Health insurance plan says no transplant coverage with his policy / patient has Medicare A&B

[Guest guest]

Just found out a patient from Puerto Rico thought to initially

only have Medicare A & B primary does have a second insurance (group health

plan) might actually be primary. Since Friday I have been working

with the other insurance – Pan American Life (in Puerto

Rico) to clarify the primary/secondary status (peritoneal dialysis

started 07/01/09, under 65, not on disability) and transplant benefits. I

submitted a letter of medical necessity with the transplant CPT codes for an

upcoming live donor kidney transplant for Pan American Life to review.

Today I received a letter from Pan American Life indicating

that his group health policy does not include any coverage for organ

transplantation –

§ as such can

we proceed with the kidney transplant with the Medicare A & B only?

§ (patient knows

the self pay costs with Medicare A & B and does have prescription coverage in

Puerto Rico – we covered that during the

eval)

Daryl Battin, MSW/LICSW

Financial Coordinator/Social Worker

Department of Transplantation

Lahey Clinic, 41 Mall Road, Burlington

MA 01805

Ph: / FAX:

Page:

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