Guest guest Posted March 14, 2008 Report Share Posted March 14, 2008 I am not very sure of what you are asking but if the pt is entitled to Medicare than it does become effective the 1 day of the month that he got transplanted. If he is not entitled to Medicare then you can not bill Medicare for the evaluation. If you guys did an evaluation prior to any ins. coverage I think the pt is responsible for the charges. Beverly Antoine, LPN Transplant Financial Coordinator LSU-UMC Laffayette, LA bantoi@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Friday, March 14, 2008 9:36 AM To: TxFinancialCoordinators Subject: Medicare Entitlement Good Morning All I have a patient who did not qualify for Medicare in November 2007.Patient lived in India. They came in initially as an International (SELF-PAY) Transplant Patient. I month to transplant the patient presents and insurance policy. We hustle and get an authorization for the transplant but they will not pay for evaluations that took place before Coverage began. I am not clear because now the patient believes that he is entitled to the Medicare retro back to the Day 1 of the month if transplant because a social worker told them that... They do not have enough working quarters in this country to qualify.Spouse doesn't work..... am I missing something ? Transplant Finance Coordinator Brigham and Women's Hospital Division of Transplant Surgery 75 Francis Street, PBB 215 Boston, Ma 02115 Phone: 617 525-7415 The information transmitted in this electronic communication is intended for the person or entity to whom it is addressed and may contain confidential and /or privileged material. Any review, retransmission, dissemination or other use of or taking any action in reliance upon this information by persons or entities other that the intended recipient is prohibited. If you recieve this information in error, please contact the compliance helpline at 1- and properly dispose of this information The information transmitted in this electronic communication is intended onlyfor the person or entity to whom it is addressed and may contain confidentialand/or privileged material. Any review, retransmission, dissemination or otheruse of or taking of any action in reliance upon this information by persons orentities other than the intended recipient is prohibited. If you received thisinformation in error, please contact the Compliance HelpLine at andproperly dispose of this information. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 14, 2008 Report Share Posted March 14, 2008 What is the entitlement event? 65, dialysis or transplant? How long were they in the country before the entitlement event? If the patient is over 65 they can pay to enroll in Medicare even if they don't have enough work credits. Becca Jerominski Financial Coordinator Transplant Program Christiana Health Care Services Phone (302)623-7088 Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 14, 2008 Report Share Posted March 14, 2008 The patient was in the country for 4 months... with no US work history. They gave a deposit for Self pay Transplant b/c they had no Insurance. -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Jerominski, Sent: Friday, March 14, 2008 3:43 PMTo: TxFinancialCoordinators Subject: RE: Medicare Entitlement What is the entitlement event? 65, dialysis or transplant? How long were they in the country before the entitlement event? If the patient is over 65 they can pay to enroll in Medicare even if they don't have enough work credits. Becca Jerominski Financial Coordinator Transplant Program Christiana Health Care Services Phone (302)623-7088 Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 14, 2008 Report Share Posted March 14, 2008 He will not be entitled to Medicare. He will have to pay for the evaluation. Did his ins. pay for the transplant or did he not have a pre-exist clause. Beverly Antoine, LPN Transplant Financial Coordinator LSU-UMC Laffayette, LA bantoi@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Friday, March 14, 2008 2:48 PM To: TxFinancialCoordinators Subject: RE: Medicare Entitlement The patient was in the country for 4 months... with no US work history. They gave a deposit for Self pay Transplant b/c they had no Insurance. RE: Medicare Entitlement What is the entitlement event? 65, dialysis or transplant? How long were they in the country before the entitlement event? If the patient is over 65 they can pay to enroll in Medicare even if they don't have enough work credits. Becca Jerominski Financial Coordinator Transplant Program Christiana Health Care Services Phone (302)623-7088 Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 14, 2008 Report Share Posted March 14, 2008 The insurance paid for the transplant... I was surprised they will not pay for the evaluations -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Antoine, Beverly A.Sent: Friday, March 14, 2008 3:53 PMTo: TxFinancialCoordinators Subject: RE: Medicare Entitlement He will not be entitled to Medicare. He will have to pay for the evaluation. Did his ins. pay for the transplant or did he not have a pre-exist clause. Beverly Antoine, LPN Transplant Financial Coordinator LSU-UMC Laffayette, LA bantoilsuhsc (DOT) edu From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Friday, March 14, 2008 2:48 PMTo: TxFinancialCoordinators Subject: RE: Medicare Entitlement The patient was in the country for 4 months... with no US work history. They gave a deposit for Self pay Transplant b/c they had no Insurance. -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Jerominski, Sent: Friday, March 14, 2008 3:43 PMTo: TxFinancialCoordinators Subject: RE: Medicare Entitlement What is the entitlement event? 65, dialysis or transplant? How long were they in the country before the entitlement event? If the patient is over 65 they can pay to enroll in Medicare even if they don't have enough work credits. Becca Jerominski Financial Coordinator Transplant Program Christiana Health Care Services Phone (302)623-7088 Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 14, 2008 Report Share Posted March 14, 2008 The insurance paid for the transplant... I was surprised they will not pay for the evaluations [Aguiar, J.] That's because, unlike Medicare, there is no 'pre-entitlement' clause on a commercial ins policy. Services are covered only when the policy is active (subject to all kinds of exclusions, exceptions, & assorted fine print, of course!), but not before or after. Keep in mind, the pre-entitlement coverage under Medicare is only applicable in the case of a kidney tx. For someone needing a heart or a liver, for example, there is no coverage under Medicare until the effective date listed on the card. J. Aguiar Mayo Clinic Arizona .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 14, 2008 Report Share Posted March 14, 2008 Yes that is a surprise that they paid for the transplant. They will not pay because at the time you guys did the evaluation he did not have insurance therefore, they are not responsible to cover the eval however, you still have the patient deposit. Beverly Antoine, LPN Transplant Financial Coordinator LSU-UMC Laffayette, LA bantoi@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Friday, March 14, 2008 2:55 PM To: TxFinancialCoordinators Subject: RE: Medicare Entitlement The insurance paid for the transplant... I was surprised they will not pay for the evaluations RE: Medicare Entitlement What is the entitlement event? 65, dialysis or transplant? How long were they in the country before the entitlement event? If the patient is over 65 they can pay to enroll in Medicare even if they don't have enough work credits. Becca Jerominski Financial Coordinator Transplant Program Christiana Health Care Services Phone (302)623-7088 Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 14, 2008 Report Share Posted March 14, 2008 From what I understand the deposit was returned when we flipped the registration from self-pay to Commercial. this was a very involved case ... -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Antoine, Beverly A.Sent: Friday, March 14, 2008 4:06 PMTo: TxFinancialCoordinators Subject: RE: Medicare Entitlement Yes that is a surprise that they paid for the transplant. They will not pay because at the time you guys did the evaluation he did not have insurance therefore, they are not responsible to cover the eval however, you still have the patient deposit. Beverly Antoine, LPN Transplant Financial Coordinator LSU-UMC Laffayette, LA bantoilsuhsc (DOT) edu From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Friday, March 14, 2008 2:55 PMTo: TxFinancialCoordinators Subject: RE: Medicare Entitlement The insurance paid for the transplant... I was surprised they will not pay for the evaluations -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Antoine, Beverly A.Sent: Friday, March 14, 2008 3:53 PMTo: TxFinancialCoordinators Subject: RE: Medicare Entitlement He will not be entitled to Medicare. He will have to pay for the evaluation. Did his ins. pay for the transplant or did he not have a pre-exist clause. Beverly Antoine, LPN Transplant Financial Coordinator LSU-UMC Laffayette, LA bantoilsuhsc (DOT) edu size=2 width="100%" align=center tabIndex=-1> From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Friday, March 14, 2008 2:48 PMTo: TxFinancialCoordinators Subject: RE: Medicare Entitlement The patient was in the country for 4 months... with no US work history. They gave a deposit for Self pay Transplant b/c they had no Insurance. -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Jerominski, Sent: Friday, March 14, 2008 3:43 PMTo: TxFinancialCoordinators Subject: RE: Medicare Entitlement What is the entitlement event? 65, dialysis or transplant? How long were they in the country before the entitlement event? If the patient is over 65 they can pay to enroll in Medicare even if they don't have enough work credits. Becca Jerominski Financial Coordinator Transplant Program Christiana Health Care Services Phone (302)623-7088 Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 14, 2008 Report Share Posted March 14, 2008 The billing department will just have to send the patient the bill for the evaluation or the center will have to eat the charges. Beverly Antoine, LPN Transplant Financial Coordinator LSU-UMC Laffayette, LA bantoi@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Friday, March 14, 2008 3:09 PM To: TxFinancialCoordinators Subject: RE: Medicare Entitlement From what I understand the deposit was returned when we flipped the registration from self-pay to Commercial. this was a very involved case ... RE: Medicare Entitlement What is the entitlement event? 65, dialysis or transplant? How long were they in the country before the entitlement event? If the patient is over 65 they can pay to enroll in Medicare even if they don't have enough work credits. Becca Jerominski Financial Coordinator Transplant Program Christiana Health Care Services Phone (302)623-7088 Fax Quote Link to comment Share on other sites More sharing options...
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