Guest guest Posted April 19, 2001 Report Share Posted April 19, 2001 Does anyone have any information on how Kaiser Permanent reimburses for LVAD/Heart Transplant? I have a patient here who is emergently receiving an LVAD today and all they will quote me is 100% of customary/allowable? Since I am in Utah I am uncertain what that may end up being. Pamela LDS Hospital Salt Lake City, UT ldpharri@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2001 Report Share Posted April 19, 2001 Thanks for your thoughts . I was hoping some one in Californiacould tell me how they are reimbursed. Do we have a Stanford TFC there Icould contact?[(Aguiar, )] I'm not sure about Stanford, (this close to SLC I'm lucky if I remember where I'M from!) but we do have Sandy who's now w/UCLA & used to be w/Cedars-I'm sure she's dealt w/them plenty of times. Who else is from CA who might have some thoughts? J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2001 Report Share Posted April 19, 2001 Pamela, It's been my experience that if you are not a contracted center for tx with Kaiser that they, usually, want to do case by case contract. You usually need to contact their National Tx Hub. Here's some names and numbers you may find helpful. I hope they are still accurate. Provider relations for central regions: s National Tx Coordinator : Pam Husso (I think she was promoted to another position recently) Regional Tx Coordinator: Grams: Tx Hub North: JoAnne Green If one of these individuals cannot help you they should be able to steer you in the right direction. I hope this helps. Chaney UNMC Does anyone have any information on how Kaiser Permanent reimburses for LVAD/Heart Transplant? I have a patient here who is emergently receiving an LVAD today and all they will quote me is 100% of customary/allowable? Since I am in Utah I am uncertain what that may end up being. Pamela LDS Hospital Salt Lake City, UT ldpharri@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2001 Report Share Posted April 19, 2001 Thanks and everyone who is trying to help me out! >>> mchaney@... 04/19/01 09:57AM >>> Pamela, It's been my experience that if you are not a contracted center for tx with Kaiser that they, usually, want to do case by case contract. You usually need to contact their National Tx Hub. Here's some names and numbers you may find helpful. I hope they are still accurate. Provider relations for central regions: s National Tx Coordinator : Pam Husso (I think she was promoted to another position recently) Regional Tx Coordinator: Grams: Tx Hub North: JoAnne Green If one of these individuals cannot help you they should be able to steer you in the right direction. I hope this helps. Chaney UNMC Does anyone have any information on how Kaiser Permanent reimburses for LVAD/Heart Transplant? I have a patient here who is emergently receiving an LVAD today and all they will quote me is 100% of customary/allowable? Since I am in Utah I am uncertain what that may end up being. Pamela LDS Hospital Salt Lake City, UT ldpharri@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2001 Report Share Posted April 19, 2001 Although I'm in CT we have difficulty being reimbursed for LVAD's unless they are carved out of a transplant contract with a device clause. As of yet it hasn't happened. B Hartford Transplant Program LDPharri@... 04/19/01 11:26AM >>> Thanks for your thoughts . I was hoping some one in California could tell me how they are reimbursed. Do we have a Stanford TFC there I could contact? Pam LDS Hospital. >>> LAguiar@... 04/19/01 09:13AM >>> Does anyone have any information on how Kaiser Permanent reimburses for LVAD/Heart Transplant? I have a patient here who is emergently receiving an LVAD today and all they will quote me is 100% of customary/allowable? Since I am in Utah I am uncertain what that may end up being. [(Aguiar, )] Are you talking w/the front-line benefits people? I think you need to find the case mgr, especially if the pt might end up receiving a heart tx, & ask him/her. I've never had a Kaiser pt ( & I only see tx pts, btw) who wasn't under a case rate or global fee, but someone in the benefits are probably wouldn't have that kind of information. The case mgr would. The other piece to keep in mind is that the reimbursement rate MY ctr establishes w/any ins is bound to be different than what your ctr would establish or what a ctr in Florida would have, just as we all have different Medicare reimbursement rates because of population, location, etc. Good luck, J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2001 Report Share Posted April 19, 2001 , We carve the LVAD out as well. With the cost of it coming out of the life time max and the transplant max not kicking in until the actual heart transplant. As you know the length of time of the devise varies so greatly. Thanks, for your input. Hope to meet all you guys in SLC this month. >>> jbucche@... 04/19/01 10:13AM >>> Although I'm in CT we have difficulty being reimbursed for LVAD's unless they are carved out of a transplant contract with a device clause. As of yet it hasn't happened. B Hartford Transplant Program LDPharri@... 04/19/01 11:26AM >>> Thanks for your thoughts . I was hoping some one in California could tell me how they are reimbursed. Do we have a Stanford TFC there I could contact? Pam LDS Hospital. >>> LAguiar@... 04/19/01 09:13AM >>> Does anyone have any information on how Kaiser Permanent reimburses for LVAD/Heart Transplant? I have a patient here who is emergently receiving an LVAD today and all they will quote me is 100% of customary/allowable? Since I am in Utah I am uncertain what that may end up being. [(Aguiar, )] Are you talking w/the front-line benefits people? I think you need to find the case mgr, especially if the pt might end up receiving a heart tx, & ask him/her. I've never had a Kaiser pt ( & I only see tx pts, btw) who wasn't under a case rate or global fee, but someone in the benefits are probably wouldn't have that kind of information. The case mgr would. The other piece to keep in mind is that the reimbursement rate MY ctr establishes w/any ins is bound to be different than what your ctr would establish or what a ctr in Florida would have, just as we all have different Medicare reimbursement rates because of population, location, etc. Good luck, J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2001 Report Share Posted April 19, 2001 Good Morning Pam, All is not lost. The analyst for Transplant Administration @ UCLA has not come in yet. We are contracted with Kaiser for heart transplants; therefore some data does exist. I forwarded your e-mail to her. As soon as she comes in I will get you some ball park figures and scenarios . Sandy Financial Coordinator Transplant Administration UCLA Medical Center PHONE FAX E-MAIL SK@... RE: LVAD/Heart Transplant Thanks for your thoughts . I was hoping some one in California could tell me how they are reimbursed. Do we have a Stanford TFC there I could contact? Pam LDS Hospital. >>> LAguiar@... 04/19/01 09:13AM >>> Does anyone have any information on how Kaiser Permanent reimburses for LVAD/Heart Transplant? I have a patient here who is emergently receiving an LVAD today and all they will quote me is 100% of customary/allowable? Since I am in Utah I am uncertain what that may end up being. [(Aguiar, )] Are you talking w/the front-line benefits people? I think you need to find the case mgr, especially if the pt might end up receiving a heart tx, & ask him/her. I've never had a Kaiser pt ( & I only see tx pts, btw) who wasn't under a case rate or global fee, but someone in the benefits are probably wouldn't have that kind of information. The case mgr would. The other piece to keep in mind is that the reimbursement rate MY ctr establishes w/any ins is bound to be different than what your ctr would establish or what a ctr in Florida would have, just as we all have different Medicare reimbursement rates because of population, location, etc. Good luck, J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2001 Report Share Posted April 19, 2001 GREAT Sandy, Thanks so much! I will wait to hear. What a great support system! Thanks for putting us all in touch with each other. >>> SK@... 04/19/01 10:34AM >>> Good Morning Pam, All is not lost. The analyst for Transplant Administration @ UCLA has not come in yet. We are contracted with Kaiser for heart transplants; therefore some data does exist. I forwarded your e-mail to her. As soon as she comes in I will get you some ball park figures and scenarios . Sandy Financial Coordinator Transplant Administration UCLA Medical Center PHONE FAX E-MAIL SK@... RE: LVAD/Heart Transplant Thanks for your thoughts . I was hoping some one in California could tell me how they are reimbursed. Do we have a Stanford TFC there I could contact? Pam LDS Hospital. >>> LAguiar@... 04/19/01 09:13AM >>> Does anyone have any information on how Kaiser Permanent reimburses for LVAD/Heart Transplant? I have a patient here who is emergently receiving an LVAD today and all they will quote me is 100% of customary/allowable? Since I am in Utah I am uncertain what that may end up being. [(Aguiar, )] Are you talking w/the front-line benefits people? I think you need to find the case mgr, especially if the pt might end up receiving a heart tx, & ask him/her. I've never had a Kaiser pt ( & I only see tx pts, btw) who wasn't under a case rate or global fee, but someone in the benefits are probably wouldn't have that kind of information. The case mgr would. The other piece to keep in mind is that the reimbursement rate MY ctr establishes w/any ins is bound to be different than what your ctr would establish or what a ctr in Florida would have, just as we all have different Medicare reimbursement rates because of population, location, etc. Good luck, J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
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