Guest guest Posted February 19, 2004 Report Share Posted February 19, 2004 I know we discuss this issues a lot. Our patient had his kidney tx May 2003. He had a living donor and applied for Medicare after the tx. He has been medically retired on disability since 1983. His medical insurance is from his former employer (federal government). He can keep the insurance as long he pays the insurance premiums. Medicare became effective May 03. To date Medicare or insurance will not determine who is primary. So his post medical care cost is not getting paid. Would you be so kind to share who you think is primary or know how to get a final answer. Thanks for your input. . 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 February 19, 2004 Report Share Posted February 19, 2004 If the kidney transplant in May, 2003 is the qualifying event for ESRD Medicare eligibility, i.e. he was not on HD or PD previously, then his 30-month coordination period began in May and ends Oct, 2005. Even though he is retired from the federal gov't, if he is still being carried for insurance purposes as an active employee because he is under 65, then his Medicare is secondary. If his plan states that when he got Medicare, the plan converted to a Medicare supplement, then Medicare would be primary. His dual entitlement status due to ESRD and Disability Medicare entitlement is not relevant for insurance coordination. Except that if he is considered an active employee for insurance purposes, then his 2003 ESRD entitlement date would then make Medicare secondary since ESRD Medicare coordination rules take precedence over Disability rules. You need to know on what basis his former employer is covering him. And make sure they understand how ESRD coordination works. The Medicare COB office in New York City, , can confirm if Medicare is primary or secondary. If they do not have it correct, you can ask them how you or the patient can get SS to correct his record, and then his Medicare payor priority. Sometimes they do not know about (or update) when there is a previous kidney transplant. WHO IS PRIMARY I know we discuss this issues a lot. Our patient had his kidney tx May 2003. He had a living donor and applied for Medicare after the tx. He has been medically retired on disability since 1983. His medical insurance is from his former employer (federal government). He can keep the insurance as long he pays the insurance premiums. Medicare became effective May 03. To date Medicare or insurance will not determine who is primary. So his post medical care cost is not getting paid. Would you be so kind to share who you think is primary or know how to get a final answer. Thanks for your input. . 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 February 19, 2004 Report Share Posted February 19, 2004 Fred I thank you so much for your information --ljm > WHO IS PRIMARY > > I know we discuss this issues a lot. Our patient had his kidney tx May > 2003. He had a living donor and applied for Medicare after the tx. He > has > been medically retired on disability since 1983. His medical insurance > is > from his former employer (federal government). He can keep the insurance > as > long he pays the insurance premiums. Medicare became effective May 03. > To > date Medicare or insurance will not determine who is primary. So his > post > medical care cost is not getting paid. > Would you be so kind to share who you think is primary or know how to > get a > final answer. > Thanks for your input. . > > > 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 February 20, 2004 Report Share Posted February 20, 2004 The best way to solve this is to call the Medicare Coordination of Benefits office in New York. That phone number is 1- and follow the prompts. You will probably need the 2728 form to fax them. I would also establish a time line, i.e. When did he retire - Retirement date When was his transplant When did he receive his transplant If he or his spouse is not working - Medicare is the automatic primary payer because usually in the Federal Govt BC/BS when they get Medicare they benefit is dropped to a Medicare Supplement policy. Hope this helps. Bev Larson, Norfolk, VA . >>> Leona.Moseley@... 02/19/04 03:50PM >>>I know we discuss this issues a lot. Our patient had his kidney tx May2003. He had a living donor and applied for Medicare after the tx. He hasbeen medically retired on disability since 1983. His medical insurance isfrom his former employer (federal government). He can keep the insurance aslong he pays the insurance premiums. Medicare became effective May 03. Todate Medicare or insurance will not determine who is primary. So his postmedical care cost is not getting paid. Would you be so kind to share who you think is primary or know how to get afinal answer. Thanks for your input. . LEONA JOYCE MOSELEY,SR. PSR OU MEDICAL CENTER ADMITTING & TRANSPLANT FINANCIAL SERVICESPHONE #FAX #E-MAIL ADDRESS: Leona.Moseley@...BE AN ORGAN DONOR Quote Link to comment Share on other sites More sharing options...
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