out of network and paid at out of network

benefit level, Medicare will pay up to Medicare liability.

Austria

Specialty Contracting

Methodist Health System

1441 North Beckley Avenue

Dallas,Texas 75203

Phone:

Fax:

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of Mast, Deborah

Sent: Friday, July 27, 2007 4:22

PM

To: TxFinancialCoordinators ;

TxFinancialCoordinators

Subject: RE:

question

If the pt

has a benefit and chooses not to use it by going out of network, I do not

believe medicare will pay as primary...

Sent from my GoodLink synchronized handheld (www.good.com)

question

pt has commercial insurance thru part time employment (primary

insurance)

has medicare and medicaid also.

pt worked up at a hospital that commerical insurance will not pay

because out of network. (found out too late)

Could that hospital accept the denial from commercial insurance but

then bill medicare and medicaid with no problems? or can medicare deny

too? thanks

Patti Montemayor, RN CCTC

Transplant Coordinator

and White Hospital

254/724-8448

***********************************************************************

This electronic transmission contains information from Methodist Health

System and should be considered confidential and privileged. The

information contained in the above messages is intended only for the

use of the individual(s) and entity(ies) named above. If you are not

the intended recipient, be aware that any disclosure, copying,

distribution, or use of this information is prohibited. If you receive

this transmission in error, please notify the sender immediately by

return e-mail. Methodist Health System, its subsidiaries and

affiliates hereby claim all applicable privileges related to the

transmission of this communication.

[Guest guest]

They will pay but it will be pennies on the dollar. Stoops , LCSW, MPA, MSHA, CCMProgram Operations ManagerThe Clarian Transplant Centerswatson@... office fax questionpt has commercial insurance thru part time employment (primaryinsurance)has medicare and medicaid also.pt worked up at a hospital that commerical insurance will not paybecause out of network. (found out too late)Could that hospital accept the denial from commercial insurance butthen bill medicare and medicaid with no problems? or can medicare denytoo? thanksPatti Montemayor, RN CCTCTransplant Coordinator and White Hospital254/724-8448***********************************************************************This electronic transmission contains information from Methodist HealthSystem and should be considered confidential and privileged. Theinformation contained in the above messages is intended only for theuse of the individual(s) and entity(ies) named above. If you are notthe intended recipient, be aware that any disclosure, copying,distribution, or use of this information is prohibited. If you receivethis transmission in error, please notify the sender immediately byreturn e-mail. Methodist Health System, its subsidiaries andaffiliates hereby claim all applicable privileges related to thetransmission of this communication.

[Guest guest]

My understanding is that if a patient is in an HMO network and the HMO does not pay because the patient chooses to go out of the network, medicare does not pay. However, if the patient has the option to go out of network (at a reduced rate), medicare will pay as secondary.

Janet M. Lovely

Lankenau Hospital

Phila., PA

questionpt has commercial insurance thru part time employment (primaryinsurance)has medicare and medicaid also.pt worked up at a hospital that commerical insurance will not paybecause out of network. (found out too late)Could that hospital accept the denial from commercial insurance butthen bill medicare and medicaid with no problems? or can medicare denytoo? thanksPatti Montemayor, RN CCTCTransplant Coordinator and White Hospital254/724-8448

[Guest guest]

thank you, everyone, for your help. I just LOVE this list serv . . . .

..

Patti Montemayor, RN CCTC

Transplant Coordinator

and White Hospital

254/724-8448

>>> lovelyj@... 7/30/2007 11:56 AM >>>

My understanding is that if a patient is in an HMO network and the HMO

does not pay because the patient chooses to go out of the network,

medicare does not pay. However, if the patient has the option to go

out

of network (at a reduced rate), medicare will pay as secondary.

Janet M. Lovely

Lankenau Hospital

Phila., PA

question

pt has commercial insurance thru part time employment (primary

insurance)

has medicare and medicaid also.

pt worked up at a hospital that commerical insurance will not

pay

because out of network. (found out too late)

Could that hospital accept the denial from commercial insurance

but

then bill medicare and medicaid with no problems? or can

medicare deny

too? thanks

Patti Montemayor, RN CCTC

Transplant Coordinator

and White Hospital

254/724-8448