Medicare question

[Guest guest]

Hi , your patient can enroll anytime once he is eligible for Renal Medicare, as long as he gets his application in no later than the 12th month after his transplant. As long as he takes A & B together, he won't get gummed up in open enrollment or face a Part B premium penalty. SSA will process the app when they get it so he shouldn't apply any sooner than the month before he wants it to start (e.g. apply in Dec for a Jan start date) ..however, he can request a retro date on Part A up to 12 months earlier than the application is processed (e.g. applies in Dec 2007 based on a transplant that took place in Dec 2006. Part A entitlement will be 12/1/06, Part B 12/1/07). Most of our patients who put it off will sign up at the time of transplant which is what we strongly encourage, if for no other reason than the safety net factor on immunosuppressant coverage.

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 DonovanSent: Friday, May 12, 2006 10:43 AMTo: TxFinancialCoordinators Subject: medicare questionGood afternoon-I have a kidney patient who wishes to wait to apply for Medicare untilcloser to month 30 because it would be more of a hinderance at this time. Heis unable to afford the Part B premium at this time, and has privateinsurance with 100% inpatient coverage, and only a $5 outpatient copay. Myquestion is can the patient apply any time? Can they apply a few monthsahead to have everything ready prior to month 30, or do they have to applyduring open enrollment the year before? What are the rules in thissituation?Thanks DonovanTransplant Financial CoordinatorSUNY Upstate Medical University750 East StreetSyracuse, New York 13210Phone: 315 464-6290Fax: 315 464-6288Donovanl@...The information contained in this email is confidential intended only forthe use of the party to whom it is addressed. If you are not the intendedrecipient, please be aware that you are strictly prohibited from sharing,distributing, or copying this email. If you have received this email bymistake, please notify the sender. Thank you.

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[Guest guest]

Regards All:

I need a little help on this one. I have a 34 year old male with CF from Utah who was referred to our tx center due to the complexicity of his case. This male requires a simultaneous Liver/D Lung Tx. He is covered by Utah risk pool, very limited benefits. While interviewing him yesterday I found that he previously received SSD and had Medicare A,B (1994). With medical management and recovery he was able to go back to work, but then lost his SSD and Medicare. My question is: If he re-applies for SSD based on the same previously qualifying disease and is deemed eligible, would his Medicare re-activate at that time or would he have the 24 month wait again?

Much help on this!

Shellie Staib Transplant Credit Analyst Patient Business Services (PBS) UPMC Presbyterian/Shadyside 2 Hot Metal Street Quantum One Bldg Cube S351 Phone:(412)432-5541 Fax:(412)432-5590

[Guest guest]

Shellie,

As he lost disability status by returning to work, he must re-establish a new disability. He would have to start over w/a 24 mo.period of non-work d/t disability; then he would be MCR eligible again. Is is sad that one must be disabled even with a life-threatening illness, but can recieve the same Medicare coverage just by virtue of being 65yo or having ESRD...which has a maintence, life-sustaining treatment via dialysis. Thus the people who need the transplant the most with the shortest window of opportunity to be transplanted and survive are the least likely to ever get the coverage.

Sher Stirling-Burgin, RN, CCM550 N. University Blvd, Rm 4601Indianapolis, IN 46202-5250Transplant Financial CoordinatorMultivisceral/ Liver/ Intestine/ Pancreas phone FX

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Staib, ShellieSent: Thursday, May 18, 2006 3:50 PMTo: TxFinancialCoordinators Subject: Medicare question

Regards All:

I need a little help on this one. I have a 34 year old male with CF from Utah who was referred to our tx center due to the complexicity of his case. This male requires a simultaneous Liver/D Lung Tx. He is covered by Utah risk pool, very limited benefits. While interviewing him yesterday I found that he previously received SSD and had Medicare A,B (1994). With medical management and recovery he was able to go back to work, but then lost his SSD and Medicare. My question is: If he re-applies for SSD based on the same previously qualifying disease and is deemed eligible, would his Medicare re-activate at that time or would he have the 24 month wait again?

Much help on this!

Shellie Staib Transplant Credit Analyst Patient Business Services (PBS) UPMC Presbyterian/Shadyside 2 Hot Metal Street Quantum One Bldg Cube S351 Phone:(412)432-5541 Fax:(412)432-5590

[Guest guest]

I have not had this issue, but on a number of other issues (including cobra, social security, etc.) the patient's Congressman/woman has been of great help in resolving & expediting the matter.>>> M1@... 05/23 10:13 AM >>>

HelpWe have a pt age 53 with cerebral palsy who was placed on a VAD for destination therapy, the patient has a day limit BC of 120 days with no rx coverage or DME, we applied and received Medicaid of PA with this coverage. He is now in an LTEC and has coverage until 6/28/06The family applied for Medicare for patient and were denied because the family had refused Medicare coverage 25 years ago for patient. They were told the patient can not qualify for medicare now until age 62--we suggested the consult an attorney since this is a different medical condition than the CP which they declined 25 years ago. Has anyone out there had this problem come up. This is a first for us.Any help appreciated. Financial Coordinator**********************************************************************This email and any files transmitted with it are confidential andintended solely for the use of the individual or entity to whom theyare addressed. If you have received this email in error please notifythe West Penn Allegheny Health System Help Desk at 412 330-4357.This footnote also confirms that this email message has been swept byMIMEsweeper for the presence of computer viruses.**********************************************************************