Guest guest Posted September 7, 2001 Report Share Posted September 7, 2001 ok, im putting this out to the brain trust (thats all of you guys)[(Aguiar, )] The brain trust thanks you for your confidence in our collective wisdom... a kidney patient gets called in for txp. they have esrd medicare prime because they are beyond the 30month coord period, and they have a group health insurance secondary. the patient has allowed their part b to terminate. i believe that no patient can be forced to take medicare part b and that the group health insurance will pay the charges that come through after medicare part a pays their part.[(Aguiar, )] While no payer would actually put a gun to their member's head & force them to apply for Medicare (at least as far as I know anyway), what they can & will do is to only reimburse the 20% for a Part B charge that they would be responsible for if Medicare Part B WERE in place. (They can also do the same thing w/Part A charges & only pay the Part A deductibles). It's their way of "encouraging" the member to make sure Medicare is in place & paying as primary when they're supposed to, I guess. does this jive with everyones opinion and/or experience? [(Aguiar, )] Actually, the payer for one of my pts who's scheduled for LRD Kidney 10/4 is doing exactly that-they've caculated the 30 mos COB based on when he originally started dialysis, & on the 31st month started reimbursing his claims as secondary to Medicare. He's scrambling right now to get his Part B reinstated because he claims he "never rec'd a bill" for it & it was cx'd 7/1, but he also sat here in my office demanding to know why he had to "have" Medicare when he had other ins. J. Aguiar Beth Israel Deaconess, Boston Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2001 Report Share Posted September 10, 2001 Hello all, I just want to pass along some information on a program that can help patients who are paying for medications out of pocket. It is the United Health alliance tele 1- thru the Southwestern Vermont PHO 100 Hospital Drive. Bennington, Vermont 05201. Toll free 1-. According to the information I was sent these medications are made by american pharmacetical companies that have been sold to Canadian pharmacies. Medications are about ½ the price and the ordering physician does not need a Canadian license. Payment is by check, money order or credit card and are sent to the patients home. This is for individual use onlly. I think there is a web site where prices can be checked but I haven't checked it out yet. It may be under MedicineAssist. Fax forms may be obtained there also. B. Hartford Transplant Program >>> haroldw@... 09/07/01 10:25AM >>> ok, im putting this out to the brain trust (thats all of you guys)..... a kidney patient gets called in for txp. they have esrd medicare prime because they are beyond the 30month coord period, and they have a group health insurance secondary. the patient has allowed their part b to terminate. i believe that no patient can be forced to take medicare part b and that the group health insurance will pay the charges that come through after medicare part a pays their part. does this jive with everyones opinion and/or experience? is there actually any medicare or insurance reg that clearly states this? thanks in advance for your thoughts.... Rusty Ward Financial Consultant Liver Transplant Program (fax) haroldw@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2001 Report Share Posted September 11, 2001 nne, Thanks for sharing that. I passed it along to our Social Worker.... will let you know if it pans out for any of our patients. Thanks again! a Re: medicare question Hello all, I just want to pass along some information on a program that can help patients who are paying for medications out of pocket. It is the United Health alliance tele 1- thru the Southwestern Vermont PHO 100 Hospital Drive. Bennington, Vermont 05201. Toll free 1-. According to the information I was sent these medications are made by american pharmacetical companies that have been sold to Canadian pharmacies. Medications are about ½ the price and the ordering physician does not need a Canadian license. Payment is by check, money order or credit card and are sent to the patients home. This is for individual use onlly. I think there is a web site where prices can be checked but I haven't checked it out yet. It may be under MedicineAssist. Fax forms may be obtained there also. B. Hartford Transplant Program >>> haroldw@... 09/07/01 10:25AM >>> ok, im putting this out to the brain trust (thats all of you guys)..... a kidney patient gets called in for txp. they have esrd medicare prime because they are beyond the 30month coord period, and they have a group health insurance secondary. the patient has allowed their part b to terminate. i believe that no patient can be forced to take medicare part b and that the group health insurance will pay the charges that come through after medicare part a pays their part. does this jive with everyones opinion and/or experience? is there actually any medicare or insurance reg that clearly states this? thanks in advance for your thoughts.... Rusty Ward Financial Consultant Liver Transplant Program (fax) haroldw@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2003 Report Share Posted October 21, 2003 That is correct. Jan McIlvaine Lankenau Hospital Phila., PA MEDICARE QUESTION Patient Medicare effective 4-1-99 due to dialysis. Patient has K/P tx 11-17-00. Won't Medicare be in effect 36 months post tx not post date of dialysis start date? thanks in advance for your information. ljm LEONA JOYCE MOSELEY,SR. PSR OU MEDICAL CENTER ADMITTING & TRANSPLANT FINANCIAL SERVICES PHONE # FAX # E-MAIL ADDRESS: Leona.Moseley@... BE AN ORGAN DONOR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2003 Report Share Posted October 21, 2003 correct, unless he or spouse is actively working and has GHP. If they have GHP it would be primary over Medicare. L. Woodward Renal Transplant Financial Coordinator Univ of Ark for Med Sciences (501)603-1007 FAX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2003 Report Share Posted October 21, 2003 30 month coordination period (who is primary) is in relationship to ESRD/dialysis or ESRD/transplant (predialysis) information. Length of time person is eligible for continued Medicare is reflective of transplant date (3 years). New Medicare Premium amounts for 2004: Medicare Part B premiums will be increasing to $66.60 per month (from $58.70 - 2003) and Part A deductible will now be $876, per benefit period (from $840 - 2003). Part B deductible will remain the same at $100 per year. Part A premiums costs have a slight increase over 2003 rates, if person does not have enough quarters of Medicare covered employment. Also coinsurance increase for 61st thru 90th day and 91st to 150th day admissions. -Lori Bond MEDICARE QUESTION Patient Medicare effective 4-1-99 due to dialysis. Patient has K/P tx 11-17-00. Won't Medicare be in effect 36 months post tx not post date of dialysis start date? thanks in advance for your information. ljm LEONA JOYCE MOSELEY,SR. PSR OU MEDICAL CENTER ADMITTING & TRANSPLANT FINANCIAL SERVICES PHONE # FAX # E-MAIL ADDRESS: Leona.Moseley@... BE AN ORGAN DONOR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2003 Report Share Posted October 21, 2003 36 months from transplant date. Donovan Transplant Financial Coordinator SUNY Upstate Medical University 750 East Street Syracuse, New York 13210 Phone: 315 464-6290 Fax: 315 464-6288 Donovanl@... The information contained in this email is confidential intended only for the use of the party to whom it is addressed. If you are not the intended recipient, please be aware that you are strictly prohibited from sharing, distributing, or copying this email. If you have received this email by mistake, please notify the sender. Thank you. >>> Leona.Moseley@... 10/21/03 02:11PM >>> Patient Medicare effective 4-1-99 due to dialysis. Patient has K/P tx 11-17-00. Won't Medicare be in effect 36 months post tx not post date of dialysis start date? thanks in advance for your information. ljm LEONA JOYCE MOSELEY,SR. PSR OU MEDICAL CENTER ADMITTING & TRANSPLANT FINANCIAL SERVICES PHONE # FAX # E-MAIL ADDRESS: Leona.Moseley@... BE AN ORGAN DONOR Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2003 Report Share Posted October 21, 2003 again, remember this all changes is he is currently employed and has insurance. L. Woodward Renal Transplant Financial Coordinator Univ of Ark for Med Sciences (501)603-1007 FAX Quote Link to comment Share on other sites More sharing options...
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