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Hi Everyone,

I have a question concerning the instance by where Medicare becomes Primary

during the COB period for an ESRD patient.

As I understand it, Medicare becomes Primary when the patient is in an LGHP in

which the plan covers fewer than 100 employees or the plan denies the claim

because the benefits are exhausted or the services are not covered under the

plan. If a patient with ESRD is employed in a large corporation but has really

poor medical coverage, e.g. payment of $400 per day for hospital room and board

only and no coverage of professional fees, the patient's LGHP would remain

Primary during the COB period because the company has more than 100 employees,

right? Thank you.

Teri Cowling

TFC

UT Southwestern Medical Center

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