Guest guest Posted December 21, 2006 Report Share Posted December 21, 2006 & Program Committee: I have a topic suggestion for the next TFCA workshop. It might be interesting to have a panel of Transplant Directors/Case Managers from the larger commercial insurance companies present and be available for debate/questions about benefits, the authorization process, the centers of excellence (COE) concepts, etc. Those of us who work at transplant facilities that are not affiliated with major/university-based medical centers frequently come up against a brick wall when we have a patient who has insurance coverage that mandates use of an out-of-state transplant center. Oftentimes, going out of the patient’s state of residence proves to be too much of a hardship and patients are not offered any alternatives; they often opt to wait out the 30-month COB period and return for evaluation and transplant under their Medicare coverage. Even then some insurance contracts do not provide secondary coverage outside a COE network. There are excellent, high quality transplant centers throughout the U.S. that have no hope of ever qualifying for a COE network based on volume. It could prove to be an interesting session…………. Barbara Cochrane, MSN, RN Transplant Financial Coordinator Transplant Services Department Mercy Medical Center—Des Moines, Iowa Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2006 Report Share Posted December 21, 2006 I think this is an excellent suggestion. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Cochrane, Barbara ESent: Thursday, December 21, 2006 2:46 PMTo: TxFinancialCoordinators Subject: 2007 Workshop & Program Committee: I have a topic suggestion for the next TFCA workshop. It might be interesting to have a panel of Transplant Directors/Case Managers from the larger commercial insurance companies present and be available for debate/questions about benefits, the authorization process, the centers of excellence (COE) concepts, etc. Those of us who work at transplant facilities that are not affiliated with major/university-based medical centers frequently come up against a brick wall when we have a patient who has insurance coverage that mandates use of an out-of-state transplant center. Oftentimes, going out of the patient’s state of residence proves to be too much of a hardship and patients are not offered any alternatives; they often opt to wait out the 30-month COB period and return for evaluation and transplant under their Medicare coverage. Even then some insurance contracts do not provide secondary coverage outside a COE network. There are excellent, high quality transplant centers throughout the U.S. that have no hope of ever qualifying for a COE network based on volume. It could prove to be an interesting session…………. Barbara Cochrane, MSN, RN Transplant Financial Coordinator Transplant Services Department Mercy Medical Center—Des Moines, Iowa Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2006 Report Share Posted December 22, 2006 The only way that would happen is if they ins carriers we've approached for the last 2 yrs ( & I know who you're talking about, Barbara, & we've contacted them MULTIPLE times) could bring themselves to even answer our requests, much less accept it, but so far, the only 'response' we've ever gotten is resounding silence! J. Aguiar Beth Israel Deaconess, Boston From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Tyler, A.Sent: Thursday, December 21, 2006 6:03 PMTo: TxFinancialCoordinators Subject: RE: 2007 Workshop .. Quote Link to comment Share on other sites More sharing options...
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