RE: new questions..... do you have a fe w minutes?!

[Guest guest]

Hello,

This is the information I use - taken directly from the government (easy to read and understand hah) document:

End Stage Renal Disease (ESRD)[Medicare rs Manual, §3335]Medicare is secondary for beneficiaries under age 65 who are entitled to Medicare solely on the basis ofESRD who have health insurance coverage under an employer sponsored Group Health Plan (GHP) asa result of the current or former employment of the beneficiary or a family member regardless of the sizeof the employer.Medicare is secondary payer to GHPs for individuals eligible for or entitled to Medicare benefits basedon ESRD for the following coordination of benefit (COB) periods:Date of Medicare Eligibility COB Period October 1, 1981 - January 31, 1990 - 12 months February 1, 1990 - February 29, 1996 - 18 months March 1, 1996 - Present - 30 months Dually Entitled BeneficiariesWhen an individual is eligible for or entitled to Medicare based on ESRD and also entitled on the basisof age or disability they are considered dually entitled to Medicare and other provisions apply. EffectiveAugust 10, 1993, GHPs are subject to the ESRD COB period for any plan enrollee eligible for orentitled to Medicare based on ESRD, regardless of whether that individual also is entitled to Medicareon the basis of age or disability. However, if Medicare is primary for an individual who is already entitledon the basis of age or disability when he/she becomes eligible on the basis of ESRD, the ESRD COBperiod would not apply.

I have found the biggest problem is with retiree's that have a full retiree group plan and Medicare and then they develop ESRD after the age of 65 (Medicare/COB contractor sometimes considers it a group plan and has made it primary over Medicare) and defining if a commercial insurance plan is subject to to individual or group definition.

Remember a long standing ESRD patient can have many 30 month coordination periods if he always has a long enough break between a successful transplant and restarting dialysis. But the first entitlement (either age or disability) can effect the permanent long range COB issues with all new insurance plan additions and new ESRD entitlements.

Lori BondFinancial Counselor in TransplantLegacy Good Samaritan Hospital and Medical Center

-----Original Message-----From: Debbie Orton Sent: Tuesday, June 04, 2002 1:47 PMTo: TxFinancialCoordinators Subject: Re: new questions..... do you have afew minutes?!It has been my understanding that if the patient was originally approved for Medicare with ESRD and later approved for a disability other that ESRD you go by the original disability Benefit in your case the ESRD so the patient is right Medicare would be prime. I have also believe that the working group insurance would be secondary and then the retirement policy.hope this helps>>> a.Summa@... 06/04/02 04:30PM >>>Hi everyone,We have had several questions arise of late regarding Medicare MSP and dualeligibility, as well as when the patient may, or may not, lose the Medicareas primary.I have 2 questions pose to the group, and one is quite lengthy, so pleasebear with me, as it gets a bit complicated....First one is this:Patient began dialysis in 1987, eligible for Medicare due to ESRD, has groupplan primary. During coordination period, he becomes disabled for anotherreason and is unable to continue working (in 1989). By the time he has histransplant in 1990, his Medicare is primary.He returns to dialysis in 2002 and is being evaluated for his 2nd kidney tx.He now tells me that his group plan became a "retirement" plan, however henow also has group coverage thru his spouse's employer. Since he is now backon dialysis, he again becomes eligible for Medicare due to ESRD.His dialysis center is telling him that they must bill his group planprimary, but he insists that his Medicare is primary and will remain primaryfor the rest of his life, regardless of his ESRD eligibility, and regardlessof the fact that he still has 2 group plans. When checking with the Medicaresystem, they show no transplant data, and the old MSP info shows mcareprimary as of 1988. (end of first ESRD coord period) However, pver the last12 years, Medicare has continued to pay as primary.(do you follow me, so far?!?)I was always of the understanding that once the patient had the transplant,and they still maintained their coverage under a group plan, whether it betheir own, or thru a spouse, that group plan would AGAIN become primaryafter 3 years post transplant, and Medicare coverage would continue assecondary. No longer Medicare due to ESRD, but the patient remainsdisabled/retired and eligible due to disability. And, if his group plan is now primary, In what order we list these 3? Hisretirement plan primary, his spouse's active plan secondary, and Medicare3rd? Or, would his wife's active plan be primary, since his is a retirementplan?(I know we have opened up a "can of worms" with this one....!)I am being challenged on this one, by both the patient, and our socialworker....Please give me your thoughts on this one.Second question: (this one's a lot easier....) If patient turned downMedicare Part B at the time of dialysis, and he elects to enroll at the timeof the transplant, is there a penalty or a "wait" time at the time oftransplant? I don't believe there is, but the social worker is asking forthis in writing.ok, now that I've made you put on your thinking caps this late in theafternoon.... I'll let you mull over this... and I will anxiously await yourreplies.In the meantime, I'm leaving for the day!Thanks, in advance!a

[Guest guest]

comments below>>/rea

new questions..... do you have a few

minutes?!

Hi everyone,

We have had several questions arise of late regarding Medicare MSP and dual

eligibility, as well as when the patient may, or may not, lose the Medicare

as primary.

I have 2 questions pose to the group, and one is quite lengthy, so please

bear with me, as it gets a bit complicated....

First one is this:

Patient began dialysis in 1987, eligible for Medicare due to ESRD, has group

plan primary. During coordination period, he becomes disabled for another

reason and is unable to continue working (in 1989).>>> ( did he inform

soc.sec of his disability?)<<<<<

By the time he has his

transplant in 1990, his Medicare is primary.

He returns to dialysis in 2002 and is being evaluated for his 2nd kidney tx.

He now tells me that his group plan became a " retirement " plan, however he

now also has group coverage thru his spouse's employer. Since he is now back

on dialysis, he again becomes eligible for Medicare due to ESRD.

His dialysis center is telling him that they must bill his group plan

primary, but he insists that his Medicare is primary and will remain primary

for the rest of his life, regardless of his ESRD eligibility, and regardless

of the fact that he still has 2 group plans.>>>> it is (maybe) because his

Mcare is disability and he is correct by telling you that Mcare is

primary>>>>>>

When checking with the Medicare

system, they show no transplant data, and the old MSP info shows mcare

primary as of 1988.>>>> this was the responsibility of the txp ctr- to

report the txp)>>>>>> (end of first ESRD coord period) However, pver the

last

12 years, Medicare has continued to pay as primary.

(do you follow me, so far?!?)>>>>> yes.. <<<<<<

I was always of the understanding that once the patient had the transplant,

and they still maintained their coverage under a group plan, whether it be

their own, or thru a spouse, that group plan would AGAIN become primary

after 3 years post transplant, and Medicare coverage would continue as

secondary. No longer Medicare due to ESRD, but the patient remains

disabled/retired and eligible due to disability. >>>> I had a pt who had

Mcare disability and also had ins through his company. He is disabled and

unable to work, Mcare was primary..because it was primary at the time of

dialysis. >>>>

And, if his group plan is now primary, In what order we list these 3? His

retirement plan primary, his spouse's active plan secondary, and Medicare

3rd? Or, would his wife's active plan be primary, since his is a retirement

plan? >>> Mcare-primary

>>>Spouse's ins- second ( still working)

>>> Third- his ins ( retired)

(I know we have opened up a " can of worms " with this one....!)

I am being challenged on this one, by both the patient, and our social

worker....

Please give me your thoughts on this one.>>>> Had the same situation before.

This what our FI told me.>>>>

Second question: (this one's a lot easier....) If patient turned down

Medicare Part B at the time of dialysis, and he elects to enroll at the time

of the transplant, is there a penalty or a " wait " time at the time of

transplant? I don't believe there is, but the social worker is asking for

this in writing. >>>>>>>no, but he has to do it during the regular

enrollment. I believe it is from Jan to March?? to be elig for benefits in

July.<<<<<<

The penalty is for the Mcare retirement not ESRD.>>>>>>>

Rea.........

ok, now that I've made you put on your thinking caps this late in the

afternoon.... I'll let you mull over this... and I will anxiously await your

replies.

In the meantime, I'm leaving for the day!

Thanks, in advance!

a

[Guest guest]

But, since his first transplant failed AFTER 3 years, wouldn't he again have

to go thru the 30 month coordination period? (regardless of his disability,

he does have coverage under 2 group plans, and his eligibility is now due to

ESRD)

Re: new questions..... do you have a few

minutes?!

It has been my understanding that if the patient was originally approved for

Medicare with ESRD and later approved for a disability other that ESRD you

go by the original disability Benefit in your case the ESRD so the patient

is right Medicare would be prime. I have also believe that the working group

insurance would be secondary and then the retirement policy.

hope this helps

>>> a.Summa@... 06/04/02 04:30PM >>>

Hi everyone,

We have had several questions arise of late regarding Medicare MSP and dual

eligibility, as well as when the patient may, or may not, lose the Medicare

as primary.

I have 2 questions pose to the group, and one is quite lengthy, so please

bear with me, as it gets a bit complicated....

First one is this:

Patient began dialysis in 1987, eligible for Medicare due to ESRD, has group

plan primary. During coordination period, he becomes disabled for another

reason and is unable to continue working (in 1989). By the time he has his

transplant in 1990, his Medicare is primary.

He returns to dialysis in 2002 and is being evaluated for his 2nd kidney tx.

He now tells me that his group plan became a " retirement " plan, however he

now also has group coverage thru his spouse's employer. Since he is now back

on dialysis, he again becomes eligible for Medicare due to ESRD.

His dialysis center is telling him that they must bill his group plan

primary, but he insists that his Medicare is primary and will remain primary

for the rest of his life, regardless of his ESRD eligibility, and regardless

of the fact that he still has 2 group plans. When checking with the Medicare

system, they show no transplant data, and the old MSP info shows mcare

primary as of 1988. (end of first ESRD coord period) However, pver the last

12 years, Medicare has continued to pay as primary.

(do you follow me, so far?!?)

I was always of the understanding that once the patient had the transplant,

and they still maintained their coverage under a group plan, whether it be

their own, or thru a spouse, that group plan would AGAIN become primary

after 3 years post transplant, and Medicare coverage would continue as

secondary. No longer Medicare due to ESRD, but the patient remains

disabled/retired and eligible due to disability.

And, if his group plan is now primary, In what order we list these 3? His

retirement plan primary, his spouse's active plan secondary, and Medicare

3rd? Or, would his wife's active plan be primary, since his is a retirement

plan?

(I know we have opened up a " can of worms " with this one....!)

I am being challenged on this one, by both the patient, and our social

worker....

Please give me your thoughts on this one.

Second question: (this one's a lot easier....) If patient turned down

Medicare Part B at the time of dialysis, and he elects to enroll at the time

of the transplant, is there a penalty or a " wait " time at the time of

transplant? I don't believe there is, but the social worker is asking for

this in writing.

ok, now that I've made you put on your thinking caps this late in the

afternoon.... I'll let you mull over this... and I will anxiously await your

replies.

In the meantime, I'm leaving for the day!

Thanks, in advance!

a

[Guest guest]

No. because his Mcare was due to disability w/c has been in effect.

rea

Re: new questions..... do you have a few

minutes?!

It has been my understanding that if the patient was originally approved for

Medicare with ESRD and later approved for a disability other that ESRD you

go by the original disability Benefit in your case the ESRD so the patient

is right Medicare would be prime. I have also believe that the working group

insurance would be secondary and then the retirement policy.

hope this helps

>>> a.Summa@... 06/04/02 04:30PM >>>

Hi everyone,

We have had several questions arise of late regarding Medicare MSP and dual

eligibility, as well as when the patient may, or may not, lose the Medicare

as primary.

I have 2 questions pose to the group, and one is quite lengthy, so please

bear with me, as it gets a bit complicated....

First one is this:

Patient began dialysis in 1987, eligible for Medicare due to ESRD, has group

plan primary. During coordination period, he becomes disabled for another

reason and is unable to continue working (in 1989). By the time he has his

transplant in 1990, his Medicare is primary.

He returns to dialysis in 2002 and is being evaluated for his 2nd kidney tx.

He now tells me that his group plan became a " retirement " plan, however he

now also has group coverage thru his spouse's employer. Since he is now back

on dialysis, he again becomes eligible for Medicare due to ESRD.

His dialysis center is telling him that they must bill his group plan

primary, but he insists that his Medicare is primary and will remain primary

for the rest of his life, regardless of his ESRD eligibility, and regardless

of the fact that he still has 2 group plans. When checking with the Medicare

system, they show no transplant data, and the old MSP info shows mcare

primary as of 1988. (end of first ESRD coord period) However, pver the last

12 years, Medicare has continued to pay as primary.

(do you follow me, so far?!?)

I was always of the understanding that once the patient had the transplant,

and they still maintained their coverage under a group plan, whether it be

their own, or thru a spouse, that group plan would AGAIN become primary

after 3 years post transplant, and Medicare coverage would continue as

secondary. No longer Medicare due to ESRD, but the patient remains

disabled/retired and eligible due to disability.

And, if his group plan is now primary, In what order we list these 3? His

retirement plan primary, his spouse's active plan secondary, and Medicare

3rd? Or, would his wife's active plan be primary, since his is a retirement

plan?

(I know we have opened up a " can of worms " with this one....!)

I am being challenged on this one, by both the patient, and our social

worker....

Please give me your thoughts on this one.

Second question: (this one's a lot easier....) If patient turned down

Medicare Part B at the time of dialysis, and he elects to enroll at the time

of the transplant, is there a penalty or a " wait " time at the time of

transplant? I don't believe there is, but the social worker is asking for

this in writing.

ok, now that I've made you put on your thinking caps this late in the

afternoon.... I'll let you mull over this... and I will anxiously await your

replies.

In the meantime, I'm leaving for the day!

Thanks, in advance!

a

[Guest guest]

but, I always thought that even if Medicare is due to a disability, as long

as the patient has an active group plan, the Medicare is secondary to that

group plan.... this is what the medicare billing supervisor told me,

too...... I'm still confused!

Re: new questions..... do you have a few

minutes?!

It has been my understanding that if the patient was originally approved for

Medicare with ESRD and later approved for a disability other that ESRD you

go by the original disability Benefit in your case the ESRD so the patient

is right Medicare would be prime. I have also believe that the working group

insurance would be secondary and then the retirement policy.

hope this helps

>>> a.Summa@... 06/04/02 04:30PM >>>

Hi everyone,

We have had several questions arise of late regarding Medicare MSP and dual

eligibility, as well as when the patient may, or may not, lose the Medicare

as primary.

I have 2 questions pose to the group, and one is quite lengthy, so please

bear with me, as it gets a bit complicated....

First one is this:

Patient began dialysis in 1987, eligible for Medicare due to ESRD, has group

plan primary. During coordination period, he becomes disabled for another

reason and is unable to continue working (in 1989). By the time he has his

transplant in 1990, his Medicare is primary.

He returns to dialysis in 2002 and is being evaluated for his 2nd kidney tx.

He now tells me that his group plan became a " retirement " plan, however he

now also has group coverage thru his spouse's employer. Since he is now back

on dialysis, he again becomes eligible for Medicare due to ESRD.

His dialysis center is telling him that they must bill his group plan

primary, but he insists that his Medicare is primary and will remain primary

for the rest of his life, regardless of his ESRD eligibility, and regardless

of the fact that he still has 2 group plans. When checking with the Medicare

system, they show no transplant data, and the old MSP info shows mcare

primary as of 1988. (end of first ESRD coord period) However, pver the last

12 years, Medicare has continued to pay as primary.

(do you follow me, so far?!?)

I was always of the understanding that once the patient had the transplant,

and they still maintained their coverage under a group plan, whether it be

their own, or thru a spouse, that group plan would AGAIN become primary

after 3 years post transplant, and Medicare coverage would continue as

secondary. No longer Medicare due to ESRD, but the patient remains

disabled/retired and eligible due to disability.

And, if his group plan is now primary, In what order we list these 3? His

retirement plan primary, his spouse's active plan secondary, and Medicare

3rd? Or, would his wife's active plan be primary, since his is a retirement

plan?

(I know we have opened up a " can of worms " with this one....!)

I am being challenged on this one, by both the patient, and our social

worker....

Please give me your thoughts on this one.

Second question: (this one's a lot easier....) If patient turned down

Medicare Part B at the time of dialysis, and he elects to enroll at the time

of the transplant, is there a penalty or a " wait " time at the time of

transplant? I don't believe there is, but the social worker is asking for

this in writing.

ok, now that I've made you put on your thinking caps this late in the

afternoon.... I'll let you mull over this... and I will anxiously await your

replies.

In the meantime, I'm leaving for the day!

Thanks, in advance!

a

[Guest guest]

That is what I was also told by CMS here.

Re: new questions..... do you have a few

minutes?!

It has been my understanding that if the patient was originally approved for

Medicare with ESRD and later approved for a disability other that ESRD you

go by the original disability Benefit in your case the ESRD so the patient

is right Medicare would be prime. I have also believe that the working group

insurance would be secondary and then the retirement policy.

hope this helps

>>> a.Summa@... 06/04/02 04:30PM >>>

Hi everyone,

We have had several questions arise of late regarding Medicare MSP and dual

eligibility, as well as when the patient may, or may not, lose the Medicare

as primary.

I have 2 questions pose to the group, and one is quite lengthy, so please

bear with me, as it gets a bit complicated....

First one is this:

Patient began dialysis in 1987, eligible for Medicare due to ESRD, has group

plan primary. During coordination period, he becomes disabled for another

reason and is unable to continue working (in 1989). By the time he has his

transplant in 1990, his Medicare is primary.

He returns to dialysis in 2002 and is being evaluated for his 2nd kidney tx.

He now tells me that his group plan became a " retirement " plan, however he

now also has group coverage thru his spouse's employer. Since he is now back

on dialysis, he again becomes eligible for Medicare due to ESRD.

His dialysis center is telling him that they must bill his group plan

primary, but he insists that his Medicare is primary and will remain primary

for the rest of his life, regardless of his ESRD eligibility, and regardless

of the fact that he still has 2 group plans. When checking with the Medicare

system, they show no transplant data, and the old MSP info shows mcare

primary as of 1988. (end of first ESRD coord period) However, pver the last

12 years, Medicare has continued to pay as primary.

(do you follow me, so far?!?)

I was always of the understanding that once the patient had the transplant,

and they still maintained their coverage under a group plan, whether it be

their own, or thru a spouse, that group plan would AGAIN become primary

after 3 years post transplant, and Medicare coverage would continue as

secondary. No longer Medicare due to ESRD, but the patient remains

disabled/retired and eligible due to disability.

And, if his group plan is now primary, In what order we list these 3? His

retirement plan primary, his spouse's active plan secondary, and Medicare

3rd? Or, would his wife's active plan be primary, since his is a retirement

plan?

(I know we have opened up a " can of worms " with this one....!)

I am being challenged on this one, by both the patient, and our social

worker....

Please give me your thoughts on this one.

Second question: (this one's a lot easier....) If patient turned down

Medicare Part B at the time of dialysis, and he elects to enroll at the time

of the transplant, is there a penalty or a " wait " time at the time of

transplant? I don't believe there is, but the social worker is asking for

this in writing.

ok, now that I've made you put on your thinking caps this late in the

afternoon.... I'll let you mull over this... and I will anxiously await your

replies.

In the meantime, I'm leaving for the day!

Thanks, in advance!

a

[Guest guest]

Also age - working aged the employee number is lowered to 20 employees.

Lori BondFinancial Counselor in TransplantLegacy Good Samaritan Hospital and Medical Center

RE: new questions..... do you have afe w minutes?!But, since his first transplant failed AFTER 3 years, wouldn't he again haveto go thru the 30 month coordination period? (regardless of his disability,he does have coverage under 2 group plans, and his eligibility is now due toESRD)-----Original Message-----From: Debbie Orton Sent: Tuesday, June 04, 2002 4:47 PMTo: TxFinancialCoordinators Subject: Re: new questions..... do you have a fewminutes?!It has been my understanding that if the patient was originally approved forMedicare with ESRD and later approved for a disability other that ESRD yougo by the original disability Benefit in your case the ESRD so the patientis right Medicare would be prime. I have also believe that the working groupinsurance would be secondary and then the retirement policy.hope this helps>>> a.Summa@... 06/04/02 04:30PM >>>Hi everyone,We have had several questions arise of late regarding Medicare MSP and dualeligibility, as well as when the patient may, or may not, lose the Medicareas primary. I have 2 questions pose to the group, and one is quite lengthy, so pleasebear with me, as it gets a bit complicated.... First one is this:Patient began dialysis in 1987, eligible for Medicare due to ESRD, has groupplan primary. During coordination period, he becomes disabled for anotherreason and is unable to continue working (in 1989). By the time he has histransplant in 1990, his Medicare is primary. He returns to dialysis in 2002 and is being evaluated for his 2nd kidney tx.He now tells me that his group plan became a "retirement" plan, however henow also has group coverage thru his spouse's employer. Since he is now backon dialysis, he again becomes eligible for Medicare due to ESRD. His dialysis center is telling him that they must bill his group planprimary, but he insists that his Medicare is primary and will remain primaryfor the rest of his life, regardless of his ESRD eligibility, and regardlessof the fact that he still has 2 group plans. When checking with the Medicaresystem, they show no transplant data, and the old MSP info shows mcareprimary as of 1988. (end of first ESRD coord period) However, pver the last12 years, Medicare has continued to pay as primary. (do you follow me, so far?!?) I was always of the understanding that once the patient had the transplant,and they still maintained their coverage under a group plan, whether it betheir own, or thru a spouse, that group plan would AGAIN become primaryafter 3 years post transplant, and Medicare coverage would continue assecondary. No longer Medicare due to ESRD, but the patient remainsdisabled/retired and eligible due to disability. And, if his group plan is now primary, In what order we list these 3? Hisretirement plan primary, his spouse's active plan secondary, and Medicare3rd? Or, would his wife's active plan be primary, since his is a retirementplan? (I know we have opened up a "can of worms" with this one....!) I am being challenged on this one, by both the patient, and our socialworker.... Please give me your thoughts on this one.Second question: (this one's a lot easier....) If patient turned downMedicare Part B at the time of dialysis, and he elects to enroll at the timeof the transplant, is there a penalty or a "wait" time at the time oftransplant? I don't believe there is, but the social worker is asking forthis in writing.ok, now that I've made you put on your thinking caps this late in theafternoon.... I'll let you mull over this... and I will anxiously await yourreplies. In the meantime, I'm leaving for the day! Thanks, in advance!a

[Guest guest]

both groups are LARGE- one is Disney, the other is Florida hospital.

Re: new questions..... do you have a few

minutes?!

It has been my understanding that if the patient was originally approved for

Medicare with ESRD and later approved for a disability other that ESRD you

go by the original disability Benefit in your case the ESRD so the patient

is right Medicare would be prime. I have also believe that the working group

insurance would be secondary and then the retirement policy.

hope this helps

>>> a.Summa@... 06/04/02 04:30PM >>>

Hi everyone,

We have had several questions arise of late regarding Medicare MSP and dual

eligibility, as well as when the patient may, or may not, lose the Medicare

as primary.

I have 2 questions pose to the group, and one is quite lengthy, so please

bear with me, as it gets a bit complicated....

First one is this:

Patient began dialysis in 1987, eligible for Medicare due to ESRD, has group

plan primary. During coordination period, he becomes disabled for another

reason and is unable to continue working (in 1989). By the time he has his

transplant in 1990, his Medicare is primary.

He returns to dialysis in 2002 and is being evaluated for his 2nd kidney tx.

He now tells me that his group plan became a " retirement " plan, however he

now also has group coverage thru his spouse's employer. Since he is now back

on dialysis, he again becomes eligible for Medicare due to ESRD.

His dialysis center is telling him that they must bill his group plan

primary, but he insists that his Medicare is primary and will remain primary

for the rest of his life, regardless of his ESRD eligibility, and regardless

of the fact that he still has 2 group plans. When checking with the Medicare

system, they show no transplant data, and the old MSP info shows mcare

primary as of 1988. (end of first ESRD coord period) However, pver the last

12 years, Medicare has continued to pay as primary.

(do you follow me, so far?!?)

I was always of the understanding that once the patient had the transplant,

and they still maintained their coverage under a group plan, whether it be

their own, or thru a spouse, that group plan would AGAIN become primary

after 3 years post transplant, and Medicare coverage would continue as

secondary. No longer Medicare due to ESRD, but the patient remains

disabled/retired and eligible due to disability.

And, if his group plan is now primary, In what order we list these 3? His

retirement plan primary, his spouse's active plan secondary, and Medicare

3rd? Or, would his wife's active plan be primary, since his is a retirement

plan?

(I know we have opened up a " can of worms " with this one....!)

I am being challenged on this one, by both the patient, and our social

worker....

Please give me your thoughts on this one.

Second question: (this one's a lot easier....) If patient turned down

Medicare Part B at the time of dialysis, and he elects to enroll at the time

of the transplant, is there a penalty or a " wait " time at the time of

transplant? I don't believe there is, but the social worker is asking for

this in writing.

ok, now that I've made you put on your thinking caps this late in the

afternoon.... I'll let you mull over this... and I will anxiously await your

replies.

In the meantime, I'm leaving for the day!

Thanks, in advance!

a

[Guest guest]

My understanding is different. I just spoke to n Melton about this

yesterday. I thought that if a pt has an insurance, large or small group,

it would follow COB.

Can you comment on this?

rea

From: Bond, Lori :LPH Trnsplnt

Sent: Wednesday, June 05, 2002 10:41 AM

To: 'TxFinancialCoordinators '

Subject: RE: new questions..... do you have a fe w

minutes?!

Also age - working aged the employee number is lowered to 20 employees.

Lori Bond

Financial Counselor in Transplant

Legacy Good Samaritan Hospital and Medical Center

Re: new questions..... do you have a few

minutes?!

It has been my understanding that if the patient was originally approved for

Medicare with ESRD and later approved for a disability other that ESRD you

go by the original disability Benefit in your case the ESRD so the patient

is right Medicare would be prime. I have also believe that the working group

insurance would be secondary and then the retirement policy.

hope this helps

>>> a.Summa@... 06/04/02 04:30PM >>>

Hi everyone,

We have had several questions arise of late regarding Medicare MSP and dual

eligibility, as well as when the patient may, or may not, lose the Medicare

as primary.

I have 2 questions pose to the group, and one is quite lengthy, so please

bear with me, as it gets a bit complicated....

First one is this:

Patient began dialysis in 1987, eligible for Medicare due to ESRD, has group

plan primary. During coordination period, he becomes disabled for another

reason and is unable to continue working (in 1989). By the time he has his

transplant in 1990, his Medicare is primary.

He returns to dialysis in 2002 and is being evaluated for his 2nd kidney tx.

He now tells me that his group plan became a " retirement " plan, however he

now also has group coverage thru his spouse's employer. Since he is now back

on dialysis, he again becomes eligible for Medicare due to ESRD.

His dialysis center is telling him that they must bill his group plan

primary, but he insists that his Medicare is primary and will remain primary

for the rest of his life, regardless of his ESRD eligibility, and regardless

of the fact that he still has 2 group plans. When checking with the Medicare

system, they show no transplant data, and the old MSP info shows mcare

primary as of 1988. (end of first ESRD coord period) However, pver the last

12 years, Medicare has continued to pay as primary.

(do you follow me, so far?!?)

I was always of the understanding that once the patient had the transplant,

and they still maintained their coverage under a group plan, whether it be

their own, or thru a spouse, that group plan would AGAIN become primary

after 3 years post transplant, and Medicare coverage would continue as

secondary. No longer Medicare due to ESRD, but the patient remains

disabled/retired and eligible due to disability.

And, if his group plan is now primary, In what order we list these 3? His

retirement plan primary, his spouse's active plan secondary, and Medicare

3rd? Or, would his wife's active plan be primary, since his is a retirement

plan?

(I know we have opened up a " can of worms " with this one....!)

I am being challenged on this one, by both the patient, and our social

worker....

Please give me your thoughts on this one.

Second question: (this one's a lot easier....) If patient turned down

Medicare Part B at the time of dialysis, and he elects to enroll at the time

of the transplant, is there a penalty or a " wait " time at the time of

transplant? I don't believe there is, but the social worker is asking for

this in writing.

ok, now that I've made you put on your thinking caps this late in the

afternoon.... I'll let you mull over this... and I will anxiously await your

replies.

In the meantime, I'm leaving for the day!

Thanks, in advance!

a

[Guest guest]

I thank all of you for your responses, however, I am still confused! Some of

you are agreeing w/me in that the wife's active group plan should be

primary, Medicare 2nd and his retirement 3rd at this point.... a few of you

are stating that his Medicare should be primary..... Yet, I really think

that, in this case, because he does have an active group plan thru his wife,

that plan should be primary. I feel that because he did not inform Medicare

of his other policy, or of his returning to dialysis, they are showing

themselves as primary in error.

I know that I am probably " beating a dead horse " , as they say.............

a

new questions..... do you have a few

minutes?!

Hi everyone,

We have had several questions arise of late regarding Medicare MSP and dual

eligibility, as well as when the patient may, or may not, lose the Medicare

as primary.

I have 2 questions pose to the group, and one is quite lengthy, so please

bear with me, as it gets a bit complicated....

First one is this:

Patient began dialysis in 1987, eligible for Medicare due to ESRD, has group

plan primary. During coordination period, he becomes disabled for another

reason and is unable to continue working (in 1989). By the time he has his

transplant in 1990, his Medicare is primary.

He returns to dialysis in 2002 and is being evaluated for his 2nd kidney tx.

He now tells me that his group plan became a " retirement " plan, however he

now also has group coverage thru his spouse's employer. Since he is now back

on dialysis, he again becomes eligible for Medicare due to ESRD.

His dialysis center is telling him that they must bill his group plan

primary, but he insists that his Medicare is primary and will remain primary

for the rest of his life, regardless of his ESRD eligibility, and regardless

of the fact that he still has 2 group plans. When checking with the Medicare

system, they show no transplant data, and the old MSP info shows mcare

primary as of 1988. (end of first ESRD coord period) However, pver the last

12 years, Medicare has continued to pay as primary.

(do you follow me, so far?!?)

I have the understanding that once the patient had the transplant,

and they still maintained their coverage under a group plan, whether it be

their own, or thru a spouse, that group plan would AGAIN become primary

after 3 years post transplant, and Medicare coverage would continue as

secondary. No longer Medicare due to ESRD, but the patient remains

disabled/retired and eligible due to disability.

And, if his group plan is now primary, In what order we list these 3? His

retirement plan primary, his spouse's active plan secondary, and Medicare

3rd? Or, would his wife's active plan be primary, since his is a retirement

plan?

(I know we have opened up a " can of worms " with this one....!)

I am being challenged on this one, by both the patient, and our social

worker....

Please give me your thoughts on this one.

Second question: (this one's a lot easier....) If patient turned down

Medicare Part B at the time of dialysis, and he elects to enroll at the time

of the transplant, is there a penalty or a " wait " time at the time of

transplant? I don't believe there is, but the social worker is asking for

this in writing.

ok, now that I've made you put on your thinking caps this late in the

afternoon.... I'll let you mull over this... and I will anxiously await your

replies.

In the meantime, I'm leaving for the day!

Thanks, in advance!

a