RE: Kidney tx question for Medicare coverage

[Guest guest]

If she was transplanted October 2003, then October 2006 was the final month of her Renal Medicare coverage. If she returned to HD in that final month, BCBS has indeed dodged the bullet - Medicare primary until she is no longer eligible for the Renal coverage.

on Financial Counselor Legacy Transplant Services Good Samaritan Hospital 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@...

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Mendoza, P.Sent: Thursday, July 26, 2007 12:24 PMTo: TxFinancialCoordinators Subject: Kidney tx question for Medicare coverageImportance: High

SCENARIO: BCBS is denying her claims saying that she has Medicare Primary. She received a Kidney TX back in 10/2003. According to the H & P on 7/17/07 in power chart she started back on hemodialysis in 10/2006. Can you tell me who is primary....Medicare or BCBS?? Medicare should be secondary based on COB right?

(I usually don't deal with Kidney.. but our Kidney coordinator is out on leave)

Thanks and have a wonderful day!

Mendoza Liver Transplant Financial Coordinator Mayo Clinic ville Bldg 120 West P: F: Pager: 3-9648 Mendoza.mayo (DOT) edu Silence is often misinterpreted but never misquoted

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[Guest guest]

No, it's primary. She would have had entitlement for Medicare from the 1st tx in Oct '03 (even if she didn't actually HAVE it, she was at least entitled to it & many commercial ins' will start the clock running from that point anyway); her entitlement for that episode would have run thru at least 10/31/06 (depending on when she was d/c from the hospital from the tx surgery itself), so if she re-started dialysis in October '06, it's still considered the same eligibility period which would make Medicare primary since she never made it the full 36 mos post-tx w/o having to return to dialysis.

J. Aguiar

Mayo Clinic Arizona

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Mendoza, P.Sent: Thursday, July 26, 2007 12:24 PMTo: TxFinancialCoordinators Subject: Kidney tx question for Medicare coverageImportance: High

SCENARIO: BCBS is denying her claims saying that she has Medicare Primary. She received a Kidney TX back in 10/2003. According to the H & P on 7/17/07 in power chart she started back on hemodialysis in 10/2006. Can you tell me who is primary….Medicare or BCBS?? Medicare should be secondary based on COB right?

(I usually don't deal with Kidney.. but our Kidney coordinator is out on leave)

Thanks and have a wonderful day!

Mendoza Liver Transplant Financial Coordinator Mayo Clinic ville Bldg 120 West P: F: Pager: 3-9648 Mendoza.mayo (DOT) edu Silence is often misinterpreted but never misquoted

[Guest guest]

Medicare should be primary because she should have completed the 30mts COB and she started back on hemo she should not have to gothrough another COB period.because she did not have the full 36mts.

Bev

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Mendoza, P.Sent: Thursday, July 26, 2007 2:24 PMTo: TxFinancialCoordinators Subject: Kidney tx question for Medicare coverageImportance: High

SCENARIO: BCBS is denying her claims saying that she has Medicare Primary. She received a Kidney TX back in 10/2003. According to the H & P on 7/17/07 in power chart she started back on hemodialysis in 10/2006. Can you tell me who is primary….Medicare or BCBS?? Medicare should be secondary based on COB right?

(I usually don't deal with Kidney.. but our Kidney coordinator is out on leave)

Thanks and have a wonderful day!

Mendoza Liver Transplant Financial Coordinator Mayo Clinic ville Bldg 120 West P: F: Pager: 3-9648 Mendoza.mayo (DOT) edu Silence is often misinterpreted but never misquoted