Guest guest Posted August 9, 2002 Report Share Posted August 9, 2002 Try: Hospital Manual ESRD Appendix-Coverage of Services Section E218.3 http://www.hcfa.gov/pubforms/10%5Fhospital/hoe200.htm and Social Security Act Section 1881 8(d) (falls on page 7 of 9 page print out) http://www.ssa.gov/OP_Home/ssact/title18/1881.htm Lori Bond Financial Counselor in Transplant Legacy Good Samaritan Hospital and Medical Center medicare Can anyone confirm how long is the post-op follow-up for kidney/liver donors ? Or if someone can give me a direct website to go to. Any information will be greatly appreciated ! Thanks- Sioson Renal TFC NY Presby Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2002 Report Share Posted August 9, 2002 HI,Out here in California the donor post-op follow up is 3 months. Can go longer if complication develop within that time frame. Includes Meds for post op pain or infection. Ann Reilly UCSF Pre-Kidney Tx F/C (415)353-8779 > >Reply-To: TxFinancialCoordinators >To: " TxFinancialCoordinators " ><TxFinancialCoordinators > >Subject: medicare >Date: Fri, 09 Aug 2002 15:07:44 -0400 > >Can anyone confirm how long is the post-op follow-up for kidney/liver >donors ? > >Or if someone can give me a direct website to go to. > >Any information will be greatly appreciated ! > >Thanks- > Sioson >Renal TFC >NY Presby > _________________________________________________________________ Chat with friends online, try MSN Messenger: http://messenger.msn.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2003 Report Share Posted January 22, 2003 Hold the bill -- better to bill once Medicare is up on line (usually 6 to 8 weeks from application), then refund commercial insurance later. Entitlement goes back date ESRD eligibility (dialysis) whether or not the patient signed up at point of dialysis or point of transplant. -Lori Medicare We have a kidney transplant patient who just received a cadaveric kidney. She started CAPD 6/00. She has commercial insurance. so she did not sign up for Medicare until Dec 2002 when Medicare would become prime. Medicare lost her paperwork, so she has no card or number. Even though she is not in the system, once she is, Medicare will be prime. Will the effective date go back to 6/00 when she started CAPDdialysis? If we bill her commercial they will deny it based on COB dates.Payment for hospital and MD's. will be delayed until she becomes active with Medicare. Any advice? Thanks again for your help. Hartford Hospital Transplant Program Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2003 Report Share Posted January 22, 2003 We had a case like this and the Medicare entitlement date was after the Coordination of Benefits period ended (in this case 12/02). It caused a lot of confusion with billing, because Medicare had trouble computing that the COB was over at the date of entitlement. However, in the end, they paid. Jan McIlvaine Lankenau Hospital Phila., PA Medicare We have a kidney transplant patient who just received a cadaveric kidney. She started CAPD 6/00. She has commercial insurance. so she did not sign up for Medicare until Dec 2002 when Medicare would become prime. Medicare lost her paperwork, so she has no card or number. Even though she is not in the system, once she is, Medicare will be prime. Will the effective date go back to 6/00 when she started CAPDdialysis? If we bill her commercial they will deny it based on COB dates.Payment for hospital and MD's. will be delayed until she becomes active with Medicare. Any advice? Thanks again for your help. Hartford Hospital Transplant Program Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2003 Report Share Posted February 17, 2003 Now that her Medicare is primary and no part B, her BC/bS policy will pickup for any out patient treatment. She'll be liable for any co-pays, deductibles and out of pockets. So yes she'll incure more out of pocket now that BC/BS will be like the part B side.Deb Wade Medicare > Good morning- > I have a patient that has BCBS primary and Medicare 2ndary due to esrd. She > just completed her 30 m cob period. She did not opt for Part B as her BCBS > covered everything but a $5 copay. Now that BCBS is 2ndary, can she be > penalized for not opting for the Part B by her BCBS? > > This is for a kidney transplant, so she would not have been eligible for > Medicare for any other reason. > > I would appreciate any input. > > Donovan > Transplant Financial Coordinator > SUNY Upstate Medical University > 750 East Street > Syracuse, New York 13210 > PH: > FAX: > Donovanl@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2003 Report Share Posted February 17, 2003 BCBS can they say she is liable for more then her $5 copay due to no Part B? (as a penalty?) Donovan Transplant Financial Coordinator SUNY Upstate Medical University 750 East Street Syracuse, New York 13210 PH: FAX: Donovanl@... >>> DWade@... 02/17/03 10:11AM >>> Now that her Medicare is primary and no part B, her BC/bS policy will pickup for any out patient treatment. She'll be liable for any co-pays, deductibles and out of pockets. So yes she'll incure more out of pocket now that BC/BS will be like the part B side.Deb Wade Medicare > Good morning- > I have a patient that has BCBS primary and Medicare 2ndary due to esrd. She > just completed her 30 m cob period. She did not opt for Part B as her BCBS > covered everything but a $5 copay. Now that BCBS is 2ndary, can she be > penalized for not opting for the Part B by her BCBS? > > This is for a kidney transplant, so she would not have been eligible for > Medicare for any other reason. > > I would appreciate any input. > > Donovan > Transplant Financial Coordinator > SUNY Upstate Medical University > 750 East Street > Syracuse, New York 13210 > PH: > FAX: > Donovanl@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2003 Report Share Posted February 17, 2003 Yes, DW Medicare > > > > Good morning- > > I have a patient that has BCBS primary and Medicare 2ndary due to esrd. > She > > just completed her 30 m cob period. She did not opt for Part B as her > BCBS > > covered everything but a $5 copay. Now that BCBS is 2ndary, can she be > > penalized for not opting for the Part B by her BCBS? > > > > This is for a kidney transplant, so she would not have been eligible for > > Medicare for any other reason. > > > > I would appreciate any input. > > > > Donovan > > Transplant Financial Coordinator > > SUNY Upstate Medical University > > 750 East Street > > Syracuse, New York 13210 > > PH: > > FAX: > > Donovanl@... > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2003 Report Share Posted February 17, 2003 Verify with the plan. Some plans have a clause of no coverage if eligible for government or other insurance & it was declined. She may be able to sign up for part B now without a penalty due to other coverage or as it is now time for open enrollment.... Re: Medicare BCBS can they say she is liable for more then her $5 copay due to no Part B? (as a penalty?) Donovan Transplant Financial Coordinator SUNY Upstate Medical University 750 East Street Syracuse, New York 13210 PH: FAX: Donovanl@... >>> DWade@... 02/17/03 10:11AM >>> Now that her Medicare is primary and no part B, her BC/bS policy will pickup for any out patient treatment. She'll be liable for any co-pays, deductibles and out of pockets. So yes she'll incure more out of pocket now that BC/BS will be like the part B side.Deb Wade Medicare > Good morning- > I have a patient that has BCBS primary and Medicare 2ndary due to esrd. She > just completed her 30 m cob period. She did not opt for Part B as her BCBS > covered everything but a $5 copay. Now that BCBS is 2ndary, can she be > penalized for not opting for the Part B by her BCBS? > > This is for a kidney transplant, so she would not have been eligible for > Medicare for any other reason. > > I would appreciate any input. > > Donovan > Transplant Financial Coordinator > SUNY Upstate Medical University > 750 East Street > Syracuse, New York 13210 > PH: > FAX: > Donovanl@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2003 Report Share Posted February 17, 2003 but why would she have to do that and pay $60 more per month for coverage that she would have not needed, due to adequate BCBS coverage? She would be paying double for the same coverage? Does not make sense.... Donovan Transplant Financial Coordinator SUNY Upstate Medical University 750 East Street Syracuse, New York 13210 PH: FAX: Donovanl@... >>> Joan.Kersten@... 02/17/03 02:01PM >>> Verify with the plan. Some plans have a clause of no coverage if eligible for government or other insurance & it was declined. She may be able to sign up for part B now without a penalty due to other coverage or as it is now time for open enrollment.... Re: Medicare BCBS can they say she is liable for more then her $5 copay due to no Part B? (as a penalty?) Donovan Transplant Financial Coordinator SUNY Upstate Medical University 750 East Street Syracuse, New York 13210 PH: FAX: Donovanl@... >>> DWade@... 02/17/03 10:11AM >>> Now that her Medicare is primary and no part B, her BC/bS policy will pickup for any out patient treatment. She'll be liable for any co-pays, deductibles and out of pockets. So yes she'll incure more out of pocket now that BC/BS will be like the part B side.Deb Wade Medicare > Good morning- > I have a patient that has BCBS primary and Medicare 2ndary due to esrd. She > just completed her 30 m cob period. She did not opt for Part B as her BCBS > covered everything but a $5 copay. Now that BCBS is 2ndary, can she be > penalized for not opting for the Part B by her BCBS? > > This is for a kidney transplant, so she would not have been eligible for > Medicare for any other reason. > > I would appreciate any input. > > Donovan > Transplant Financial Coordinator > SUNY Upstate Medical University > 750 East Street > Syracuse, New York 13210 > PH: > FAX: > Donovanl@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2003 Report Share Posted February 19, 2003 When I meet with patients for financial counseling I explain this to them and explain their options. I have been told by patients that dialysis centers tell them to take Part A because it is " free " . I tell patients that if they are not going to enroll in Part B then do not enroll in Part A because this can hurt them for several reasons. We have a patient who transferred from another transplant center due to an insurance change and he only had Part A. We had to place him on hold until Medicare Part B becomes active in July! He had completed his 30 month COB period. He only took Part A because he had an HMO. He did this to save a few bucks but it hurt him in the long run. We have had a few patients who contacted SS and were able to get the Part B reinstated, since they had applied for it then did not continue to pay the premium, by back paying the premium. Perhaps you could look into this. Good Luck. Porter University Hospitals of Cleveland Re: Medicare BCBS can they say she is liable for more then her $5 copay due to no Part B? (as a penalty?) Donovan Transplant Financial Coordinator SUNY Upstate Medical University 750 East Street Syracuse, New York 13210 PH: FAX: Donovanl@... >>> DWade@... 02/17/03 10:11AM >>> Now that her Medicare is primary and no part B, her BC/bS policy will pickup for any out patient treatment. She'll be liable for any co-pays, deductibles and out of pockets. So yes she'll incure more out of pocket now that BC/BS will be like the part B side.Deb Wade Medicare > Good morning- > I have a patient that has BCBS primary and Medicare 2ndary due to > esrd. She > just completed her 30 m cob period. She did not opt for Part B as her BCBS > covered everything but a $5 copay. Now that BCBS is 2ndary, can she be > penalized for not opting for the Part B by her BCBS? > > This is for a kidney transplant, so she would not have been eligible > for Medicare for any other reason. > > I would appreciate any input. > > Donovan > Transplant Financial Coordinator > SUNY Upstate Medical University > 750 East Street > Syracuse, New York 13210 > PH: > FAX: > Donovanl@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2003 Report Share Posted February 19, 2003 We counsel all of our kidney patients to decide if and when they want to enroll in ESRD Medicare as it relates to their current insurance situation, i.e. plan ahead. And if they decide to enroll, to get both Parts. We always counsel against getting just Part A and declining Part B. We want them to see it as an “all or nothing” situation. For the reasons you mention. Re: Medicare BCBS can they say she is liable for more then her $5 copay due to no Part B? (as a penalty?) Donovan Transplant Financial Coordinator SUNY Upstate Medical University 750 East Street Syracuse, New York 13210 PH: FAX: Donovanl@... >>> DWade@... 02/17/03 10:11AM >>> Now that her Medicare is primary and no part B, her BC/bS policy will pickup for any out patient treatment. She'll be liable for any co-pays, deductibles and out of pockets. So yes she'll incure more out of pocket now that BC/BS will be like the part B side.Deb Wade Medicare > Good morning- > I have a patient that has BCBS primary and Medicare 2ndary due to > esrd. She > just completed her 30 m cob period. She did not opt for Part B as her BCBS > covered everything but a $5 copay. Now that BCBS is 2ndary, can she be > penalized for not opting for the Part B by her BCBS? > > This is for a kidney transplant, so she would not have been eligible > for Medicare for any other reason. > > I would appreciate any input. > > Donovan > Transplant Financial Coordinator > SUNY Upstate Medical University > 750 East Street > Syracuse, New York 13210 > PH: > FAX: > Donovanl@... > > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.