Donor Follow Up/Another issue with MSP

[Guest guest]

Thanks again for the info everyone. I'm still looking for something concrete to bring back to the group, so if anyone can offer me documentation or advise on where to look on this I would appreciate it. Google and I will still be looking for something more concrete so I will let you know if I find something.

I have another unique situation with which I could use some help. I have a patient who is under 65, disabled for a reason other then ESRD several years ago and became entitled to Medicare. She started on dialysis so became entitled for ESRD 11/07. She has a commercial policy through her husband who works for an employer with 11 FTE. The employer is in a council of small enterprises (according to the card). From what I read, this means that as long as 1 employer belonging to the counsel has more than 100 employees the 30 month coordination period would start and Medicare would have become the secondary payer as soon as the patient started dialysis. Is that a true statement? I have called the patient's insurance carrier's Medicare person for 4 days straight I think she may be avoiding me! Thanks as always for any advise!

Becca Jerominski

Financial Coordinator

Transplant Program

Christiana Health Care Services

Phone 623-7088

[Guest guest]

The woman at the insurance company advised me that at the time the

patient was enrolled with their plan the employer had less than 100

employees based on the W2's so Medicare was primary. My

thought/question - when the patient's entitlement changed 11/07, do

the rules on the number employees need to be considered at that time

to establish COB? If the employeer had less than 100 employees in

2005 but had more than 100 in 2007 - does that affect Medicare as

secondary payer? Again, any thoughts would be appriciated.

>

> Thanks again for the info everyone. I'm still looking for something

> concrete to bring back to the group, so if anyone can offer me

> documentation or advise on where to look on this I would appreciate

it.

> Google and I will still be looking for something more concrete so I

will

> let you know if I find something.

>

> I have another unique situation with which I could use some help. I

have

> a patient who is under 65, disabled for a reason other then ESRD

several

> years ago and became entitled to Medicare. She started on dialysis

so

> became entitled for ESRD 11/07. She has a commercial policy through

her

> husband who works for an employer with 11 FTE. The employer is in a

> council of small enterprises (according to the card). From what I

read,

> this means that as long as 1 employer belonging to the counsel has

more

> than 100 employees the 30 month coordination period would start and

> Medicare would have become the secondary payer as soon as the

patient

> started dialysis. Is that a true statement? I have called the

patient's

> insurance carrier's Medicare person for 4 days straight I think she

may

> be avoiding me! Thanks as always for any advise!

>

> Becca Jerominski

> Financial Coordinator

> Transplant Program

> Christiana Health Care Services

> Phone 623-7088

>

>

>

[Guest guest]

The woman at the insurance company advised me that at the time the

patient was enrolled with their plan the employer had less than 100

employees based on the W2's so Medicare was primary. My

thought/question - when the patient's entitlement changed 11/07, do

the rules on the number employees need to be considered at that time

to establish COB? If the employeer had less than 100 employees in

2005 but had more than 100 in 2007 - does that affect Medicare as

secondary payer? Again, any thoughts would be appriciated.

>

> Thanks again for the info everyone. I'm still looking for something

> concrete to bring back to the group, so if anyone can offer me

> documentation or advise on where to look on this I would appreciate

it.

> Google and I will still be looking for something more concrete so I

will

> let you know if I find something.

>

> I have another unique situation with which I could use some help. I

have

> a patient who is under 65, disabled for a reason other then ESRD

several

> years ago and became entitled to Medicare. She started on dialysis

so

> became entitled for ESRD 11/07. She has a commercial policy through

her

> husband who works for an employer with 11 FTE. The employer is in a

> council of small enterprises (according to the card). From what I

read,

> this means that as long as 1 employer belonging to the counsel has

more

> than 100 employees the 30 month coordination period would start and

> Medicare would have become the secondary payer as soon as the

patient

> started dialysis. Is that a true statement? I have called the

patient's

> insurance carrier's Medicare person for 4 days straight I think she

may

> be avoiding me! Thanks as always for any advise!

>

> Becca Jerominski

> Financial Coordinator

> Transplant Program

> Christiana Health Care Services

> Phone 623-7088

>

>

>