RE: Hard lesson learned Part II

[Guest guest]

Good Morning All,

I have a question for all the Medicare experts out there. Many of our email topics have covered similar situations, but I want to throw this one back out there and see what you think.

I have a patient who transplanted pre dialysis and has an EGHP. He received Medicare due to his transplant and began to pay his part B premiums. He has recently called me to inquire why he should continue his part B. Are there any ramifications to his canceling part B? He thinks his EGHP is adequate coverage and he does not need Medicare. Could someone tell me, based on his particular situation, what I should tell him?

Thanks so much!

-----Original Message-----From: on, :LPH Trnsplnt Sent: Monday, December 06, 2004 7:50 PMTo: txfinancialcoordinators Subject: Hard lesson learned Part II

Hi Everyone, thought you'd be interested in the reference our local SSA office sent to me, regarding the question of whether ESRD beneficiaries have a right to a new Initial Enrollment Period for Part B at the time of transplant, assuming the claimant enrolled in Part A only at an earlier opportunity. If anyone else's local office has a citation to challenge this I'd love to see it (Bev Larson's maybe?):

Hi ,

Sorry it took so long to get back to you. Again, I am sure I am correct on this subject (not that I'm always happy to be right ) I can provide a reference from our manual which clearly shows how claimants should be cautioned about filing for Part A only during the IEP:

(HI 00801.247)

F. POLICY — EFFECT OF MSP PROVISIONS ON FILING

Because Medicare will not be paying full benefits in many cases where there is a group health insurance plan, some individuals may not wish to enroll in R-SMI when first eligible.

It is important to remember that the special enrollment period (SEP) rules applicable to aged and disabled individuals do not apply to people entitled to R-HI. Therefore, it is extremely important to properly inform ESRD patients (including dual eligibles) who have GHP coverage about their options with respect to filing an application for R-HI. An individual may wish to:

File for both R-HI and R-SMI at initial R-HI eligibility even though Medicare can only make secondary payments until the end of the ESRD coordination period. With expenses as high as those for treatment of ESRD, an individual may consider secondary Medicare payments to be well worth the monthly SMI premium.

Defer filing for R-HI (and R-SMI) until the end of the ESRD coordination period. This will permit the individual to defer paying for SMI until Medicare becomes the primary payer of benefits.

ESRD patients with GHP coverage should be discouraged from filing for R-HI while rejecting R-SMI at initial eligibility. Once R-SMI is refused, enrollment can only take place during a GEP, with coverage effective the following July. This will usually mean a gap in coverage between the end of primary payments by the GHP and the beginning of SMI in the month of July. It may also result in a premium surcharge for late enrollment. If an individual with GHP coverage files an application for R-HI in the mistaken belief that Medicare will be primary payer of benefits, the application may be withdrawn as provided for in HI 00801.197.

It's still not good news, but hopefully this spells it out better. As always, call or e-mail me if you have any other questions.. Ann

onFinancial CounselorLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 toll free faxlmorriso@...``There are some upon this earth of yours who lay claim to know us, and who do their deeds of passion, pride, ill-will, hatred, envy, bigotry, and selfishness in our name, who are as strange to us and all our kith and kin, as if they had never lived. Remember that, and charge their doings on themselves, not us.'' - The Ghost of Christmas Present

IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

[Guest guest]

Good Morning All,

I have a question for all the Medicare experts out there. Many of our email topics have covered similar situations, but I want to throw this one back out there and see what you think.

I have a patient who transplanted pre dialysis and has an EGHP. He received Medicare due to his transplant and began to pay his part B premiums. He has recently called me to inquire why he should continue his part B. Are there any ramifications to his canceling part B? He thinks his EGHP is adequate coverage and he does not need Medicare. Could someone tell me, based on his particular situation, what I should tell him?

Thanks so much!

-----Original Message-----From: on, :LPH Trnsplnt Sent: Monday, December 06, 2004 7:50 PMTo: txfinancialcoordinators Subject: Hard lesson learned Part II

Hi Everyone, thought you'd be interested in the reference our local SSA office sent to me, regarding the question of whether ESRD beneficiaries have a right to a new Initial Enrollment Period for Part B at the time of transplant, assuming the claimant enrolled in Part A only at an earlier opportunity. If anyone else's local office has a citation to challenge this I'd love to see it (Bev Larson's maybe?):

Hi ,

Sorry it took so long to get back to you. Again, I am sure I am correct on this subject (not that I'm always happy to be right ) I can provide a reference from our manual which clearly shows how claimants should be cautioned about filing for Part A only during the IEP:

(HI 00801.247)

F. POLICY — EFFECT OF MSP PROVISIONS ON FILING

Because Medicare will not be paying full benefits in many cases where there is a group health insurance plan, some individuals may not wish to enroll in R-SMI when first eligible.

It is important to remember that the special enrollment period (SEP) rules applicable to aged and disabled individuals do not apply to people entitled to R-HI. Therefore, it is extremely important to properly inform ESRD patients (including dual eligibles) who have GHP coverage about their options with respect to filing an application for R-HI. An individual may wish to:

File for both R-HI and R-SMI at initial R-HI eligibility even though Medicare can only make secondary payments until the end of the ESRD coordination period. With expenses as high as those for treatment of ESRD, an individual may consider secondary Medicare payments to be well worth the monthly SMI premium.

Defer filing for R-HI (and R-SMI) until the end of the ESRD coordination period. This will permit the individual to defer paying for SMI until Medicare becomes the primary payer of benefits.

ESRD patients with GHP coverage should be discouraged from filing for R-HI while rejecting R-SMI at initial eligibility. Once R-SMI is refused, enrollment can only take place during a GEP, with coverage effective the following July. This will usually mean a gap in coverage between the end of primary payments by the GHP and the beginning of SMI in the month of July. It may also result in a premium surcharge for late enrollment. If an individual with GHP coverage files an application for R-HI in the mistaken belief that Medicare will be primary payer of benefits, the application may be withdrawn as provided for in HI 00801.197.

It's still not good news, but hopefully this spells it out better. As always, call or e-mail me if you have any other questions.. Ann

onFinancial CounselorLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 toll free faxlmorriso@...``There are some upon this earth of yours who lay claim to know us, and who do their deeds of passion, pride, ill-will, hatred, envy, bigotry, and selfishness in our name, who are as strange to us and all our kith and kin, as if they had never lived. Remember that, and charge their doings on themselves, not us.'' - The Ghost of Christmas Present

IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

[Guest guest]

apart from the safety net issue, I would advise him to make sure there is no clause in his policy that says the EGHP will start paying as secondary at 31 months post-transplant. We're seeing more and more of that.

on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@...

"Probably all organic beings which have ever lived on this earth have descended from some one primordial form, into which life was first breathed. There is grandeur in this view of life that...from so simple a beginning endless forms most beautiful and most wonderful have been, and are being evolved." - Darwin

RE: Hard lesson learned Part II

Good Morning All,

I have a question for all the Medicare experts out there. Many of our email topics have covered similar situations, but I want to throw this one back out there and see what you think.

I have a patient who transplanted pre dialysis and has an EGHP. He received Medicare due to his transplant and began to pay his part B premiums. He has recently called me to inquire why he should continue his part B. Are there any ramifications to his canceling part B? He thinks his EGHP is adequate coverage and he does not need Medicare. Could someone tell me, based on his particular situation, what I should tell him?

Thanks so much!

-----Original Message-----From: on, :LPH Trnsplnt Sent: Monday, December 06, 2004 7:50 PMTo: txfinancialcoordinators Subject: Hard lesson learned Part II

Hi Everyone, thought you'd be interested in the reference our local SSA office sent to me, regarding the question of whether ESRD beneficiaries have a right to a new Initial Enrollment Period for Part B at the time of transplant, assuming the claimant enrolled in Part A only at an earlier opportunity. If anyone else's local office has a citation to challenge this I'd love to see it (Bev Larson's maybe?):

Hi ,

Sorry it took so long to get back to you. Again, I am sure I am correct on this subject (not that I'm always happy to be right ) I can provide a reference from our manual which clearly shows how claimants should be cautioned about filing for Part A only during the IEP:

(HI 00801.247)

F. POLICY — EFFECT OF MSP PROVISIONS ON FILING

Because Medicare will not be paying full benefits in many cases where there is a group health insurance plan, some individuals may not wish to enroll in R-SMI when first eligible.

It is important to remember that the special enrollment period (SEP) rules applicable to aged and disabled individuals do not apply to people entitled to R-HI. Therefore, it is extremely important to properly inform ESRD patients (including dual eligibles) who have GHP coverage about their options with respect to filing an application for R-HI. An individual may wish to:

File for both R-HI and R-SMI at initial R-HI eligibility even though Medicare can only make secondary payments until the end of the ESRD coordination period. With expenses as high as those for treatment of ESRD, an individual may consider secondary Medicare payments to be well worth the monthly SMI premium.

Defer filing for R-HI (and R-SMI) until the end of the ESRD coordination period. This will permit the individual to defer paying for SMI until Medicare becomes the primary payer of benefits.

ESRD patients with GHP coverage should be discouraged from filing for R-HI while rejecting R-SMI at initial eligibility. Once R-SMI is refused, enrollment can only take place during a GEP, with coverage effective the following July. This will usually mean a gap in coverage between the end of primary payments by the GHP and the beginning of SMI in the month of July. It may also result in a premium surcharge for late enrollment. If an individual with GHP coverage files an application for R-HI in the mistaken belief that Medicare will be primary payer of benefits, the application may be withdrawn as provided for in HI 00801.197.

It's still not good news, but hopefully this spells it out better. As always, call or e-mail me if you have any other questions.. Ann

onFinancial CounselorLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 toll free faxlmorriso@...``There are some upon this earth of yours who lay claim to know us, and who do their deeds of passion, pride, ill-will, hatred, envy, bigotry, and selfishness in our name, who are as strange to us and all our kith and kin, as if they had never lived. Remember that, and charge their doings on themselves, not us.'' - The Ghost of Christmas Present

IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

[Guest guest]

Re: The forward from ..... what is R-HI and R-SMI so I can intrepret the reply?

RE: Hard lesson learned Part II

Good Morning All,

I have a question for all the Medicare experts out there. Many of our email topics have covered similar situations, but I want to throw this one back out there and see what you think.

I have a patient who transplanted pre dialysis and has an EGHP. He received Medicare due to his transplant and began to pay his part B premiums. He has recently called me to inquire why he should continue his part B. Are there any ramifications to his canceling part B? He thinks his EGHP is adequate coverage and he does not need Medicare. Could someone tell me, based on his particular situation, what I should tell him?

Thanks so much!

-----Original Message-----From: on, :LPH Trnsplnt Sent: Monday, December 06, 2004 7:50 PMTo: txfinancialcoordinators Subject: Hard lesson learned Part II

Hi Everyone, thought you'd be interested in the reference our local SSA office sent to me, regarding the question of whether ESRD beneficiaries have a right to a new Initial Enrollment Period for Part B at the time of transplant, assuming the claimant enrolled in Part A only at an earlier opportunity. If anyone else's local office has a citation to challenge this I'd love to see it (Bev Larson's maybe?):

Hi ,

Sorry it took so long to get back to you. Again, I am sure I am correct on this subject (not that I'm always happy to be right ) I can provide a reference from our manual which clearly shows how claimants should be cautioned about filing for Part A only during the IEP:

(HI 00801.247)

F. POLICY — EFFECT OF MSP PROVISIONS ON FILING

Because Medicare will not be paying full benefits in many cases where there is a group health insurance plan, some individuals may not wish to enroll in R-SMI when first eligible.

It is important to remember that the special enrollment period (SEP) rules applicable to aged and disabled individuals do not apply to people entitled to R-HI. Therefore, it is extremely important to properly inform ESRD patients (including dual eligibles) who have GHP coverage about their options with respect to filing an application for R-HI. An individual may wish to:

File for both R-HI and R-SMI at initial R-HI eligibility even though Medicare can only make secondary payments until the end of the ESRD coordination period. With expenses as high as those for treatment of ESRD, an individual may consider secondary Medicare payments to be well worth the monthly SMI premium.

Defer filing for R-HI (and R-SMI) until the end of the ESRD coordination period. This will permit the individual to defer paying for SMI until Medicare becomes the primary payer of benefits.

ESRD patients with GHP coverage should be discouraged from filing for R-HI while rejecting R-SMI at initial eligibility. Once R-SMI is refused, enrollment can only take place during a GEP, with coverage effective the following July. This will usually mean a gap in coverage between the end of primary payments by the GHP and the beginning of SMI in the month of July. It may also result in a premium surcharge for late enrollment. If an individual with GHP coverage files an application for R-HI in the mistaken belief that Medicare will be primary payer of benefits, the application may be withdrawn as provided for in HI 00801.197.

It's still not good news, but hopefully this spells it out better. As always, call or e-mail me if you have any other questions.. Ann

onFinancial CounselorLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 toll free faxlmorriso@...``There are some upon this earth of yours who lay claim to know us, and who do their deeds of passion, pride, ill-will, hatred, envy, bigotry, and selfishness in our name, who are as strange to us and all our kith and kin, as if they had never lived. Remember that, and charge their doings on themselves, not us.'' - The Ghost of Christmas Present

IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

[Guest guest]

Renal-Hospital Insurance (Part A) and Renal-Supplemental Medical Insurance (Part

on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@...

"Probably all organic beings which have ever lived on this earth have descended from some one primordial form, into which life was first breathed. There is grandeur in this view of life that...from so simple a beginning endless forms most beautiful and most wonderful have been, and are being evolved." - Darwin

RE: Hard lesson learned Part II

Good Morning All,

I have a question for all the Medicare experts out there. Many of our email topics have covered similar situations, but I want to throw this one back out there and see what you think.

I have a patient who transplanted pre dialysis and has an EGHP. He received Medicare due to his transplant and began to pay his part B premiums. He has recently called me to inquire why he should continue his part B. Are there any ramifications to his canceling part B? He thinks his EGHP is adequate coverage and he does not need Medicare. Could someone tell me, based on his particular situation, what I should tell him?

Thanks so much!

-----Original Message-----From: on, :LPH Trnsplnt Sent: Monday, December 06, 2004 7:50 PMTo: txfinancialcoordinators Subject: Hard lesson learned Part II

Hi Everyone, thought you'd be interested in the reference our local SSA office sent to me, regarding the question of whether ESRD beneficiaries have a right to a new Initial Enrollment Period for Part B at the time of transplant, assuming the claimant enrolled in Part A only at an earlier opportunity. If anyone else's local office has a citation to challenge this I'd love to see it (Bev Larson's maybe?):

Hi ,

Sorry it took so long to get back to you. Again, I am sure I am correct on this subject (not that I'm always happy to be right ) I can provide a reference from our manual which clearly shows how claimants should be cautioned about filing for Part A only during the IEP:

(HI 00801.247)

F. POLICY — EFFECT OF MSP PROVISIONS ON FILING

Because Medicare will not be paying full benefits in many cases where there is a group health insurance plan, some individuals may not wish to enroll in R-SMI when first eligible.

It is important to remember that the special enrollment period (SEP) rules applicable to aged and disabled individuals do not apply to people entitled to R-HI. Therefore, it is extremely important to properly inform ESRD patients (including dual eligibles) who have GHP coverage about their options with respect to filing an application for R-HI. An individual may wish to:

File for both R-HI and R-SMI at initial R-HI eligibility even though Medicare can only make secondary payments until the end of the ESRD coordination period. With expenses as high as those for treatment of ESRD, an individual may consider secondary Medicare payments to be well worth the monthly SMI premium.

Defer filing for R-HI (and R-SMI) until the end of the ESRD coordination period. This will permit the individual to defer paying for SMI until Medicare becomes the primary payer of benefits.

ESRD patients with GHP coverage should be discouraged from filing for R-HI while rejecting R-SMI at initial eligibility. Once R-SMI is refused, enrollment can only take place during a GEP, with coverage effective the following July. This will usually mean a gap in coverage between the end of primary payments by the GHP and the beginning of SMI in the month of July. It may also result in a premium surcharge for late enrollment. If an individual with GHP coverage files an application for R-HI in the mistaken belief that Medicare will be primary payer of benefits, the application may be withdrawn as provided for in HI 00801.197.

It's still not good news, but hopefully this spells it out better. As always, call or e-mail me if you have any other questions.. Ann

onFinancial CounselorLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 toll free faxlmorriso@...``There are some upon this earth of yours who lay claim to know us, and who do their deeds of passion, pride, ill-will, hatred, envy, bigotry, and selfishness in our name, who are as strange to us and all our kith and kin, as if they had never lived. Remember that, and charge their doings on themselves, not us.'' - The Ghost of Christmas Present

IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.