Hard lesson learned

[Guest guest]

Hi to All,

I learned a hard lesson today that I want to share in case others are in the

dark about the finer points of Medicare enrollment.

Our patient has been on dialysis since May of 2002. In April of 2004, she

signed up for Medicare ESRD Part A ONLY w/an effective date of 4/1/03. She

subsequently missed her first (limited) opportunity to sign up for Part B.

I mistakenly believed her transplant event would re-open the window of

opportunity for Part B. Instead, she is now bound by the rules of regular

open enrollment, so no Part B until July 05. Meanwhile ...if you're still

with me... her COB period ended 10/31/04, making Part A primary over her two

EGHPs on Nov 1. And both EGHPs will only consider her Part B claims at 20%

because, per contract language I did not know about, she should have put

her Part B in place by now. Needless to say, we have to postpone surgery.

How much fun was that phone call? NOT MUCH.

According to our ESRD expert at SSA, there is a silver lining. Pt can

withdraw her original claim and reapply w/a new effective date of 11/1/04

for Parts A & B. If there were any Part A claims paid from 4/03 to present,

she would have to pay them back - but the likelihood is almost nonexistent,

as she has had 2 EGHPs in place during this time. SSA estimates this

process will take " a couple, three months " as opposed waiting for a 7/1/05

Part B effective date if she applies during open enrollment.

In the words of Daffy Duck " My head is spli--it--ing. " Needless to say I've

added several new topics to my benefits verification checklist. Hope this

saves someone else's patient from the disappointment of postponing surgery.

on

Financial Counselor

Legacy Transplant Services

1040 NW 22nd Ave Ste 480

Portland OR 97210

toll free

fax

lmorris@...

" The test of our progress is not whether we add more to the abundance of

those who have much; it is whether we provide enough for those who have too

little. "

- lin Delano Roosevelt

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]

I would suggest that your appeal this decision. Her transplant date should open the door for Part B as well as the letters from her two group insurance that state they will only pay 20% because her part B should be in place.

This is considered a life event and should get her into the Social Security Part B world. Our Social Security folks actually tell our patients not to apply for Part B until after their 30 month coordination of benefit period is over. I encourage them to get Part A so that the process for B does not take as long.

I think your Social Security Expert should be challenged on this. Bev>>> lmorriso@... 11/23/2004 6:28:49 PM >>>

Hi to All, I learned a hard lesson today that I want to share in case others are in thedark about the finer points of Medicare enrollment.Our patient has been on dialysis since May of 2002. In April of 2004, shesigned up for Medicare ESRD Part A ONLY w/an effective date of 4/1/03. Shesubsequently missed her first (limited) opportunity to sign up for Part B.I mistakenly believed her transplant event would re-open the window ofopportunity for Part B. Instead, she is now bound by the rules of regularopen enrollment, so no Part B until July 05. Meanwhile ...if you're stillwith me... her COB period ended 10/31/04, making Part A primary over her twoEGHPs on Nov 1. And both EGHPs will only consider her Part B claims at 20%because, per contract language I did not know about, she should have puther Part B in place by now. Needless to say, we have to postpone surgery.How much fun was that phone call? NOT MUCH.According to our ESRD expert at SSA, there is a silver lining. Pt canwithdraw her original claim and reapply w/a new effective date of 11/1/04for Parts A & B. If there were any Part A claims paid from 4/03 to present,she would have to pay them back - but the likelihood is almost nonexistent,as she has had 2 EGHPs in place during this time. SSA estimates thisprocess will take "a couple, three months" as opposed waiting for a 7/1/05Part B effective date if she applies during open enrollment. In the words of Daffy Duck "My head is spli--it--ing." Needless to say I'veadded several new topics to my benefits verification checklist. Hope thissaves someone else's patient from the disappointment of postponing surgery. on Financial CounselorLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 toll free faxlmorris@..."The test of our progress is not whether we add more to the abundance ofthose who have much; it is whether we provide enough for those who have toolittle." - lin Delano RooseveltIMPORTANT NOTICE: This communication, including any attachment, containsinformation that may be confidential or privileged, and is intended solelyfor the entity or individual to whom it is addressed. If you are not theintended recipient, you should contact the sender and delete the message.Any unauthorized disclosure, copying, or distribution of this message isstrictly prohibited. Nothing in this email, including any attachment, isintended to be a legally binding signature.

[Guest guest]

, I too have a patient in a similar situation. He has only maintained

his Medicare part A since he still works and has Commercial primary. After

I told him that his Commercial could opt to pay only 20% of his costs, we

contacted our local Medicare office re: enrollment periods for part B. The

person I spoke with (who actually seemed versed in the transplant caveats)

said that when he is transplanted he will need to re-apply as though this is

his first time and that part B would be available from the first of the

transplant month.

The patient is aware that this is 'what Medicare says', but I am always

nervous as to how this sort of thing actually plays out when the time comes.

Hard lesson learned

Hi to All,

I learned a hard lesson today that I want to share in case others are in the

dark about the finer points of Medicare enrollment.

Our patient has been on dialysis since May of 2002. In April of 2004, she

signed up for Medicare ESRD Part A ONLY w/an effective date of 4/1/03. She

subsequently missed her first (limited) opportunity to sign up for Part B.

I mistakenly believed her transplant event would re-open the window of

opportunity for Part B. Instead, she is now bound by the rules of regular

open enrollment, so no Part B until July 05. Meanwhile ...if you're still

with me... her COB period ended 10/31/04, making Part A primary over her two

EGHPs on Nov 1. And both EGHPs will only consider her Part B claims at 20%

because, per contract language I did not know about, she should have put

her Part B in place by now. Needless to say, we have to postpone surgery.

How much fun was that phone call? NOT MUCH.

According to our ESRD expert at SSA, there is a silver lining. Pt can

withdraw her original claim and reapply w/a new effective date of 11/1/04

for Parts A & B. If there were any Part A claims paid from 4/03 to present,

she would have to pay them back - but the likelihood is almost nonexistent,

as she has had 2 EGHPs in place during this time. SSA estimates this

process will take " a couple, three months " as opposed waiting for a 7/1/05

Part B effective date if she applies during open enrollment.

In the words of Daffy Duck " My head is spli--it--ing. " Needless to say I've

added several new topics to my benefits verification checklist. Hope this

saves someone else's patient from the disappointment of postponing surgery.

on

Financial Counselor

Legacy Transplant Services

1040 NW 22nd Ave Ste 480

Portland OR 97210

toll free

fax

lmorris@...

" The test of our progress is not whether we add more to the abundance of

those who have much; it is whether we provide enough for those who have too

little. "

- lin Delano Roosevelt

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]

I appreciate all the responses. Thanks in large measure to your input our manager supported proceeding w/ the December surgery and holding the claims. When it's all over but the stitching, I am going to revisit the issue w/our local ESRD contact at SSA

RE: Hard lesson learned, I too have a patient in a similar situation. He has only maintainedhis Medicare part A since he still works and has Commercial primary. AfterI told him that his Commercial could opt to pay only 20% of his costs, wecontacted our local Medicare office re: enrollment periods for part B. Theperson I spoke with (who actually seemed versed in the transplant caveats)said that when he is transplanted he will need to re-apply as though this ishis first time and that part B would be available from the first of thetransplant month.The patient is aware that this is 'what Medicare says', but I am alwaysnervous as to how this sort of thing actually plays out when the time comes.-----Original Message-----From: on, :LPH Trnsplnt Sent: Tuesday, November 23, 2004 5:29 PMTo: txfinancialcoordinators Subject: Hard lesson learnedHi to All, I learned a hard lesson today that I want to share in case others are in thedark about the finer points of Medicare enrollment.Our patient has been on dialysis since May of 2002. In April of 2004, shesigned up for Medicare ESRD Part A ONLY w/an effective date of 4/1/03. Shesubsequently missed her first (limited) opportunity to sign up for Part B.I mistakenly believed her transplant event would re-open the window ofopportunity for Part B. Instead, she is now bound by the rules of regularopen enrollment, so no Part B until July 05. Meanwhile ...if you're stillwith me... her COB period ended 10/31/04, making Part A primary over her twoEGHPs on Nov 1. And both EGHPs will only consider her Part B claims at 20%because, per contract language I did not know about, she should have puther Part B in place by now. Needless to say, we have to postpone surgery.How much fun was that phone call? NOT MUCH.According to our ESRD expert at SSA, there is a silver lining. Pt canwithdraw her original claim and reapply w/a new effective date of 11/1/04for Parts A & B. If there were any Part A claims paid from 4/03 to present,she would have to pay them back - but the likelihood is almost nonexistent,as she has had 2 EGHPs in place during this time. SSA estimates thisprocess will take "a couple, three months" as opposed waiting for a 7/1/05Part B effective date if she applies during open enrollment. In the words of Daffy Duck "My head is spli--it--ing." Needless to say I'veadded several new topics to my benefits verification checklist. Hope thissaves someone else's patient from the disappointment of postponing surgery. on Financial CounselorLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 toll free faxlmorris@..."The test of our progress is not whether we add more to the abundance ofthose who have much; it is whether we provide enough for those who have toolittle." - lin Delano RooseveltIMPORTANT NOTICE: This communication, including any attachment, containsinformation that may be confidential or privileged, and is intended solelyfor the entity or individual to whom it is addressed. If you are not theintended recipient, you should contact the sender and delete the message.Any unauthorized disclosure, copying, or distribution of this message isstrictly prohibited. Nothing in this email, including any attachment, isintended to be a legally binding signature.