Re: Commercial Ins. and Medicare

[Guest guest]

If the primary insurance does not pay then Medicare will not pay d/t patient having transplant benefits with the primary at an in-network facility.

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Louis Sent: Thursday, February 12, 2009 8:29 AMTo: Txp. Financial Coordinators AssociationSubject: Commercial Ins. and Medicare

Hi TFC'sThis is TFC 101, Brain Freeze or not enough coffee question, anyway here goesMagna-Care Primary (union), no out-of-network benefits, no coverage under the planfor Live Donor. Medicare, secondary will Medicare A & B cover the Donor ?Thanks,Louis

[Guest guest]

The rule is that if the patient does not have out of network benefits, and they

do not follow primary rules, all secondary (medicare or not) will follow primary

guidelines. Therefore the answer is no, they will not pay.

Amellia

>>> Louis 2/12/2009 7:29 AM >>>

Hi TFC's

This is TFC 101, Brain Freeze or not enough coffee question, anyway

here goes

Magna-Care Primary (union), no out-of-network benefits, no coverage

under the plan

for Live Donor. Medicare, secondary will Medicare A & B cover the Donor ?

Thanks,

Louis

[Guest guest]

Phyllis, thanks. If the primary insurance does not pay then Medicare will not pay d/t patient having transplant benefits with the primary at an in-network facility.From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Louis Sent: Thursday, February 12, 2009 8:29 AMTo: Txp. Financial Coordinators AssociationSubject: Commercial Ins. and MedicareHi TFC'sThis is TFC 101, Brain Freeze or not enough coffee question, anyway here goesMagna-Care Primary (union), no out-of-network benefits, no coverage under the planfor Live Donor. Medicare, secondary will Medicare A & B cover the Donor ?Thanks,Louis

[Guest guest]

Amelia, thank you.The rule is that if the patient does not have out of network benefits, and they do not follow primary rules, all secondary (medicare or not) will follow primary guidelines. Therefore the answer is no, they will not pay.Amellia>>> Louis <gonzallmail (DOT) rockefeller.edu> 2/12/2009 7:29 AM >>>Hi TFC'sThis is TFC 101, Brain Freeze or not enough coffee question, anyway here goesMagna-Care Primary (union), no out-of-network benefits, no coverage under the planfor Live Donor. Medicare, secondary will Medicare A & B cover the Donor ?Thanks,Louis

[Guest guest]

Louis,

Medicare should be paying the donor costs as secondary if the primary

coverage has no donor coverage for as long as the transplant was

approved.

Louis wrote:

Phyllis, thanks.

If the primary insurance does not pay then Medicare will not pay d/t

patient having transplant benefits with the primary at an in-network

facility.

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[Guest guest]

Hi , Pls. elaborate, Medicare pays the costs as secondary, so the recipient is responsible for the donor primary charges? Louis,Medicare should be paying the donor costs as secondary if the primary coverage has no donor coverage for as long as the transplant was approved. Louis wrote:Phyllis, thanks. If the primary insurance does not pay then Medicare will not pay d/t patient having transplant benefits with the primary at an in-network facility.--------------------

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[Guest guest]

For as long as the transplant is approve by the primary carrier,

coverage will be based on eligibility and benefits. If there are no

donor coverage according to the plan provisions, then Medicare steps up

to the plate to pay the donor charges as primary.

Louis wrote:

Hi ,

Pls. elaborate, Medicare pays the costs as secondary, so the

recipient is responsible

for the donor primary charges?

Louis,

Medicare should be paying the donor costs as secondary if the primary

coverage has no donor coverage for as long as the transplant was

approved.

Cather

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you.

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[Guest guest]

Insurance,MagnaCare, No Out-of-Pocket benefits, No Donor Coverage.Conflicting with previous replies. Thanks, LouisFor as long as the transplant is approve by the primary carrier, coverage will be based on eligibility and benefits. If there are no donor coverage according to the plan provisions, then Medicare steps up to the plate to pay the donor charges as primary.Louis wrote:Hi , Pls. elaborate, Medicare pays the costs as secondary, so the recipient is responsible for the donor primary charges? Louis,Medicare should be paying the donor costs as secondary if the primary coverage has no donor coverage for as long as the transplant was approved.Cather This electronic message is intended to be for the use only of the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Thank you.<CAP7002.vcf>--------------------

This electronic message is intended to be for the use only of the named recipient, and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the named recipient, please notify us immediately by contacting the sender at the electronic mail address noted above, and delete and destroy all copies of this message. Thank you.

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