Whose Primary

[Guest guest]

I have a problem patient and I would like your input.

We have a 16 year old who had a kidney transplant in July 1996. In August

of 2001 started dialysis and is a candidate for a second transplant. Father

has group coverage and the boy (patient) has Medicare.

The boy had group primary/Medicare secondary from July 1996 till August

1999, at that time Medicare became primary. The question is in August 2001

who is primary?? From what I read in the HCFA handbook he should start

another coordination period which would make his group primary, but,

Medicare is saying they are still primary.

The other concern is it necessary for him to carry Part B coverage if his

group pays 100%?

Does anyone have any insight????

Sharon

MEMORIAL HERMAN

Fax

e-mail: sharon_lewis@...

[Guest guest]

Dear Sharon:

It is my understanding that Medicare would be primary in 8/01 as long as

there was no gap in his Medicare coverage. If his Medicare coverage did

end, he would need to go through the coordination of benefits period again.

Also, re: part B coverage, this is a big issue. Patients are being put in a

difficult bind - paying premiums for coverage they don't need, but may need

at a later date. This patient could get part A only, but needs to be

advised that they will pay a higher premium for part B if they purchase it

in the future.

Hope this helps.

Jan

p.s. Obviously the Congress had good intentions with this legislation, but

probably did not understand the adverse effect on patients like those listed

above. I think our group should consider a method for communicating our

concerns to the legislators - and suggest something that would work better

for patients.

Whose Primary

I have a problem patient and I would like your input.

We have a 16 year old who had a kidney transplant in July 1996. In August

of 2001 started dialysis and is a candidate for a second transplant. Father

has group coverage and the boy (patient) has Medicare.

The boy had group primary/Medicare secondary from July 1996 till August

1999, at that time Medicare became primary. The question is in August 2001

who is primary?? From what I read in the HCFA handbook he should start

another coordination period which would make his group primary, but,

Medicare is saying they are still primary.

The other concern is it necessary for him to carry Part B coverage if his

group pays 100%?

Does anyone have any insight????

Sharon

MEMORIAL HERMAN

Fax

e-mail: sharon_lewis@...

[Guest guest]

Have any of you had problems with Mailhanderls Insurance????They do not

coordinate benefits for prescription coverage. Therefore, they will not pick up

the 20% after Medicare pays 80%. This leaves the patient in a situation where

he has to pay the $380.00 (for one of my patients) co ins.

I told the patient to use the mailorder program and get his meds for 90 days for

one $30.00 copay. Obviously, this is a problem. I called the Mailhanders Union

in D.C. and was told they did not know this was a problem. Any

thoughts??????Bev Larson, SNGH, Noroflk, VA.