Re: Evaluation Insurance Question

[Guest guest]

I would have him and his nephrologist appeal for in network benefits

citing transportation, family support etc if possible.

Cigna may not pay the zone 1 evaluation bills if not authorized.

>>> " Battin, Daryl J. " 10/31/06 2:08 PM >>>

We have a patient with CIGNA interested in a transplant at Lahey - has

been denied as Lahey is not a LifeSource Center and his transplant has

to be done at such.

Patient is not yet on dialysis - will start soon and then be Medicare

eligible. Suggestion has been to go ahead with the transplant

evaluation at Lahey and by the time he comes to transplant Medicare

will

possibly be prime.

Has anyone dealt with a scenario such as this? Would this only be

feasible if Medicare prime? And, if Medicare prime have people had

experience with CIGNA paying as secondary at a non-LifeSource center?

Daryl Battin, LICSW

Financial Coordinator/Social Worker

Kidney Transplant Program

Lahey Clinic

41 Mall Road

Burlington, MA 01805

781 744-7166--Phone

781 744-5009--Fax

See our web page at http://www.lahey.org for a full directory of Lahey

sites, staff, services and career opportunities.

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[Guest guest]

Our center is not within their network either but our contracting dept has been able to negotiate individual contracts with them for our patients. The other center within their network is 50+ miles away. I would check with your contracting department.Sherri -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Battin, Daryl J.Sent: Tuesday, October 31, 2006 2:08 PMTo: TxFinancialCoordinators Subject: Evaluation Insurance QuestionWe have a patient with CIGNA interested in a transplant at Lahey – has been denied as Lahey is not a LifeSource Center and his transplant has to be done at such. Patient is not yet on dialysis – will start soon and then be Medicare eligible. Suggestion has been to go ahead with the transplant evaluation at Lahey and by the time he comes to transplant Medicare will possibly be prime. Has anyone dealt with a scenario such as this? Would this only be feasible if Medicare prime? And, if Medicare prime have people had experience with CIGNA paying as secondary at a non-LifeSource center? Daryl Battin, LICSWFinancial Coordinator/Social WorkerKidney Transplant ProgramLahey Clinic41 Mall RoadBurlington, MA 01805781 744-7166--Phone781 744-5009--Fax See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities.THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records.

[Guest guest]

Regional

appeal done and denied as he has no in network benefits, thus the Medicare

question/coverage being raised by nephrology.

Daryl Battin, LICSW

Financial Coordinator/Social

Worker

Kidney Transplant

Program, Lahey Clinic

Phone: 781 744-7166/781

744-8974

Fax: 781 744-5009

Re:

Evaluation Insurance Question

I would have him and his nephrologist appeal for in

network benefits

citing transportation, family support etc if possible.

Cigna may not pay the zone 1 evaluation bills if not authorized.

>>> " Battin, Daryl J. " <Daryl.J.BattinLahey (DOT) org>

10/31/06 2:08 PM >>>

We have a patient with CIGNA interested in a transplant at Lahey - has

been denied as Lahey is not a LifeSource Center and his transplant has

to be done at such.

Patient is not yet on dialysis - will start soon and then be Medicare

eligible. Suggestion has been to go ahead with the transplant

evaluation at Lahey and by the time he comes to transplant Medicare

will

possibly be prime.

Has anyone dealt with a scenario such as this? Would this only be

feasible if Medicare prime? And, if Medicare prime have people had

experience with CIGNA paying as secondary at a non-LifeSource center?

Daryl Battin, LICSW

Financial Coordinator/Social Worker

Kidney Transplant Program

Lahey Clinic

41 Mall Road

Burlington, MA 01805

781 744-7166--Phone

781 744-5009--Fax

See our web page at http://www.lahey.org

for a full directory of Lahey

sites, staff, services and career opportunities.

THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS

ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL

AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the

intended recipient, your use of this message for any purpose is strictly

prohibited. If you have received this communication in error, please

delete the message and notify the sender so that we may correct our

records.

See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities.THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records.

[Guest guest]

I had this same scenario happen just a

week ago. Only it was with Aetna instead. What

I found out is the patient plan is set by the employer and the insurance

company is denying it because of the wording in the employer’s contract. The

insurance stated they could do it with the employers permission. So I sent the patient

to his human resource department to see if he could get a patient specific

agreement to allow him to use our facility as an in network facility. Well they

did not do that but the employer gave him the option to change to the ppo plan

which would give him out of network benefits and raised the out of network

payment to 85% instead of 60% out of network cost. So maybe this is something

you can suggest, have your patient start with the Employer’s HR dept.

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of anne Buccheri

Sent: Wednesday, November 01, 2006

9:16 AM

To: TxFinancialCoordinators

Subject: Re:

Evaluation Insurance Question

I would have him and his nephrologist appeal for in

network benefits

citing transportation, family support etc if possible.

Cigna may not pay the zone 1 evaluation bills if not authorized.

>>> " Battin, Daryl J. " <Daryl.J.BattinLahey (DOT) org>

10/31/06 2:08 PM >>>

We have a patient with CIGNA interested in a transplant at Lahey - has

been denied as Lahey is not a LifeSource

Center and his transplant

has

to be done at such.

Patient is not yet on dialysis - will start soon and then be Medicare

eligible. Suggestion has been to go ahead with the transplant

evaluation at Lahey and by the time he comes to transplant Medicare

will

possibly be prime.

Has anyone dealt with a scenario such as this? Would this only be

feasible if Medicare prime? And, if Medicare prime have people had

experience with CIGNA paying as secondary at a non-LifeSource center?

Daryl Battin, LICSW

Financial Coordinator/Social Worker

Kidney Transplant Program

Lahey Clinic

41 Mall Road

Burlington, MA 01805

781 744-7166--Phone

781 744-5009--Fax

See our web page at http://www.lahey.org

for a full directory of Lahey

sites, staff, services and career opportunities.

THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS

ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL

AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the

intended recipient, your use of this message for any purpose is strictly

prohibited. If you have received this communication in error, please

delete the message and notify the sender so that we may correct our

records.

[Guest guest]

There is a copy of the CMS letter addressed

to regarding Medicare Coverage if patients decide to go out of network.

The CMS letter states should the patient decide to go out of network and

the plan states that it will make no payment should the plan enrollee go out of

network for transplant services, Medicare will not make a secondary payment.

Austria

Specialty Contracting

Methodist Health System

1441 North Beckley Avenue

Dallas,Texas 75203

Phone:

Fax:

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Battin, Daryl J.

Sent: Wednesday, November 01, 2006

8:26 AM

To: TxFinancialCoordinators

Subject: RE:

Evaluation Insurance Question

Regional appeal done and denied as he has

no in network benefits, thus the Medicare question/coverage being raised by

nephrology.

Daryl Battin, LICSW

Financial

Coordinator/Social Worker

Kidney Transplant

Program, Lahey Clinic

Phone: 781 744-7166/781 744-8974

Fax: 781 744-5009

Re:

Evaluation Insurance Question

I would have him and his nephrologist appeal for in

network benefits

citing transportation, family support etc if possible.

Cigna may not pay the zone 1 evaluation bills if not authorized.

>>> " Battin, Daryl J. " <Daryl.J.BattinLahey (DOT) org>

10/31/06 2:08 PM >>>

We have a patient with CIGNA interested in a transplant at Lahey - has

been denied as Lahey is not a LifeSource

Center and his transplant

has

to be done at such.

Patient is not yet on dialysis - will start soon and then be Medicare

eligible. Suggestion has been to go ahead with the transplant

evaluation at Lahey and by the time he comes to transplant Medicare

will

possibly be prime.

Has anyone dealt with a scenario such as this? Would this only be

feasible if Medicare prime? And, if Medicare prime have people had

experience with CIGNA paying as secondary at a non-LifeSource center?

Daryl Battin, LICSW

Financial Coordinator/Social Worker

Kidney Transplant Program

Lahey Clinic

41 Mall Road

Burlington, MA 01805

781 744-7166--Phone

781 744-5009--Fax

See our web page at http://www.lahey.org

for a full directory of Lahey

sites, staff, services and career opportunities.

THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS

ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL

AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the

intended recipient, your use of this message for any purpose is strictly

prohibited. If you have received this communication in error, please

delete the message and notify the sender so that we may correct our

records.

See our web page at http://www.lahey.org for

a full directory of Lahey sites, staff, services and career opportunities.

THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT

MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM

DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your

use of this message for any purpose is strictly prohibited. If you have

received this communication in error, please delete the message and notify the

sender so that we may correct our records.

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

This electronic transmission contains information from Methodist Health

System and should be considered confidential and privileged. The

information contained in the above messages is intended only for the

use of the individual(s) and entity(ies) named above. If you are not

the intended recipient, be aware that any disclosure, copying,

distribution, or use of this information is prohibited. If you receive

this transmission in error, please notify the sender immediately by

return e-mail. Methodist Health System, its subsidiaries and

affiliates hereby claim all applicable privileges related to the

transmission of this communication.

[Guest guest]

The ltr is talking about is in the Medicare section of the TFCA Resource Guide, btw.

J. Aguiar

Beth Israel Deaconess, Boston

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Austria, Sent: Wednesday, November 01, 2006 10:28 AMTo: TxFinancialCoordinators Subject: RE: Evaluation Insurance Question

There is a copy of the CMS letter addressed to regarding Medicare Coverage if patients decide to go out of network. The CMS letter states should the patient decide to go out of network and the plan states that it will make no payment should the plan enrollee go out of network for transplant services, Medicare will not make a secondary payment.

Austria

Specialty Contracting

Methodist Health System

1441 North Beckley Avenue

Dallas,Texas 75203

Phone:

Fax:

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Battin, Daryl J.Sent: Wednesday, November 01, 2006 8:26 AMTo: TxFinancialCoordinators Subject: RE: Evaluation Insurance Question

Regional appeal done and denied as he has no in network benefits, thus the Medicare question/coverage being raised by nephrology.

Daryl Battin, LICSW

Financial Coordinator/Social Worker

Kidney Transplant Program, Lahey Clinic

Phone: 781 744-7166/781 744-8974

Fax: 781 744-5009

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of anne BuccheriSent: Wednesday, November 01, 2006 9:16 AMTo: TxFinancialCoordinators Subject: Re: Evaluation Insurance Question

I would have him and his nephrologist appeal for in network benefitsciting transportation, family support etc if possible.Cigna may not pay the zone 1 evaluation bills if not authorized.>>> "Battin, Daryl J." <Daryl.J.BattinLahey (DOT) org> 10/31/06 2:08 PM >>>We have a patient with CIGNA interested in a transplant at Lahey - hasbeen denied as Lahey is not a LifeSource Center and his transplant hasto be done at such.Patient is not yet on dialysis - will start soon and then be Medicareeligible. Suggestion has been to go ahead with the transplantevaluation at Lahey and by the time he comes to transplant Medicarewillpossibly be prime. Has anyone dealt with a scenario such as this? Would this only befeasible if Medicare prime? And, if Medicare prime have people hadexperience with CIGNA paying as secondary at a non-LifeSource center?Daryl Battin, LICSWFinancial Coordinator/Social WorkerKidney Transplant ProgramLahey Clinic41 Mall RoadBurlington, MA 01805781 744-7166--Phone781 744-5009--FaxSee our web page at http://www.lahey.org for a full directory of Laheysites, staff, services and career opportunities.THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT ISADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIALAND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not theintended recipient, your use of this message for any purpose is strictlyprohibited. If you have received this communication in error, pleasedelete the message and notify the sender so that we may correct ourrecords.

See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities.THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records.

***********************************************************************This electronic transmission contains information from Methodist Health System and should be considered confidential and privileged. The information contained in the above messages is intended only for the use of the individual(s) and entity(ies) named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of this information is prohibited. If you receive this transmission in error, please notify the sender immediately by return e-mail. Methodist Health System, its subsidiaries and affiliates hereby claim all applicable privileges related to the transmission of this communication.

[Guest guest]

If you put the eval on your cost report you do not have to worry about what CIGNA pays as the patient's Medicare will cover eval.>>> "anne Buccheri" 11/1/2006 9:16 am >>>I would have him and his nephrologist appeal for in network benefitsciting transportation, family support etc if possible.Cigna may not pay the zone 1 evaluation bills if not authorized.>>> "Battin, Daryl J." 10/31/06 2:08 PM >>>We have a patient with CIGNA interested in a transplant at Lahey - hasbeen denied as Lahey is not a LifeSource Center and his transplant hasto be done at such.Patient is not yet on dialysis - will start soon and then be Medicareeligible. Suggestion has been to go ahead with the transplantevaluation at Lahey and by the time he comes to transplant Med!

icarewillpossibly be prime. Has anyone dealt with a scenario such as this? Would this only befeasible if Medicare prime? And, if Medicare prime have people hadexperience with CIGNA paying as secondary at a non-LifeSource center?Daryl Battin, LICSWFinancial Coordinator/Social WorkerKidney Transplant ProgramLahey Clinic41 Mall RoadBurlington, MA 01805781 744-7166--Phone781 744-5009--FaxSee our web page at http://www.lahey.org for a full directory of Laheysites, staff, services and career opportunities.THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT ISADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIALAND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not theintended recipient, your use of this message for any purpose is strictlyprohibited. If you have receive!

d this communication in error, pleasedelete the message and notify the sender so that we may correct ourrecords.

[Guest guest]

It is like I said in my first response, if he has no out of network benefit he must use their LifeSource Center, like it or not. The best he can hope for is to change insurance during his open season at work>>> " " 11/2/2006 3:03 pm >>>Eval can be covered but for 30 months Cigna will remain primary andstill have Life Source network that applies. What if patient is listedand comes in for kidney transplant??? They will not cover because ofusing a non approved center unless exception can be given by Cigna--ptcan do appeal based on hardship. We tried this and were still denied. Financial Coordinator>>> BALarson@... 11/2/2006 7:59 am >>>If you put the eval on your cost report you do not have to worry aboutwhat CIGNA pays as the patient's Medicare will cover eval.!

>>> "anne Buccheri" 11/1/2006 9:16 am >>>I would have him and his nephrologist appeal for in network benefitsciting transportation, family support etc if possible.Cigna may not pay the zone 1 evaluation bills if not authorized.>>> "Battin, Daryl J." 10/31/06 2:08 PM >>>We have a patient with CIGNA interested in a transplant at Lahey - hasbeen denied as Lahey is not a LifeSource Center and his transplant hasto be done at such.Patient is not yet on dialysis - will start soon and then be Medicareeligible. Suggestion has been to go ahead with the transplantevaluation at Lahey and by the time he comes to transplant Medicarewillpossibly be prime. Has anyone dealt with a scenario such as this? Would this only befeasible if Medicare prime? And, if Medicar!

e prime have people hadexperience with CIGNA paying as secondary at a non-LifeSource center?Daryl Battin, LICSWFinancial Coordinator/Social WorkerKidney Transplant ProgramLahey Clinic41 Mall RoadBurlington, MA 01805781 744-7166--Phone781 744-5009--FaxSee our web page at http://www.lahey.org for a full directory of Laheysites, staff, services and career opportunities.THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT ISADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIALAND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not theintended recipient, your use of this message for any purpose isstrictlyprohibited. If you have received this communication in error, pleasedelete the message and notify the sender so that we may correct ourrecords.  !

;