RE: RE: Coverage for Immunosuppressants

[Guest guest]

Medicare HMO's must always match the same level of benefits as the

person would have under regular Medicare. They can add benefits, but

they cannot take them away.

Fred L. Forsthoffer, MBA

Financial Analyst

Banner Samaritan Transplant Services

, , F-

RE: Coverage for Immunosuppressants

Does anyone know whether a Medicare HMO is required to provide coverage

for

immunosuppressants medications after a transplant if they pay for the

transplant at a non-Medicare approved center?

Thanks,

Janet M. Lovely

Lankenau Hospital

Phila., PA

[Guest guest]

Right ----

But if the patient is transplanted at a non-Medicare approved center, Medicare

has no obligation for the immunos. However, if the patient has a Medicare HMO

which pays for the txp. (at a non-Medicare approved center), is the Medicare HMO

then obligated to then pay for the immunos.

RE: Coverage for Immunosuppressants

Does anyone know whether a Medicare HMO is required to provide coverage

for

immunosuppressants medications after a transplant if they pay for the

transplant at a non-Medicare approved center?

Thanks,

Janet M. Lovely

Lankenau Hospital

Phila., PA

[Guest guest]

The guiding principle is if one has a Medicare-covered service at a

Non-Medicare facility, the service is not covered by Medicare.

Likewise, (I checked my references) Medicare coverage of

immunosuppressive meds is CONTINGENT UPON a Medicare payment for the

transplant.

So immunosuppressive meds are NOT covered following transplants

performed in facilities that are not Medicare-approved for the type of

organ transplanted. (Because Medicare did not pay them.) I do not

think this has been changed by Congress in the past few years.

However Medicare does cover hospital and medical care ordinarily covered

by Medicare even if the transplant took place in a Non-Medicare

facility.

So in this case, the Medicare HMO is obligated to pay for

transplant-related medical and hospital care, but not

immunosuppressives.

Fred L. Forsthoffer, MBA

Financial Analyst

Banner Samaritan Transplant Services

, , F-

RE: Coverage for Immunosuppressants

Does anyone know whether a Medicare HMO is required to provide coverage

for

immunosuppressants medications after a transplant if they pay for the

transplant at a non-Medicare approved center?

Thanks,

Janet M. Lovely

Lankenau Hospital

Phila., PA

[Guest guest]

Fred -

Thanks for the clarification. It would be helpful to me to know what your

references are. Jan

RE: Coverage for Immunosuppressants

Does anyone know whether a Medicare HMO is required to provide coverage

for

immunosuppressants medications after a transplant if they pay for the

transplant at a non-Medicare approved center?

Thanks,

Janet M. Lovely

Lankenau Hospital

Phila., PA