Guest guest Posted December 21, 2010 Report Share Posted December 21, 2010 yes - my employer is also a "maintenance of benefits" plan (as opposed to a "coordination of benefits" plan. All self-insured employers have the right to do this on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... "Ring out old shapes of foul disease,Ring out the narrowing lust of gold;Ring out the thousand wars of old,Ring in the thousand years of peace."- Alfred Lord Tennyson -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of babydolgSent: Tuesday, December 21, 2010 1:26 PMTo: TxFinancialCoordinators Subject: MEDICARE/UHC Good afternoon! We are out of network with UHC. Medicare A & B is primary. I received benefits but also in the plan it states NON DUPLICATE PLAN IF MEDICARE BENEFIT IS THE SAME OR EXCEEDS UHC BENEFIT THEY WILL NOT MAKE ANY ADDITIONAL PAYMENTS ON THE CLAIM. IF MEDICARE'S BENEFIT IS LESS THAT UHC BENEFIT THEY WILL PAY THE DIFFERENCE BETWEEN MEDICARE'S BENEFIT AND UHC NORMAL BENEFIT. Has anyone hever came across this? So does that mean since Medicare pays 80/20 and the UHC plan also pays 80/20 that UHC will not pay on any claims? Am I understanding this right? Thanks for your help!Missy TrammellResearch Medical Center Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2010 Report Share Posted December 22, 2010 Also known as a " carve-out " policy. When secondary only pays the difference between what primary paid and what they would have paid if they had been primary which is often nothing Whitney Folsom, TFC ETMC Transplant Program 1100 E Lake St ste 340 Tyler, TX 75701 phone fax wlfolsom@... >>> " on, :LPH Trnsplnt " 12/21/2010 4:30 PM >>> yes - my employer is also a " maintenance of benefits " plan (as opposed to a " coordination of benefits " plan. All self-insured employers have the right to do this on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... " Ring out old shapes of foul disease, Ring out the narrowing lust of gold; Ring out the thousand wars of old, Ring in the thousand years of peace. " - Alfred Lord Tennyson MEDICARE/UHC Good afternoon! We are out of network with UHC. Medicare A & B is primary. I received benefits but also in the plan it states NON DUPLICATE PLAN IF MEDICARE BENEFIT IS THE SAME OR EXCEEDS UHC BENEFIT THEY WILL NOT MAKE ANY ADDITIONAL PAYMENTS ON THE CLAIM. IF MEDICARE'S BENEFIT IS LESS THAT UHC BENEFIT THEY WILL PAY THE DIFFERENCE BETWEEN MEDICARE'S BENEFIT AND UHC NORMAL BENEFIT. Has anyone hever came across this? So does that mean since Medicare pays 80/20 and the UHC plan also pays 80/20 that UHC will not pay on any claims? Am I understanding this right? Thanks for your help! Missy Trammell Research Medical Center =========================================================== This message is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this message is strictly prohibited. If you received this message in error, or are not the named recipient(s), please notify the sender and delete this e-mail from your computer. ETMC has implemented secure messaging for certain types of messages. For more information about our secure messaging system, go to: http://www.etmc.org/mail/ Thank you. =========================================================== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2010 Report Share Posted December 22, 2010 Thanks guys! > > Also known as a " carve-out " policy. When secondary only pays the difference between what primary paid and what they would have paid if they had been primary which is often nothing > > > Whitney Folsom, TFC > ETMC Transplant Program > 1100 E Lake St ste 340 > Tyler, TX 75701 > phone > fax > wlfolsom@... > > >>> " on, :LPH Trnsplnt " 12/21/2010 4:30 PM >>> > yes - my employer is also a " maintenance of benefits " plan (as opposed to a " coordination of benefits " plan. All self-insured employers have the right to do this > > on > Transplant Financial Coordinator > Legacy Good Samaritan Hospital > Legacy Transplant Services > 1040 NW 22nd Ave Ste 480 > Portland OR 97210 > direct > main office > toll-free > fax > lmorriso@... > > " Ring out old shapes of foul disease, > Ring out the narrowing lust of gold; > Ring out the thousand wars of old, > Ring in the thousand years of peace. " > - Alfred Lord Tennyson > > MEDICARE/UHC > > > > > Good afternoon! We are out of network with UHC. Medicare A & B is primary. I received benefits but also in the plan it states NON DUPLICATE PLAN IF MEDICARE BENEFIT IS THE SAME OR EXCEEDS UHC BENEFIT THEY WILL NOT MAKE ANY ADDITIONAL PAYMENTS ON THE CLAIM. IF MEDICARE'S BENEFIT IS LESS THAT UHC BENEFIT THEY WILL PAY THE DIFFERENCE BETWEEN MEDICARE'S BENEFIT AND UHC NORMAL BENEFIT. Has anyone hever came across this? So does that mean since Medicare pays 80/20 and the UHC plan also pays 80/20 that UHC will not pay on any claims? Am I understanding this right? Thanks for your help! > > Missy Trammell > Research Medical Center > > > > > > > =========================================================== > This message is confidential, intended only > for the named recipient(s) and may contain > information that is privileged or exempt from > disclosure under applicable law. If you are > not the intended recipient(s), you are notified > that the dissemination, distribution or copying > of this message is strictly prohibited. If you > received this message in error, or are not the > named recipient(s), please notify the sender > and delete this e-mail from your computer. > > ETMC has implemented secure messaging for > certain types of messages. For more information > about our secure messaging system, go to: > > http://www.etmc.org/mail/ > > Thank you. > =========================================================== > Quote Link to comment Share on other sites More sharing options...
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