RE: ESRD/Dialysis question

[Guest guest]

ESRD pts, regardless of age or size of the employer group, with a GHP, Medicare is 2ndry for the 1st 30 months due to ESRD COB. If the patient receives a transplant within that 30 month period, Medicare automatically becomes prime for the next 3 years.

E. Transplant Financial Coordinator

Temple University Hospital

Philadelphia, Pa 19140 FAX

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Fornash, M.Sent: Wednesday, September 27, 2006 1:55 PMTo: TxFinancialCoordinators Subject: ESRD/Dialysis question

Here is a doosey for everyone…

Patient became disabled and is entitled to ESRD 12/1/06 at the same time. He has a LGHP (his policy) from employer, though he has not worked since 12/04. Which COB rule would take precedence? Bill, …any thoughts?

Thanks as always!

Fornash Transplant Financial Coordinator Kidney & Pancreas Mayo Clinic ville (904) 953.6062 phone (904) 953.2681 fax fornash.angela@...

[Guest guest]

-

ESRD Medicare rules override age/disability rules.

Tyler

Transplant Financial Coord

Sacred Heart Med Ctr

Spokane, WA

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Fornash, M.Sent: Wednesday, September 27, 2006 10:55 AMTo: TxFinancialCoordinators Subject: ESRD/Dialysis question

Here is a doosey for everyone…

Patient became disabled and is entitled to ESRD 12/1/06 at the same time. He has a LGHP (his policy) from employer, though he has not worked since 12/04. Which COB rule would take precedence? Bill, …any thoughts?

Thanks as always!

Fornash Transplant Financial Coordinator Kidney & Pancreas Mayo Clinic ville (904) 953.6062 phone (904) 953.2681 fax fornash.angelamayo (DOT) edu

[Guest guest]

I knew all of that, but thanks ) ...my question was, if the dual entitlement occurred at the exact same time, would you use the disability rule or esrd rule. If the ESRD event occurred first, then the LGHP would have to play out the coordination, but what about in this case?

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , E.Sent: Wednesday, September 27, 2006 2:30 PMTo: TxFinancialCoordinators Subject: RE: ESRD/Dialysis question

ESRD pts, regardless of age or size of the employer group, with a GHP, Medicare is 2ndry for the 1st 30 months due to ESRD COB. If the patient receives a transplant within that 30 month period, Medicare automatically becomes prime for the next 3 years.

E. Transplant Financial Coordinator

Temple University Hospital

Philadelphia, Pa 19140 FAX

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Fornash, M.Sent: Wednesday, September 27, 2006 1:55 PMTo: TxFinancialCoordinators Subject: ESRD/Dialysis question

Here is a doosey for everyone…

Patient became disabled and is entitled to ESRD 12/1/06 at the same time. He has a LGHP (his policy) from employer, though he has not worked since 12/04. Which COB rule would take precedence? Bill, …any thoughts?

Thanks as always!

Fornash Transplant Financial Coordinator Kidney & Pancreas Mayo Clinic ville (904) 953.6062 phone (904) 953.2681 fax fornash.angela@...

[Guest guest]

I was informed that the 30 month COB

rule would apply even if a transplant were to occur. That at the

time of transplant Medicare would not automatically become primary.......

Please clarify

JoAnne Cannone

Lead Patient Financial Liaison

University Transplant Program

1725 W. on St.

Suite 744, Professional Building

Chicago, IL 60612

Office:

Pager 85-6131

Fax:

***********************************************************************************************************************************************************************************

[Guest guest]

You are correct.

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Joanne_Cannone@...Sent: Wednesday, September 27, 2006 2:57 PMTo: TxFinancialCoordinators Cc: TxFinancialCoordinators Subject: RE: ESRD/Dialysis question

I was informed that the 30 month COB rule would apply even if a transplant were to occur. That at the time of transplant Medicare would not automatically become primary....... Please clarify JoAnne CannoneLead Patient Financial LiaisonUniversity Transplant Program1725 W. on St.Suite 744, Professional BuildingChicago, IL 60612Office:Pager 85-6131Fax: ***********************************************************************************************************************************************************************************

[Guest guest]

ESRD trumps.

~Sher Stirling-Burgin, RN, CCM

The Clarian Transplant

Center

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Fornash, M.

Sent: Wednesday, September 27,

2006 2:56 PM

To:

TxFinancialCoordinators

Subject: RE:

ESRD/Dialysis question

I knew all of that, but thanks

) ...my question was, if the dual entitlement

occurred at the exact same time, would you use the disability rule or esrd

rule. If the ESRD event occurred first, then the LGHP would have to play

out the coordination, but what about in this case?

From:

TxFinancialCoordinators [mailto:TxFinancialCoordinators ]

On Behalf Of , E.

Sent: Wednesday, September 27,

2006 2:30 PM

To: TxFinancialCoordinators

Subject: RE:

ESRD/Dialysis question

ESRD pts, regardless of age or size of the

employer group, with a GHP, Medicare is 2ndry for the 1st 30 months due to

ESRD COB. If the patient receives a transplant within that 30 month period,

Medicare automatically becomes prime for the next 3 years.

E.

Transplant Financial Coordinator

Temple University Hospital

Philadelphia, Pa 19140

FAX

ESRD/Dialysis question

Here

is a doosey for everyone…

Patient

became disabled and is entitled to ESRD 12/1/06 at the same time. He has

a LGHP (his policy) from employer, though he has not worked since 12/04.

Which COB rule would take precedence? Bill, …any thoughts?

Thanks

as always!

Fornash

Transplant

Financial Coordinator

Kidney

& Pancreas

Mayo

Clinic ville

(904)

953.6062 phone

(904)

953.2681 fax

fornash.angelamayo (DOT) edu

[Guest guest]

I concurJ, it is confusing, but the “30” month rule does not

change because of the transplant, it has to play out in its entirety.

Hope this helps,

Thanks

Bill

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Fornash, M.

Sent: Wednesday, September 27,

2006 3:11 PM

To: TxFinancialCoordinators

Subject: RE:

ESRD/Dialysis question

You are correct.

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of Joanne_Cannonerush (DOT) edu

Sent: Wednesday, September 27,

2006 2:57 PM

To: TxFinancialCoordinators

Cc: TxFinancialCoordinators

Subject: RE:

ESRD/Dialysis question

I was informed that the 30 month COB rule would apply

even if a transplant were to occur. That at the time of transplant

Medicare would not automatically

become primary.......

Please

clarify

JoAnne

Cannone

Lead Patient Financial Liaison

University Transplant Program

1725 W. on St.

Suite 744,

Professional Building

Chicago, IL

60612

Office:

Pager 85-6131

Fax:

***********************************************************************************************************************************************************************************

[Guest guest]

Thanks everyone!

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Tyler, A.Sent: Wednesday, September 27, 2006 2:47 PMTo: TxFinancialCoordinators Subject: RE: ESRD/Dialysis question

-

ESRD Medicare rules override age/disability rules.

Tyler

Transplant Financial Coord

Sacred Heart Med Ctr

Spokane, WA

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Fornash, M.Sent: Wednesday, September 27, 2006 10:55 AMTo: TxFinancialCoordinators Subject: ESRD/Dialysis question

Here is a doosey for everyone…

Patient became disabled and is entitled to ESRD 12/1/06 at the same time. He has a LGHP (his policy) from employer, though he has not worked since 12/04. Which COB rule would take precedence? Bill, …any thoughts?

Thanks as always!

Fornash Transplant Financial Coordinator Kidney & Pancreas Mayo Clinic ville (904) 953.6062 phone (904) 953.2681 fax fornash.angelamayo (DOT) edu

[Guest guest]

Joanne that is correct, the transplant event does not "interrupt" the COB period. If pt is in a GHP at the time of transplant, Medicare will remain 2ndary until the 30 months is up. The only scenario I can think of where Medicare goes immediately primary is if the pt has a pre-emptive transplant (has not begun dialysis) and has an individual policy - in that case, Medicare, which is always primary over an individual policy, becomes primary retro to the first of the month in which the transplant takes place.

on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorrisolhs (DOT) org

"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." FDR

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Joanne_Cannone@...Sent: Wednesday, September 27, 2006 11:57 AMTo: TxFinancialCoordinators Cc: TxFinancialCoordinators Subject: RE: ESRD/Dialysis question

I was informed that the 30 month COB rule would apply even if a transplant were to occur. That at the time of transplant Medicare would not automatically become primary....... Please clarify JoAnne CannoneLead Patient Financial LiaisonUniversity Transplant Program1725 W. on St.Suite 744, Professional BuildingChicago, IL 60612Office:Pager 85-6131Fax: ***********************************************************************************************************************************************************************************