RE: Humana Plan

[Guest guest]

Yes, it replaces the traditional medicare. It is A, B and D all rolled into one.

Precert is usually required

Whitney Folsom, TFC

ETMC Transplant Program

1100 E Lake St ste 340

Tyler, TX 75701

phone

fax

wlfolsom@...

>>> Sara 3/1/2010 1:53 PM >>>

I have a kidney tx patient with a Humana Medicare Replacement Plan. Does this

mean it takes the place of regular Medicare, and is not a secondary plan?

Does anyone have any experience with Humana? I was told they do not pay for

immunos or only pay at 80%, and the pt is not able to obtain a supplement to

cover the remaining 20%. Is this accurate?

Any input would be greatly appreciated.

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[Guest guest]

Yes, you are correct. The Medicare Replacement plan takes place of regular Medicare.

Most of the Humana plans that I have worked with have a maximum out-of-pocket per year which includes the immuno's. Just ask very specific and detailed questions when you are asking for immuno benefits.

University of Utah Health Care

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of SaraSent: Monday, March 01, 2010 12:54 PMTo: TxFinancialCoordinators Subject: Humana Plan

I have a kidney tx patient with a Humana Medicare Replacement Plan. Does this mean it takes the place of regular Medicare, and is not a secondary plan?Does anyone have any experience with Humana? I was told they do not pay for immunos or only pay at 80%, and the pt is not able to obtain a supplement to cover the remaining 20%. Is this accurate?Any input would be greatly appreciated.

[Guest guest]

Oh yes.

Humana does offer

Medicare replacement policies, all 3 kinds to be exact: HMO, PPO & PFFS.

Typically they do not

pay anymore than what Traditional Medicare would pay for immunos, the 80%.

And correct, no

beneficiary is entitled to secure secondary coverage to alleviate this balance.

In this situation, a

couple things come to mind…

If the patient is of

age to get into a state based pharmaceutical program… here in NY it’s

EPIC for seniors. The only way to “supplement” what Rx coverage a

patient already has.

Does the patient meet

income guidelines for PAP for immunos? If so, with a little extra planning,

you can have your patient get their immunos thru the drug company as most PAP’s

offer free drugs to those who are only covered 80%, such as Astellas &

Roche.

Meredith Gray

Liver Transplant Financial Coordinator

University of Rochester Medical

Center

601

Elmwood Avenue Box 602

Rochester,

NY 14642

(fax)

(pager)

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From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Sara

Sent: Monday, March 01, 2010 2:54

PM

To: TxFinancialCoordinators

Subject:

Humana Plan

I have a kidney tx patient with a Humana Medicare

Replacement Plan. Does this mean it takes the place of regular Medicare, and is

not a secondary plan?

Does anyone have any experience with Humana? I was told they do not pay for

immunos or only pay at 80%, and the pt is not able to obtain a supplement to

cover the remaining 20%. Is this accurate?

Any input would be greatly appreciated.

[Guest guest]

Yes, the

Humana Medicare Replacement Plan does replace regular Medicare. We have

had a couple of patients at our center that have had Humana Replacement Plans

and their 20% coinsurance for immunos has gone toward their out-of-pocket max.

Amy Murray, Transplant Financial Coordinator

Via Christi Regional Medical

Center

929 N. St.

Francis, Ste. M157

• Wichita, KS 67214

Phone:

(316) 268.8295 • Fax: (316) 291.7765

amy.murray@...

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Sara

Sent: Monday, March 01, 2010 1:54

PM

To: TxFinancialCoordinators

Subject:

Humana Plan

I have a kidney tx patient with a Humana Medicare

Replacement Plan. Does this mean it takes the place of regular Medicare, and is

not a secondary plan?

Does anyone have any experience with Humana? I was told they do not pay for

immunos or only pay at 80%, and the pt is not able to obtain a supplement to

cover the remaining 20%. Is this accurate?

Any input would be greatly appreciated.