RE: RE: COBRA

[Guest guest]

I would really check this out because some plans will not allow you to have

both Medicare and a Cobra plan. The idea for Cobra is because you do not

have any other insurance.

I am interested in the thoughts of the others on this.

Karla Christensen

Northwestern Memorial Hospital

> RE: COBRA

>

> Good Morning Everyone! It is Monday again. Just a question: Is Medicare

> ALWAYS primary to COBRA with the exception of ESRD? If not, where can I

> find the documentation to support that? Thanks.

>

>

> The Transplant Center at

> Medical City Dallas Hospital

>

>

>

[Guest guest]

,

When a patient has Mcare ,COBRA coverage usually ends. Sometimes COBRA is

extended form 18 mo to 29 mo.

Call 1- (US Dept of Labor) if you want a copy of the COBRA

pamphlet.

Rea- UTMB Galveston TX

RE: COBRA

Good Morning Everyone! It is Monday again. Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception of ESRD? If not,

where can I

find the documentation to support that? Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

You may have Booklets from UNOS Financing Transplantation What Every Patient

Needs to Know. On page 7 it explains the Cobra coverage or Consolidated Omnibus

Budget Reconciliation Act of 1985.

Coverage may end before the maximum time limit in any of the following:

1 Premium is not paid

2 The company holding the policy stops offering an employee group health plan.

3 A covered beneficiary joins another group health plan

4 A covered beneficiary becomes eligible for Medicare

This is a summary only, hope this helps, you can order this book from UNOS

we give them to all of our Transplant candidates.

>>> kchriste@... 01/29/01 09:51AM >>>

I would really check this out because some plans will not allow you to have

both Medicare and a Cobra plan. The idea for Cobra is because you do not

have any other insurance.

I am interested in the thoughts of the others on this.

Karla Christensen

Northwestern Memorial Hospital

> RE: COBRA

>

> Good Morning Everyone! It is Monday again. Just a question: Is Medicare

> ALWAYS primary to COBRA with the exception of ESRD? If not, where can I

> find the documentation to support that? Thanks.

>

>

> The Transplant Center at

> Medical City Dallas Hospital

>

>

>

[Guest guest]

Her husband worked for a large company - over 100 employees and left to

start his own business. He was a subcontractor and took the COBRA coverage

for him and his wife. She was awarded Medicare over six months ago due to

disability, but it was listed as secondary.

Transplant Financial Coordinator

Medical City Dallas Hospital

(wk)

(fax)

(pgr)

RE: COBRA

>

> Good Morning Everyone! It is Monday again. Just a question: Is

Medicare

> ALWAYS primary to COBRA with the exception of ESRD? If not, where

can I

> find the documentation to support that? Thanks.

>

>

> The Transplant Center at

> Medical City Dallas Hospital

>

>

>

[Guest guest]

Hi :

Good question. Hopefully, the immuno. extension with help in some cases. For

pts not aged or disabled, the obvious plan is for them to return to work. In

Las Vegas, if a pt doesn't qualify for Medicaid, we have a county program they

can use which has higher income limits and share of cost options.

Unfortunately, for all of us, there are no easy answers to this one and I think

the best thing we can do is inform the patient up front as to what to expect

post-tx and then deal with them on a case by case basis. Good luck.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 11:34AM >>>

Hi Nadine

Thanks for the info. What does the patient do for meds after the transplant when

the colbra policy terms? I've had that happen once or twice and it can be a

nightmare if they do not qualify for State assistance or drug assistance

programs.

>>> TPNADINE@... 01/30/01 01:17PM >>>

Hi :

I call the patient when the referral is received and ask questions regarding

their employment (full-time, part-time, etc.) & ins. so that I can get an idea

of how the insurance is provided. Then I call the insurance company to verify

and get benefit info. If there are network issues, then the pt is notified and

instructed how to proceed. If there are limited but do-able benefits, then the

pt is scheduled into clinic and I meet with them at that time to discuss, in

detail, their tx benefits. I agree that you don't want to scare a pt away

before they ever have the opportunity to learn about tx. Also, for listed pts

on a COBRA policy, I check eligibility monthly until tx.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 08:48AM >>>

Rea

Do you contact your patients by phone prior to their first visit? What do ask

during the interview? Do you discuss their benefits prior to their first

appointment or after they have seen the staff? I hate to discourage them before

they have even had a chance to hear about transplant. I am trying to figure out

what is the best way to contact patients and obtain information. Right now I

check benefits prior to the first appointment but I usually contact only

patients they I identify as problems.

Thanks

>>> rcarrera@... 01/30/01 10:09AM >>>

nne,

A lot of times I find this out from the patient during my interview w/ them.

If they say that the insurance belongs to them yet they are not working, I

ask if the ins is COBRA. From here, I then call to ins to confirm. I wonder

what others do?

Hope this helps.

rea

RE: COBRA

Good Morning Everyone! It is Monday again.

Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception

of ESRD? If not,

where can I

find the documentation to support that?

Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

Morning

We do the same thing her as far as verification of coverage. Since we have so

many HMO's PPO and managed care programs in this area. We also need to be

careful of centers of excellence for transplants.

The RX coverage is also verified at this time to eliminate any potential

problems in that area (example limit of $3000 year for meds)

I wish that we could verify on a monthly basis, but since there are other duties

that we preform it is more likely every 3 to 6 months.

WPAHS

>>> TPNADINE@... 01/30/01 01:17PM >>>

Hi :

I call the patient when the referral is received and ask questions regarding

their employment (full-time, part-time, etc.) & ins. so that I can get an idea

of how the insurance is provided. Then I call the insurance company to verify

and get benefit info. If there are network issues, then the pt is notified and

instructed how to proceed. If there are limited but do-able benefits, then the

pt is scheduled into clinic and I meet with them at that time to discuss, in

detail, their tx benefits. I agree that you don't want to scare a pt away

before they ever have the opportunity to learn about tx. Also, for listed pts

on a COBRA policy, I check eligibility monthly until tx.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 08:48AM >>>

Rea

Do you contact your patients by phone prior to their first visit? What do ask

during the interview? Do you discuss their benefits prior to their first

appointment or after they have seen the staff? I hate to discourage them before

they have even had a chance to hear about transplant. I am trying to figure out

what is the best way to contact patients and obtain information. Right now I

check benefits prior to the first appointment but I usually contact only

patients they I identify as problems.

Thanks

>>> rcarrera@... 01/30/01 10:09AM >>>

nne,

A lot of times I find this out from the patient during my interview w/ them.

If they say that the insurance belongs to them yet they are not working, I

ask if the ins is COBRA. From here, I then call to ins to confirm. I wonder

what others do?

Hope this helps.

rea

RE: COBRA

Good Morning Everyone! It is Monday again.

Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception

of ESRD? If not,

where can I

find the documentation to support that?

Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

There are many drug co programs the patient may qualify for, we also ask if they

were in the service, in this area they can get help thru the VA.

>>> jbucche@... 01/30/01 02:34PM >>>

Hi Nadine

Thanks for the info. What does the patient do for meds after the transplant when

the colbra policy terms? I've had that happen once or twice and it can be a

nightmare if they do not qualify for State assistance or drug assistance

programs.

>>> TPNADINE@... 01/30/01 01:17PM >>>

Hi :

I call the patient when the referral is received and ask questions regarding

their employment (full-time, part-time, etc.) & ins. so that I can get an idea

of how the insurance is provided. Then I call the insurance company to verify

and get benefit info. If there are network issues, then the pt is notified and

instructed how to proceed. If there are limited but do-able benefits, then the

pt is scheduled into clinic and I meet with them at that time to discuss, in

detail, their tx benefits. I agree that you don't want to scare a pt away

before they ever have the opportunity to learn about tx. Also, for listed pts

on a COBRA policy, I check eligibility monthly until tx.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 08:48AM >>>

Rea

Do you contact your patients by phone prior to their first visit? What do ask

during the interview? Do you discuss their benefits prior to their first

appointment or after they have seen the staff? I hate to discourage them before

they have even had a chance to hear about transplant. I am trying to figure out

what is the best way to contact patients and obtain information. Right now I

check benefits prior to the first appointment but I usually contact only

patients they I identify as problems.

Thanks

>>> rcarrera@... 01/30/01 10:09AM >>>

nne,

A lot of times I find this out from the patient during my interview w/ them.

If they say that the insurance belongs to them yet they are not working, I

ask if the ins is COBRA. From here, I then call to ins to confirm. I wonder

what others do?

Hope this helps.

rea

RE: COBRA

Good Morning Everyone! It is Monday again.

Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception

of ESRD? If not,

where can I

find the documentation to support that?

Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

Hi Nadine

I have heard the patients cannot qualify for the Medicare extension if they have

disability secondary to ESRD. Has anyone else heard this?

Thanks

>>> TPNADINE@... 01/30/01 04:51PM >>>

Hi :

Good question. Hopefully, the immuno. extension with help in some cases. For

pts not aged or disabled, the obvious plan is for them to return to work. In

Las Vegas, if a pt doesn't qualify for Medicaid, we have a county program they

can use which has higher income limits and share of cost options.

Unfortunately, for all of us, there are no easy answers to this one and I think

the best thing we can do is inform the patient up front as to what to expect

post-tx and then deal with them on a case by case basis. Good luck.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 11:34AM >>>

Hi Nadine

Thanks for the info. What does the patient do for meds after the transplant when

the colbra policy terms? I've had that happen once or twice and it can be a

nightmare if they do not qualify for State assistance or drug assistance

programs.

>>> TPNADINE@... 01/30/01 01:17PM >>>

Hi :

I call the patient when the referral is received and ask questions regarding

their employment (full-time, part-time, etc.) & ins. so that I can get an idea

of how the insurance is provided. Then I call the insurance company to verify

and get benefit info. If there are network issues, then the pt is notified and

instructed how to proceed. If there are limited but do-able benefits, then the

pt is scheduled into clinic and I meet with them at that time to discuss, in

detail, their tx benefits. I agree that you don't want to scare a pt away

before they ever have the opportunity to learn about tx. Also, for listed pts

on a COBRA policy, I check eligibility monthly until tx.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 08:48AM >>>

Rea

Do you contact your patients by phone prior to their first visit? What do ask

during the interview? Do you discuss their benefits prior to their first

appointment or after they have seen the staff? I hate to discourage them before

they have even had a chance to hear about transplant. I am trying to figure out

what is the best way to contact patients and obtain information. Right now I

check benefits prior to the first appointment but I usually contact only

patients they I identify as problems.

Thanks

>>> rcarrera@... 01/30/01 10:09AM >>>

nne,

A lot of times I find this out from the patient during my interview w/ them.

If they say that the insurance belongs to them yet they are not working, I

ask if the ins is COBRA. From here, I then call to ins to confirm. I wonder

what others do?

Hope this helps.

rea

RE: COBRA

Good Morning Everyone! It is Monday again.

Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception

of ESRD? If not,

where can I

find the documentation to support that?

Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

:

I have not heard this. My understanding was that patients with dual entitlement

to Mcre (ESRD/age or ESRD/disability) would be eligible for the extension. I

would like to know if this is indeed the case because that could cause problems

for many of our pts.

Nadine

UMC, Las Vegas

>>> jbucche@... 01/31/01 06:01AM >>>

Hi Nadine

I have heard the patients cannot qualify for the Medicare extension if they have

disability secondary to ESRD. Has anyone else heard this?

Thanks

>>> TPNADINE@... 01/30/01 04:51PM >>>

Hi :

Good question. Hopefully, the immuno. extension with help in some cases. For

pts not aged or disabled, the obvious plan is for them to return to work. In

Las Vegas, if a pt doesn't qualify for Medicaid, we have a county program they

can use which has higher income limits and share of cost options.

Unfortunately, for all of us, there are no easy answers to this one and I think

the best thing we can do is inform the patient up front as to what to expect

post-tx and then deal with them on a case by case basis. Good luck.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 11:34AM >>>

Hi Nadine

Thanks for the info. What does the patient do for meds after the transplant when

the colbra policy terms? I've had that happen once or twice and it can be a

nightmare if they do not qualify for State assistance or drug assistance

programs.

>>> TPNADINE@... 01/30/01 01:17PM >>>

Hi :

I call the patient when the referral is received and ask questions regarding

their employment (full-time, part-time, etc.) & ins. so that I can get an idea

of how the insurance is provided. Then I call the insurance company to verify

and get benefit info. If there are network issues, then the pt is notified and

instructed how to proceed. If there are limited but do-able benefits, then the

pt is scheduled into clinic and I meet with them at that time to discuss, in

detail, their tx benefits. I agree that you don't want to scare a pt away

before they ever have the opportunity to learn about tx. Also, for listed pts

on a COBRA policy, I check eligibility monthly until tx.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 08:48AM >>>

Rea

Do you contact your patients by phone prior to their first visit? What do ask

during the interview? Do you discuss their benefits prior to their first

appointment or after they have seen the staff? I hate to discourage them before

they have even had a chance to hear about transplant. I am trying to figure out

what is the best way to contact patients and obtain information. Right now I

check benefits prior to the first appointment but I usually contact only

patients they I identify as problems.

Thanks

>>> rcarrera@... 01/30/01 10:09AM >>>

nne,

A lot of times I find this out from the patient during my interview w/ them.

If they say that the insurance belongs to them yet they are not working, I

ask if the ins is COBRA. From here, I then call to ins to confirm. I wonder

what others do?

Hope this helps.

rea

RE: COBRA

Good Morning Everyone! It is Monday again.

Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception

of ESRD? If not,

where can I

find the documentation to support that?

Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

Nadine

I hear this from a representative of Sangstat's Transplant Pharmacy. I know that

Medicare eligible persons who qualify solely because of his or her status as a

kidney transplant patient will not be eligible and this makes sense because they

can or should be able to return to work.

>>> TPNADINE@... 01/31/01 12:03PM >>>

:

I have not heard this. My understanding was that patients with dual entitlement

to Mcre (ESRD/age or ESRD/disability) would be eligible for the extension. I

would like to know if this is indeed the case because that could cause problems

for many of our pts.

Nadine

UMC, Las Vegas

>>> jbucche@... 01/31/01 06:01AM >>>

Hi Nadine

I have heard the patients cannot qualify for the Medicare extension if they have

disability secondary to ESRD. Has anyone else heard this?

Thanks

>>> TPNADINE@... 01/30/01 04:51PM >>>

Hi :

Good question. Hopefully, the immuno. extension with help in some cases. For

pts not aged or disabled, the obvious plan is for them to return to work. In

Las Vegas, if a pt doesn't qualify for Medicaid, we have a county program they

can use which has higher income limits and share of cost options.

Unfortunately, for all of us, there are no easy answers to this one and I think

the best thing we can do is inform the patient up front as to what to expect

post-tx and then deal with them on a case by case basis. Good luck.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 11:34AM >>>

Hi Nadine

Thanks for the info. What does the patient do for meds after the transplant when

the colbra policy terms? I've had that happen once or twice and it can be a

nightmare if they do not qualify for State assistance or drug assistance

programs.

>>> TPNADINE@... 01/30/01 01:17PM >>>

Hi :

I call the patient when the referral is received and ask questions regarding

their employment (full-time, part-time, etc.) & ins. so that I can get an idea

of how the insurance is provided. Then I call the insurance company to verify

and get benefit info. If there are network issues, then the pt is notified and

instructed how to proceed. If there are limited but do-able benefits, then the

pt is scheduled into clinic and I meet with them at that time to discuss, in

detail, their tx benefits. I agree that you don't want to scare a pt away

before they ever have the opportunity to learn about tx. Also, for listed pts

on a COBRA policy, I check eligibility monthly until tx.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 08:48AM >>>

Rea

Do you contact your patients by phone prior to their first visit? What do ask

during the interview? Do you discuss their benefits prior to their first

appointment or after they have seen the staff? I hate to discourage them before

they have even had a chance to hear about transplant. I am trying to figure out

what is the best way to contact patients and obtain information. Right now I

check benefits prior to the first appointment but I usually contact only

patients they I identify as problems.

Thanks

>>> rcarrera@... 01/30/01 10:09AM >>>

nne,

A lot of times I find this out from the patient during my interview w/ them.

If they say that the insurance belongs to them yet they are not working, I

ask if the ins is COBRA. From here, I then call to ins to confirm. I wonder

what others do?

Hope this helps.

rea

RE: COBRA

Good Morning Everyone! It is Monday again.

Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception

of ESRD? If not,

where can I

find the documentation to support that?

Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

Nadine

I spoke to a financial counselor at Stadtlanders who confirmed that patients who

are on disability secondary to ESRD will not qualify for the unlimited Medicare

benefit. They must hve another disability such as blindness etc.

Ouch.

>>> TPNADINE@... 01/31/01 12:03PM >>>

:

I have not heard this. My understanding was that patients with dual entitlement

to Mcre (ESRD/age or ESRD/disability) would be eligible for the extension. I

would like to know if this is indeed the case because that could cause problems

for many of our pts.

Nadine

UMC, Las Vegas

>>> jbucche@... 01/31/01 06:01AM >>>

Hi Nadine

I have heard the patients cannot qualify for the Medicare extension if they have

disability secondary to ESRD. Has anyone else heard this?

Thanks

>>> TPNADINE@... 01/30/01 04:51PM >>>

Hi :

Good question. Hopefully, the immuno. extension with help in some cases. For

pts not aged or disabled, the obvious plan is for them to return to work. In

Las Vegas, if a pt doesn't qualify for Medicaid, we have a county program they

can use which has higher income limits and share of cost options.

Unfortunately, for all of us, there are no easy answers to this one and I think

the best thing we can do is inform the patient up front as to what to expect

post-tx and then deal with them on a case by case basis. Good luck.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 11:34AM >>>

Hi Nadine

Thanks for the info. What does the patient do for meds after the transplant when

the colbra policy terms? I've had that happen once or twice and it can be a

nightmare if they do not qualify for State assistance or drug assistance

programs.

>>> TPNADINE@... 01/30/01 01:17PM >>>

Hi :

I call the patient when the referral is received and ask questions regarding

their employment (full-time, part-time, etc.) & ins. so that I can get an idea

of how the insurance is provided. Then I call the insurance company to verify

and get benefit info. If there are network issues, then the pt is notified and

instructed how to proceed. If there are limited but do-able benefits, then the

pt is scheduled into clinic and I meet with them at that time to discuss, in

detail, their tx benefits. I agree that you don't want to scare a pt away

before they ever have the opportunity to learn about tx. Also, for listed pts

on a COBRA policy, I check eligibility monthly until tx.

Nadine Gruidl

UMC, Las Vegas

>>> jbucche@... 01/30/01 08:48AM >>>

Rea

Do you contact your patients by phone prior to their first visit? What do ask

during the interview? Do you discuss their benefits prior to their first

appointment or after they have seen the staff? I hate to discourage them before

they have even had a chance to hear about transplant. I am trying to figure out

what is the best way to contact patients and obtain information. Right now I

check benefits prior to the first appointment but I usually contact only

patients they I identify as problems.

Thanks

>>> rcarrera@... 01/30/01 10:09AM >>>

nne,

A lot of times I find this out from the patient during my interview w/ them.

If they say that the insurance belongs to them yet they are not working, I

ask if the ins is COBRA. From here, I then call to ins to confirm. I wonder

what others do?

Hope this helps.

rea

RE: COBRA

Good Morning Everyone! It is Monday again.

Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception

of ESRD? If not,

where can I

find the documentation to support that?

Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

Hi Everyone,

Here is my crisis of the day.

We transplanted a gentleman who had Medicare A since 1998 but didn't reveal it

because he thought his care would be compromised (access to providers). He

actually denied having it and refused to sign up when it was suggested. His wife

has insurance with a small group ( under 100 employees) and we authorized the

heart transplant with Blue Cross of Watertown, which we thought was primary.

They refused to pay anything after today not even the perdiem but we couldn't

discharge him because he can't walk has many needs and has no skilled benefit.

Now he says he has Medicare (A only) although I can't bring him up in my Empire

system with the correct numbers.

This is great news since he had no skilled nursing benefit with the BCBS policy

and he now needs one, plus rehab. He is still an inpatient. He is still on

disability. Am I correct in billing the charges for the transplant to Medicare

once it is verified. I am notifying the insurance company that I think he has

Medicare. Is there any situation that he can refuse Medicare A? He received a

Medicare card effective 8/1/98. Did he have to do anything after this to have

Medicare become active? Where can I call to find out if his Medicare A is still

active since my system is not verifying him?

Thanks

B

Hartford Transplant Program

>>> rcarrera@... 01/29/01 10:06AM >>>

,

When a patient has Mcare ,COBRA coverage usually ends. Sometimes COBRA is

extended form 18 mo to 29 mo.

Call 1- (US Dept of Labor) if you want a copy of the COBRA

pamphlet.

Rea- UTMB Galveston TX

RE: COBRA

Good Morning Everyone! It is Monday again. Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception of ESRD? If not,

where can I

find the documentation to support that? Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

We transplanted a gentleman who had Medicare A since 1998 but didn't reveal it because he thought his care would be compromised (access to providers). He actually denied having it and refused to sign up when it was suggested. His wife has insurance with a small group ( under 100 employees) and we authorized the heart transplant with Blue Cross of Watertown, which we thought was primary. They refused to pay anything after today not even the perdiem but we couldn't discharge him because he can't walk has many needs and has no skilled benefit. Now he says he has Medicare (A only) although I can't bring him up in my Empire system with the correct numbers.[(Aguiar, )] As I recall, according to my intermediary WAAAAAY back when, the CWF system shows coverage once a claim has been paid for the beneficiary. Until a claim is pd, the system may not show the coverage, though the pt could very well have it. If your pt can produce a Medicare card, showing coverage effective 8/1/98, it sounds like this may be what's going on & why you can't get him to come up.

This is great news since he had no skilled nursing benefit with the BCBS policy and he now needs one, plus rehab. He is still an inpatient. He is still on disability. Am I correct in billing the charges for the transplant to Medicare once it is verified. [(Aguiar, )] Definately-if he's under 65 & wife's employer is less than 100, Medicare's primary for him.

I am notifying the insurance company that I think he has Medicare. Is there any situation that he can refuse Medicare A? [(Aguiar, )] Only if he also refused his disability checks.

He received a Medicare card effective 8/1/98. Did he have to do anything after this to have Medicare become active? [(Aguiar, )] Nope-just start presenting his card when he receives care.

Where can I call to find out if his Medicare A is still active since my system is not verifying him?[(Aguiar, )] You can try the intemediary, but they may not be able to talk to you (the privacy act). You may have to do a conference call w/him before they'll verify anything. His wife may be able to get something from the local Social Security office confirming his eligibility for you.

Good luck!

J. Aguiar

Beth Israel Deaconess, Boston

[Guest guest]

,

We have on line ability with SS. If you do not have this capability you may

have to contact your local ss office. If he is under 65 he had to apply for

part A. He probably did not apply for part B due to the cost for part B

given he had a EGHP. If he was sent a card it was active at that time.

There would be nothing else to dy. Hope this helps.

Porter

University Hospitals of Cleveland

RE: COBRA

Good Morning Everyone! It is Monday again. Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception of ESRD? If not,

where can I

find the documentation to support that? Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

This crisis sounds like a weekly event here. It is hard to believe that

patients would withhold information but they do all the time. We even make them

sign a form that they must tell us when it changes or terminate's and they still

do not.

We have a form that the patient signs which is sent to the local Social Security

office for them to release to the hospital the patients SS# and Medicare number.

If you would like I can fax you a copy of this form.

WPAHS

M1@...

>>> jbucche@... 02/05/01 12:30PM >>>

Hi Everyone,

Here is my crisis of the day.

We transplanted a gentleman who had Medicare A since 1998 but didn't reveal it

because he thought his care would be compromised (access to providers). He

actually denied having it and refused to sign up when it was suggested. His wife

has insurance with a small group ( under 100 employees) and we authorized the

heart transplant with Blue Cross of Watertown, which we thought was primary.

They refused to pay anything after today not even the perdiem but we couldn't

discharge him because he can't walk has many needs and has no skilled benefit.

Now he says he has Medicare (A only) although I can't bring him up in my Empire

system with the correct numbers.

This is great news since he had no skilled nursing benefit with the BCBS policy

and he now needs one, plus rehab. He is still an inpatient. He is still on

disability. Am I correct in billing the charges for the transplant to Medicare

once it is verified. I am notifying the insurance company that I think he has

Medicare. Is there any situation that he can refuse Medicare A? He received a

Medicare card effective 8/1/98. Did he have to do anything after this to have

Medicare become active? Where can I call to find out if his Medicare A is still

active since my system is not verifying him?

Thanks

B

Hartford Transplant Program

>>> rcarrera@... 01/29/01 10:06AM >>>

,

When a patient has Mcare ,COBRA coverage usually ends. Sometimes COBRA is

extended form 18 mo to 29 mo.

Call 1- (US Dept of Labor) if you want a copy of the COBRA

pamphlet.

Rea- UTMB Galveston TX

RE: COBRA

Good Morning Everyone! It is Monday again. Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception of ESRD? If not,

where can I

find the documentation to support that? Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

This crisis sounds like a weekly event here. It is hard to believe that patients would withhold information but they do all the time. [(Aguiar, )] One thing that I do, albeit not as often as I'd like, is to check CWF for everyone on the waiting list just to see if a pt has rec'd Medicare but "forgotten" ;-) to tell us. I do this routinely @ the time of listing as well as for anyone I know is on disability or has Medicaid. It's amazing the things that turn up! Like pt's who not only have Medicare, but have then enrolled in a Medicare HMO!! Incredible...

J. Aguiar

Beth Israel Deaconess, Boston

[Guest guest]

I would really like to see a copy of your form with regard to getting

information from Social Security. Social Security has all but made it

impossible to help patients with problems with their benefits unless the patient

is sitting in your office. Bev Larson, Sentara Norfolk General Hospital

Fax#, telephone . Thanks for your help. Bev

>>> " " 02/05/01 03:50PM >>>

This crisis sounds like a weekly event here. It is hard to believe that

patients would withhold information but they do all the time. We even make them

sign a form that they must tell us when it changes or terminate's and they still

do not.

We have a form that the patient signs which is sent to the local Social Security

office for them to release to the hospital the patients SS# and Medicare number.

If you would like I can fax you a copy of this form.

WPAHS

M1@...

>>> jbucche@... 02/05/01 12:30PM >>>

Hi Everyone,

Here is my crisis of the day.

We transplanted a gentleman who had Medicare A since 1998 but didn't reveal it

because he thought his care would be compromised (access to providers). He

actually denied having it and refused to sign up when it was suggested. His wife

has insurance with a small group ( under 100 employees) and we authorized the

heart transplant with Blue Cross of Watertown, which we thought was primary.

They refused to pay anything after today not even the perdiem but we couldn't

discharge him because he can't walk has many needs and has no skilled benefit.

Now he says he has Medicare (A only) although I can't bring him up in my Empire

system with the correct numbers.

This is great news since he had no skilled nursing benefit with the BCBS policy

and he now needs one, plus rehab. He is still an inpatient. He is still on

disability. Am I correct in billing the charges for the transplant to Medicare

once it is verified. I am notifying the insurance company that I think he has

Medicare. Is there any situation that he can refuse Medicare A? He received a

Medicare card effective 8/1/98. Did he have to do anything after this to have

Medicare become active? Where can I call to find out if his Medicare A is still

active since my system is not verifying him?

Thanks

B

Hartford Transplant Program

>>> rcarrera@... 01/29/01 10:06AM >>>

,

When a patient has Mcare ,COBRA coverage usually ends. Sometimes COBRA is

extended form 18 mo to 29 mo.

Call 1- (US Dept of Labor) if you want a copy of the COBRA

pamphlet.

Rea- UTMB Galveston TX

RE: COBRA

Good Morning Everyone! It is Monday again. Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception of ESRD? If not,

where can I

find the documentation to support that? Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

Bev

I faxed the form to you this AM at 8:45 let me know if you receive it. We use

it for patients who are unable to give us the information, and since the local

Soc Sec office will no longer give the hospital the information due to

confidentiality.

>>> BALarson@... 02/06/01 07:57AM >>>

I would really like to see a copy of your form with regard to getting

information from Social Security. Social Security has all but made it

impossible to help patients with problems with their benefits unless the patient

is sitting in your office. Bev Larson, Sentara Norfolk General Hospital

Fax#, telephone . Thanks for your help. Bev

>>> " " 02/05/01 03:50PM >>>

This crisis sounds like a weekly event here. It is hard to believe that

patients would withhold information but they do all the time. We even make them

sign a form that they must tell us when it changes or terminate's and they still

do not.

We have a form that the patient signs which is sent to the local Social Security

office for them to release to the hospital the patients SS# and Medicare number.

If you would like I can fax you a copy of this form.

WPAHS

M1@...

>>> jbucche@... 02/05/01 12:30PM >>>

Hi Everyone,

Here is my crisis of the day.

We transplanted a gentleman who had Medicare A since 1998 but didn't reveal it

because he thought his care would be compromised (access to providers). He

actually denied having it and refused to sign up when it was suggested. His wife

has insurance with a small group ( under 100 employees) and we authorized the

heart transplant with Blue Cross of Watertown, which we thought was primary.

They refused to pay anything after today not even the perdiem but we couldn't

discharge him because he can't walk has many needs and has no skilled benefit.

Now he says he has Medicare (A only) although I can't bring him up in my Empire

system with the correct numbers.

This is great news since he had no skilled nursing benefit with the BCBS policy

and he now needs one, plus rehab. He is still an inpatient. He is still on

disability. Am I correct in billing the charges for the transplant to Medicare

once it is verified. I am notifying the insurance company that I think he has

Medicare. Is there any situation that he can refuse Medicare A? He received a

Medicare card effective 8/1/98. Did he have to do anything after this to have

Medicare become active? Where can I call to find out if his Medicare A is still

active since my system is not verifying him?

Thanks

B

Hartford Transplant Program

>>> rcarrera@... 01/29/01 10:06AM >>>

,

When a patient has Mcare ,COBRA coverage usually ends. Sometimes COBRA is

extended form 18 mo to 29 mo.

Call 1- (US Dept of Labor) if you want a copy of the COBRA

pamphlet.

Rea- UTMB Galveston TX

RE: COBRA

Good Morning Everyone! It is Monday again. Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception of ESRD? If not,

where can I

find the documentation to support that? Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

;

could you fax me a copy of this form, my fax # is .

Thank you

> RE: COBRA

>

> Good Morning Everyone! It is Monday again. Just a

> question: Is Medicare

> ALWAYS primary to COBRA with the exception of ESRD? If not,

> where can I

> find the documentation to support that? Thanks.

>

>

> The Transplant Center at

> Medical City Dallas Hospital

>

>

[Guest guest]

Form wasFaxed to you

**********************************************************************

This email and any files transmitted with it are confidential and

intended solely for the use of the individual or entity to whom they

are addressed. If you have received this email in error please notify

the West Penn Allegheny Health System, Information Security

Department at .

This footnote also confirms that this email message has been swept by

MIMEsweeper for the presence of computer viruses.

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[Guest guest]

Thank you

> RE: RE: COBRA

>

> Form wasFaxed to you

>

>

>

> **********************************************************************

> This email and any files transmitted with it are confidential and

> intended solely for the use of the individual or entity to whom they

> are addressed. If you have received this email in error please notify

> the West Penn Allegheny Health System, Information Security

> Department at .

>

> This footnote also confirms that this email message has been swept by

> MIMEsweeper for the presence of computer viruses.

>

> www.mimesweeper.com

> **********************************************************************

>

>

>

[Guest guest]

Thanks for your help . Have a good day.

>>> LAguiar@... 02/05/01 01:27PM >>>

We transplanted a gentleman who had Medicare A since 1998 but didn't reveal

it because he thought his care would be compromised (access to providers).

He actually denied having it and refused to sign up when it was suggested.

His wife has insurance with a small group ( under 100 employees) and we

authorized the heart transplant with Blue Cross of Watertown, which we

thought was primary. They refused to pay anything after today not even the

perdiem but we couldn't discharge him because he can't walk has many needs

and has no skilled benefit. Now he says he has Medicare (A only) although I

can't bring him up in my Empire system with the correct numbers.

[(Aguiar, )] As I recall, according to my intermediary WAAAAAY back

when, the CWF system shows coverage once a claim has been paid for the

beneficiary. Until a claim is pd, the system may not show the coverage,

though the pt could very well have it. If your pt can produce a Medicare

card, showing coverage effective 8/1/98, it sounds like this may be what's

going on & why you can't get him to come up.

This is great news since he had no skilled nursing benefit with the BCBS

policy and he now needs one, plus rehab. He is still an inpatient. He is

still on disability. Am I correct in billing the charges for the transplant

to Medicare once it is verified.

[(Aguiar, )] Definately-if he's under 65 & wife's employer is less than

100, Medicare's primary for him.

I am notifying the insurance company that I think he has Medicare. Is there

any situation that he can refuse Medicare A?

[(Aguiar, )] Only if he also refused his disability checks.

He received a Medicare card effective 8/1/98. Did he have to do anything

after this to have Medicare become active?

[(Aguiar, )] Nope-just start presenting his card when he receives care.

Where can I call to find out if his Medicare A is still active since my

system is not verifying him?

[(Aguiar, )] You can try the intemediary, but they may not be able to

talk to you (the privacy act). You may have to do a conference call w/him

before they'll verify anything. His wife may be able to get something from

the local Social Security office confirming his eligibility for you.

Good luck!

J. Aguiar

Beth Israel Deaconess, Boston

[Guest guest]

That would be great . My fax no is .

Thanks

>>> M1@... 02/05/01 03:50PM >>>

This crisis sounds like a weekly event here. It is hard to believe that

patients would withhold information but they do all the time. We even make them

sign a form that they must tell us when it changes or terminate's and they still

do not.

We have a form that the patient signs which is sent to the local Social Security

office for them to release to the hospital the patients SS# and Medicare number.

If you would like I can fax you a copy of this form.

WPAHS

M1@...

>>> jbucche@... 02/05/01 12:30PM >>>

Hi Everyone,

Here is my crisis of the day.

We transplanted a gentleman who had Medicare A since 1998 but didn't reveal it

because he thought his care would be compromised (access to providers). He

actually denied having it and refused to sign up when it was suggested. His wife

has insurance with a small group ( under 100 employees) and we authorized the

heart transplant with Blue Cross of Watertown, which we thought was primary.

They refused to pay anything after today not even the perdiem but we couldn't

discharge him because he can't walk has many needs and has no skilled benefit.

Now he says he has Medicare (A only) although I can't bring him up in my Empire

system with the correct numbers.

This is great news since he had no skilled nursing benefit with the BCBS policy

and he now needs one, plus rehab. He is still an inpatient. He is still on

disability. Am I correct in billing the charges for the transplant to Medicare

once it is verified. I am notifying the insurance company that I think he has

Medicare. Is there any situation that he can refuse Medicare A? He received a

Medicare card effective 8/1/98. Did he have to do anything after this to have

Medicare become active? Where can I call to find out if his Medicare A is still

active since my system is not verifying him?

Thanks

B

Hartford Transplant Program

>>> rcarrera@... 01/29/01 10:06AM >>>

,

When a patient has Mcare ,COBRA coverage usually ends. Sometimes COBRA is

extended form 18 mo to 29 mo.

Call 1- (US Dept of Labor) if you want a copy of the COBRA

pamphlet.

Rea- UTMB Galveston TX

RE: COBRA

Good Morning Everyone! It is Monday again. Just a

question: Is Medicare

ALWAYS primary to COBRA with the exception of ESRD? If not,

where can I

find the documentation to support that? Thanks.

The Transplant Center at

Medical City Dallas Hospital

[Guest guest]

Thank you for your help.

>>> M1@... 02/06/01 10:22AM >>>

Form wasFaxed to you

**********************************************************************

This email and any files transmitted with it are confidential and

intended solely for the use of the individual or entity to whom they

are addressed. If you have received this email in error please notify

the West Penn Allegheny Health System, Information Security

Department at .

This footnote also confirms that this email message has been swept by

MIMEsweeper for the presence of computer viruses.

www.mimesweeper.com

**********************************************************************