RE: tx financialcoordinator- RE: rx coverage after txplt

[Guest guest]

This seems to be a problem that is getting more and more common! Typically Dan

and I are the bearers of the bad news. We usually proceed thru the evaluation

and work with the social worker to find programs or in rare instances, an

insurance plan that has drug coverage and the patient can enroll in. We review

our criteria for charity care either full or partial. We also check to see if

that patient can receive the services in their home state and will refer to the

institution nearest their home. Bottom line, if the docs say " fix it " we work

with the social worker until we have a solution...not an easy situation at best.

fran

> The Pt that has medical coverage for transplant but no prescription

> coverage or prob

> financially with getting prescriptions paid.

>

> I'm curious as to what your center does and what roll do you play?

>

> Scenario #1 the pt that may have a medicaid spenddown over $300.

> Scenario #2 the pt that has MC and a MC supplement that does not offer

> prescription coverage.

>

> Does your center go forward with eval and if so, do you the TFC try to get

> the funding for the

> pt or does your social worker?

>

> Thank you in advance,

> McIver

> Renal Financial Counselor

> Summa Health System

> Akron OH

>

>

>

> _____

>

>

[Guest guest]

hi , we will evaluate if the pt has at least Medicare and a Medigap supplement. We do our best to assess the whole picture in deciding whether we think the pt can take responsibility for obtaining his meds. In most cases if the pt is that scantily insured we find that he is getting all other meds free (samples) from his referring nephrologist and/or other MDs. We take other things into account like family and community support. Today I saw a pre-transplant pt who pays for his meds oop and brings the receipt to his dialysis unit social worker who reimburses him for up to 50% out of his NKF fund; that's pretty shaky as the unit only gets about $600/quarter from the NKF, but that particular SW tells me they don't have a very needy population right now. If the pt qualifies for PAPs, the apps get done between the TC and the SW, not the FC. Hope that helps. You're sure to receive a wide variety of responses!

The Pt that has medical coverage for transplant but no prescriptioncoverage or probfinancially with getting prescriptions paid.I'm curious as to what your center does and what roll do you play? Scenario #1 the pt that may have a medicaid spenddown over $300.Scenario #2 the pt that has MC and a MC supplement that does not offerprescription coverage. Does your center go forward with eval and if so, do you the TFC try to getthe funding for thept or does your social worker?Thank you in advance, McIverRenal Financial CounselorSumma Health System Akron OH

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[Guest guest]

If the SW cannot find prescription assistance for the patient, do you

still go ahead with the transplant, because you have already put the

patient through the evaluation process. If so, how does the patient

maintain the organ, if he/she has no prescription coverage and cannot

afford the meds. Thanks

>>> dunagan.fran@... 4/1/04 5:02:04 PM >>>

This seems to be a problem that is getting more and more common!

Typically Dan and I are the bearers of the bad news. We usually proceed

thru the evaluation and work with the social worker to find programs or

in rare instances, an insurance plan that has drug coverage and the

patient can enroll in. We review our criteria for charity care either

full or partial. We also check to see if that patient can receive the

services in their home state and will refer to the institution nearest

their home. Bottom line, if the docs say " fix it " we work with the

social worker until we have a solution...not an easy situation at best.

fran

> The Pt that has medical coverage for transplant but no

prescription

> coverage or prob

> financially with getting prescriptions paid.

>

> I'm curious as to what your center does and what roll do you play?

>

> Scenario #1 the pt that may have a medicaid spenddown over $300.

> Scenario #2 the pt that has MC and a MC supplement that does not

offer

> prescription coverage.

>

> Does your center go forward with eval and if so, do you the TFC try

to get

> the funding for the

> pt or does your social worker?

>

> Thank you in advance,

> McIver

> Renal Financial Counselor

> Summa Health System

> Akron OH

>

>

>

> _____

>

>

[Guest guest]

These finanical proof of responsibility forms will only work if the

patient is being truthful...you have to remember they are not legally

binding.

If a pre-transplant patient does not have a prescription plan in place

we put their work-up on hold until they have some way to pay for their

immunos (Medigap plan w/rx covg, Medicaid, etc.). Even if they do have

a rx plan, some can't even afford their copays. Most of our patients do

not even consider fundraising an option. We don't have a lot of options

for them here & I agree, things are just getting worse.

There are so many that fall between the gaps (unable to afford rx

copays, aren't eligible for PAPs, etc.) it's a shame & who knows what's

going to happen when Medicare Reform Act comes into the picture.

The Pt that has medical coverage for transplant but no

> prescription

> > coverage or prob

> > financially with getting prescriptions paid.

> >

> > I'm curious as to what your center does and what roll do you play?

> >

> > Scenario #1 the pt that may have a medicaid spenddown over $300.

> > Scenario #2 the pt that has MC and a MC supplement that does not

> offer

> > prescription coverage.

> >

> > Does your center go forward with eval and if so, do you the TFC

try

> to get

> > the funding for the

> > pt or does your social worker?

> >

> > Thank you in advance,

> > McIver

> > Renal Financial Counselor

> > Summa Health System

> > Akron OH

> >

> >

> >

> > _____

> >

> >