RE: Hard lesson learned Part II

[Guest guest]

I have a patient that did cancel Medicare for this same reason however he is now

suffering the consequences. Medicare became prime 12/04-- Now he is upset

because his EGHP will only pay secondary charges. SSA told him that he can

enroll during open enrollment which will not help him at all.

I am so glad that I sent a certified letter advising him to not cancel Medicare

so that this did not fall back on our office. All I can say is document,

document, document!

Felecia

Transplant Financial Coordinator

Saint 's Health Care-Transplant Program

Grand Rapids, MI 49503

PH

Fax#

>>> Fornash.@... 12/30/2004 11:34:19 AM >>>

Good Morning All,

I have a question for all the Medicare experts out there. Many of our email

topics have covered similar situations, but I want to throw this one back

out there and see what you think.

I have a patient who transplanted pre dialysis and has an EGHP. He received

Medicare due to his transplant and began to pay his part B premiums. He has

recently called me to inquire why he should continue his part B. Are there

any ramifications to his canceling part B? He thinks his EGHP is adequate

coverage and he does not need Medicare. Could someone tell me, based on his

particular situation, what I should tell him?

Thanks so much!

Hard lesson learned Part II

Hi Everyone, thought you'd be interested in the reference our local SSA

office sent to me, regarding the question of whether ESRD beneficiaries

have a right to a new Initial Enrollment Period for Part B at the time of

transplant, assuming the claimant enrolled in Part A only at an earlier

opportunity. If anyone else's local office has a citation to challenge

this I'd love to see it (Bev Larson's maybe?):

Hi ,

Sorry it took so long to get back to you. Again, I am sure I am correct on

this subject (not that I'm always happy to be right ) I can provide a

reference from our manual which clearly shows how claimants should be

cautioned about filing for Part A only during the IEP:

(HI 00801.247)

FF. POLICY * EFFECT OF MSP PROVISIONS ON FILING

Because Medicare will not be paying full benefits in many cases where there

is a group health insurance plan, some individuals may not wish to enroll in

R-SMI when first eligible.

It is important to remember that the special enrollment period (SEP) rules

applicable to aged and disabled individuals do not apply to people entitled

to R-HI. Therefore, it is extremely important to properly inform ESRD

patients (including dual eligibles) who have GHP coverage about their

options with respect to filing an application for R-HI. An individual may

wish to:

*

File for both R-HI and R-SMI at initial R-HI eligibility even though

Medicare can only make secondary payments until the end of the ESRD

coordination period. With expenses as high as those for treatment of ESRD,

an individual may consider secondary Medicare payments to be well worth the

monthly SMI premium.

*

Defer filing for R-HI (and R-SMI) until the end of the ESRD coordination

period. This will permit the individual to defer paying for SMI until

Medicare becomes the primary payer of benefits.

ESRD patients with GHP coverage should be discouraged from filing for R-HI

while rejecting R-SMI at initial eligibility. Once R-SMI is refused,

enrollment can only take place during a GEP, with coverage effective the

following July. This will usually mean a gap in coverage between the end of

primary payments by the GHP and the beginning of SMI in the month of July.

It may also result in a premium surcharge for late enrollment. If an

individual with GHP coverage files an application for R-HI in the mistaken

belief that Medicare will be primary payer of benefits, the application may

be withdrawn as provided for in HI

<http://policynet.ba.ssa.gov/poms.nsf/lnx/0600801197> 00801.197.

It's still not good news, but hopefully this spells it out better. As

always, call or e-mail me if you have any other questions.. Ann

on

Financial Counselor

Legacy Transplant Services

1040 NW 22nd Ave Ste 480

Portland OR 97210

toll free

fax

lmorriso@...

``There are some upon this earth of yours who lay claim to know us, and who

do their deeds of passion, pride, ill-will, hatred, envy, bigotry, and

selfishness in our name, who are as strange to us and all our kith and kin,

as if they had never lived. Remember that, and charge their doings on

themselves, not us.'' - The Ghost of Christmas Present

[Guest guest]

According to the Medicare web site " if you decide to drop Medicare Part

B while you have a EGHP you are eligible to sign up during " special

enrollment periods " without having to pay a higher premium " . Source:

http://medicare.custhelpcom .under ask a question type Can I delay

part B enrollment? Is it different for ESRD patients and why? As often

as I talk to Medicare and Social Security, I often get different answers

about this topic.

Hartford Hospital Transplant Program

>>> F@... 12/30/04 12:12PM >>>

I have a patient that did cancel Medicare for this same reason however

he is now suffering the consequences. Medicare became prime 12/04-- Now

he is upset because his EGHP will only pay secondary charges. SSA told

him that he can enroll during open enrollment which will not help him at

all.

I am so glad that I sent a certified letter advising him to not cancel

Medicare so that this did not fall back on our office. All I can say is

document, document, document!

Felecia

Transplant Financial Coordinator

Saint 's Health Care-Transplant Program

Grand Rapids, MI 49503

PH

Fax#

>>> Fornash.@... 12/30/2004 11:34:19 AM >>>

Good Morning All,

I have a question for all the Medicare experts out there. Many of our

email

topics have covered similar situations, but I want to throw this one

back

out there and see what you think.

I have a patient who transplanted pre dialysis and has an EGHP. He

received

Medicare due to his transplant and began to pay his part B premiums.

He has

recently called me to inquire why he should continue his part B. Are

there

any ramifications to his canceling part B? He thinks his EGHP is

adequate

coverage and he does not need Medicare. Could someone tell me, based

on his

particular situation, what I should tell him?

Thanks so much!

Hard lesson learned Part II

Hi Everyone, thought you'd be interested in the reference our local

SSA

office sent to me, regarding the question of whether ESRD

beneficiaries

have a right to a new Initial Enrollment Period for Part B at the time

of

transplant, assuming the claimant enrolled in Part A only at an

earlier

opportunity. If anyone else's local office has a citation to

challenge

this I'd love to see it (Bev Larson's maybe?):

Hi ,

Sorry it took so long to get back to you. Again, I am sure I am

correct on

this subject (not that I'm always happy to be right ) I can provide

a

reference from our manual which clearly shows how claimants should be

cautioned about filing for Part A only during the IEP:

(HI 00801.247)

FF. POLICY * EFFECT OF MSP PROVISIONS ON FILING

Because Medicare will not be paying full benefits in many cases where

there

is a group health insurance plan, some individuals may not wish to

enroll in

R-SMI when first eligible.

It is important to remember that the special enrollment period (SEP)

rules

applicable to aged and disabled individuals do not apply to people

entitled

to R-HI. Therefore, it is extremely important to properly inform ESRD

patients (including dual eligibles) who have GHP coverage about their

options with respect to filing an application for R-HI. An individual

may

wish to:

*

File for both R-HI and R-SMI at initial R-HI eligibility even though

Medicare can only make secondary payments until the end of the ESRD

coordination period. With expenses as high as those for treatment of

ESRD,

an individual may consider secondary Medicare payments to be well worth

the

monthly SMI premium.

*

Defer filing for R-HI (and R-SMI) until the end of the ESRD

coordination

period. This will permit the individual to defer paying for SMI until

Medicare becomes the primary payer of benefits.

ESRD patients with GHP coverage should be discouraged from filing for

R-HI

while rejecting R-SMI at initial eligibility. Once R-SMI is refused,

enrollment can only take place during a GEP, with coverage effective

the

following July. This will usually mean a gap in coverage between the

end of

primary payments by the GHP and the beginning of SMI in the month of

July.

It may also result in a premium surcharge for late enrollment. If an

individual with GHP coverage files an application for R-HI in the

mistaken

belief that Medicare will be primary payer of benefits, the application

may

be withdrawn as provided for in HI

<http://policynet.ba.ssa.gov/poms.nsf/lnx/0600801197> 00801.197.

It's still not good news, but hopefully this spells it out better. As

always, call or e-mail me if you have any other questions.. Ann

on

Financial Counselor

Legacy Transplant Services

1040 NW 22nd Ave Ste 480

Portland OR 97210

toll free

fax

lmorriso@...

``There are some upon this earth of yours who lay claim to know us, and

who

do their deeds of passion, pride, ill-will, hatred, envy, bigotry, and

selfishness in our name, who are as strange to us and all our kith and

kin,

as if they had never lived. Remember that, and charge their doings on

themselves, not us.'' - The Ghost of Christmas Present

[Guest guest]

HI (Health Insurance refers to Part A)

SMI (Supplementary Medical Insurance refers to Part

I think the R stands for renal.

At least this is my understanding.

Anita M. Tantaros

Transplant Financial Coordinator

Fax

------------------( Forwarded letter 1 follows )---------------------

Date: Thu, 30 Dec 2004 10:58:05 -0600

To: TxFinancialCoordinators

From: Steen.Ginger[Virginia.Steen]@HCAHealthcare.com

Sender: sentto-1988899-6485-@...

Reply-To: TxFinancialCoordinators

Subject: RE: Hard lesson learned Part II

Re: The forward from ..... what is R-HI and R-SMI so I can intrepret

the reply?

Hard lesson learned Part II

Hi Everyone, thought you'd be interested in the reference our local SSA

office sent to me, regarding the question of whether ESRD beneficiaries

have a right to a new Initial Enrollment Period for Part B at the time of

transplant, assuming the claimant enrolled in Part A only at an earlier

opportunity. If anyone else's local office has a citation to challenge

this I'd love to see it (Bev Larson's maybe?):

Hi ,

Sorry it took so long to get back to you. Again, I am sure I am correct on

this subject (not that I'm always happy to be right ) I can provide a

reference from our manual which clearly shows how claimants should be

cautioned about filing for Part A only during the IEP:

(HI 00801.247)

FF. POLICY — EFFECT OF MSP PROVISIONS ON FILING

Because Medicare will not be paying full benefits in many cases where there

is a group health insurance plan, some individuals may not wish to enroll in

R-SMI when first eligible.

It is important to remember that the special enrollment period (SEP) rules

applicable to aged and disabled individuals do not apply to people entitled

to R-HI. Therefore, it is extremely important to properly inform ESRD

patients (including dual eligibles) who have GHP coverage about their

options with respect to filing an application for R-HI. An individual may

wish to:

*

File for both R-HI and R-SMI at initial R-HI eligibility even though

Medicare can only make secondary payments until the end of the ESRD

coordination period. With expenses as high as those for treatment of ESRD,

an individual may consider secondary Medicare payments to be well worth the

monthly SMI premium.

*

Defer filing for R-HI (and R-SMI) until the end of the ESRD coordination

period. This will permit the individual to defer paying for SMI until

Medicare becomes the primary payer of benefits.

ESRD patients with GHP coverage should be discouraged from filing for R-HI

while rejecting R-SMI at initial eligibility. Once R-SMI is refused,

enrollment can only take place during a GEP, with coverage effective the

following July. This will usually mean a gap in coverage between the end of

primary payments by the GHP and the beginning of SMI in the month of July.

It may also result in a premium surcharge for late enrollment. If an

individual with GHP coverage files an application for R-HI in the mistaken

belief that Medicare will be primary payer of benefits, the application may

be withdrawn as provided for in HI

<http://policynet.ba.ssa.gov/poms.nsf/lnx/0600801197> 00801.197.

It's still not good news, but hopefully this spells it out better. As

always, call or e-mail me if you have any other questions.. Ann

on

Financial Counselor

Legacy Transplant Services

1040 NW 22nd Ave Ste 480

Portland OR 97210

toll free

fax

lmorriso@...

``There are some upon this earth of yours who lay claim to know us, and who

do their deeds of passion, pride, ill-will, hatred, envy, bigotry, and

selfishness in our name, who are as strange to us and all our kith and kin,

as if they had never lived. Remember that, and charge their doings on

themselves, not us.'' - The Ghost of Christmas Present

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