Pt Access Task Force

[Guest guest]

Hi everyone,

As you'll remember from several weeks ago, the UNOS Board of

Directors has recently upgarded what had been a subcommittee under Tx

Administrators to a Pt Access Task Force looking @ non-clinical

issues which might impact a pt's access to tx services; I, along

w/Art , chair of TAC, are serving on the Task Force.

During the first mtg in Dallas 9/27/00 it was decided to try to

work collabratively w/the payer community in developing a

standardized information exchange to encompass both the clinical

information req'd for the tx auth & the benefit information pts,

families, & TFC's need to determine coverage for the procedure. In

order to accomplish that, however, each side would need to compile a

list of pertinent information they need. a Summa had already

been working to develop a standardized benefits form & had compiled

forms from many of you. She merged them into the following list of

questions-please take a minute to review & make any additions you

might feel are important. (Please note, these are in random order,

not order of importance)

1. Are Tx services covered under the policy?

2. Type of ins plan-HMO, PPO, POS, etc?

3. Is this a Cobra plan? If so, termination date?

4. Primary or Secondary coverage?

5. Who is the subscriber? Relation to pt?

5. Deductible, Out-of-Pocket, & Life Max? Dollar amount of claims

paid to date?

6. Effective Date of policy?

7. Does Life Max include tx services?

8. If not, what is life max for tx services?

9. Pre-existing condition or waiting periods on policy?

10. Does plan require SSO? If yes, when & by whom?

11. In-network benefit levels for inpt & outpt services?

12. Out-of-network benefit levels for inpt & outpt services, if

available? Resitrictions or limitations for out-of-network services?

13. Who is contact for tx auth?

14. Will pt require seperate auths for each part & provider of eval?

15. Is tx eval auth valid for living donor?

16. How long is auth valid for? Tx eval, tx itself, etc.

17. Can eval be done @ tx ctr or must it be done @ PCP's office?

18. Is precert req'd for inpt admit? Phone# for precert?

19. Will pt require case mgmt? Phone#, fax#, etc. for case mgmt?

20. Rx Benefits-copays for brand name, generic, formulary, non-

formulary, immunos (if different), mail order vs. retail

21. Name & phone# of Rx program, mail order & retail

22. Caps, restrictions, etc. for Rx coverage

23. Organ acquisition charges-caps, limitations?

24. Mailing address for claims, hospital & MD

25. Benefits office phone#

26. PCP Info-name, address, phone#, fax#

Thanks,

J. Aguiar

Beth Israel Deaconess, Boston