Re: COB

[Guest guest]

My understanding would be that the Active Group thru the spouse would be

prime, Medicare secondary, Supplement tertiary...i hope that helps!

COB

I need help figuring out the coordination of benefits on a very

non-compliant pre kidney txp patient. The patient is withholding

insurance information to try and manipulate what center he is evaluated

at. The patient is 61 years old and eligible for Medicare 3-1-03 due to

heart failure only. He is retired and has Blue Shield PPO Medicare

Supplement secondary through his employer. He was diagnosed with ESRD

and went on dialysis 1-14-04. He doesn't want us to know that he also is

covered on Blue Shield HMO through his wife's active employment for the

past 30 years. I thought if a patient was already eligible for Medicare

due to another diagnosis prior to ESRD that they were exempt from the

COB. I spoke to CMS COB and and got two different answers! Thanks!

a

Bone Marrow & Solid Organ

Transplant Financial Supervisor

2800 L Street, Suite 420

Sacramento, CA 95816

Fax

richarp@...

[Guest guest]

I agree, if spouse is employed at an employer of 100 or more employees

COB

I need help figuring out the coordination of benefits on a very

non-compliant pre kidney txp patient. The patient is withholding

insurance information to try and manipulate what center he is evaluated

at. The patient is 61 years old and eligible for Medicare 3-1-03 due to

heart failure only. He is retired and has Blue Shield PPO Medicare

Supplement secondary through his employer. He was diagnosed with ESRD

and went on dialysis 1-14-04. He doesn't want us to know that he also is

covered on Blue Shield HMO through his wife's active employment for the

past 30 years. I thought if a patient was already eligible for Medicare

due to another diagnosis prior to ESRD that they were exempt from the

COB. I spoke to CMS COB and and got two different answers! Thanks!

a

Bone Marrow & Solid Organ

Transplant Financial Supervisor

2800 L Street, Suite 420

Sacramento, CA 95816

Fax

richarp@...

[Guest guest]

Once a patient is entitled to ESRD Medicare, ESRD coordination rules

take precedence over Disability coordination rules. However, if he

doesn't apply for ESRD Medicare and only has Disability entitlement,

then Disability coordination rules would apply, as stated below.

You need to make the patient aware of this rule: If an HMO is primary,

and the patient does not comply with the rules of their HMO and goes out

of network, then Medicare will NOT coordinate as secondary payer.

COB

I need help figuring out the coordination of benefits on a very

non-compliant pre kidney txp patient. The patient is withholding

insurance information to try and manipulate what center he is evaluated

at. The patient is 61 years old and eligible for Medicare 3-1-03 due to

heart failure only. He is retired and has Blue Shield PPO Medicare

Supplement secondary through his employer. He was diagnosed with ESRD

and went on dialysis 1-14-04. He doesn't want us to know that he also is

covered on Blue Shield HMO through his wife's active employment for the

past 30 years. I thought if a patient was already eligible for Medicare

due to another diagnosis prior to ESRD that they were exempt from the

COB. I spoke to CMS COB and and got two different answers! Thanks!

a

Bone Marrow & Solid Organ

Transplant Financial Supervisor

2800 L Street, Suite 420

Sacramento, CA 95816

Fax

richarp@...

[Guest guest]

If this patient has not had a 2728 filled out and sent to Social Security his coverage follows the disability world and the wife's insurance is the primary payer as she is actively employed.

If the 2728 has been filed and the Coordination of Benefits folks in New York Social Security should be able to tell you, if that is the case, then after his 30 month coordination of benefits period is up Medicare is prime.

It has been my experience when I get two different answers that if you call back and request a supervisor they will sort it out and give you the "correct" answer of the day. Bev

>>> richarp@... 04/27/04 04:10PM >>>I need help figuring out the coordination of benefits on a very non-compliant pre kidney txp patient. The patient is withholding insurance information to try and manipulate what center he is evaluated at. The patient is 61 years old and eligible for Medicare 3-1-03 due to heart failure only. He is retired and has Blue Shield PPO Medicare Supplement secondary through his employer. He was diagnosed with ESR and went on dialysis 1-14-04. He doesn't want us to know that he also is covered on Blue Shield HMO through his wife's active employment for the past 30 years. I thought if a patient was already eligible for Medicare due to another diagnosis prior to ESR that they were exempt from the COB. I spoke to CMS COB and and got two different answers! Thanks!a Bone Marrow & Solid OrganTransplant Financial Supervisor2800 L Street, Suite 420Sacramento, CA 95816Fax richarp@...