RE: Non par with BDCT and post-Tx f/u Care with Immunos

[Guest guest]

So you are able to still do the transplant even if you are non BDCT? I am being told that there is NO coverage for the transplant if it is done at a non BDCT facility. I am also being told they will not cover any of the post transplant care if the transplant was done at a non BDCT center. Is this different depending on the State? Thanks! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Farid, FahmySent: Tuesday, June 19, 2012 10:21 AMTo: TxFinancialCoordinators Subject: Non par with BDCT and post-Tx f/u Care with Immunos Good morning fellow TFC’s, I have a patient listed for Liver Tx. He has much higher IN Network BDCT level of coverage. We are non-BDCT par, so OON benefits at 50% after $500 DED but no OOP at our facility.We asked for IN Network exception. It was denied. We appealed and denial was upheld. Pt is auth’ed for OLT, though.Unable to negotiate OON deal. Patient is willing to pay difference of our local BC contracted rate. My question is regarding the post-Tx f/u care coverage. At which rate (regular medical services at 80%) will it be covered?How about Immunos? Has anyone had a similar case with BDCT? Thank you,Fahmy.CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you.

[Guest guest]

In Kidney, it depends on the employer group. They get to decide how restrictive the policy will be. 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@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of lisa.christiansen@...Sent: Tuesday, June 19, 2012 2:03 PMTo: TxFinancialCoordinators Subject: RE: Non par with BDCT and post-Tx f/u Care with Immunos So you are able to still do the transplant even if you are non BDCT? I am being told that there is NO coverage for the transplant if it is done at a non BDCT facility. I am also being told they will not cover any of the post transplant care if the transplant was done at a non BDCT center. Is this different depending on the State? Thanks! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Farid, FahmySent: Tuesday, June 19, 2012 10:21 AMTo: TxFinancialCoordinators Subject: Non par with BDCT and post-Tx f/u Care with Immunos Good morning fellow TFC’s, I have a patient listed for Liver Tx. He has much higher IN Network BDCT level of coverage. We are non-BDCT par, so OON benefits at 50% after $500 DED but no OOP at our facility.We asked for IN Network exception. It was denied. We appealed and denial was upheld. Pt is auth’ed for OLT, though.Unable to negotiate OON deal. Patient is willing to pay difference of our local BC contracted rate. My question is regarding the post-Tx f/u care coverage. At which rate (regular medical services at 80%) will it be covered?How about Immunos? Has anyone had a similar case with BDCT? Thank you,Fahmy.CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you.

[Guest guest]

Not exactly, it varies according to the policy, type of employer, etc…. There are policies that have BDCT mandatory requirements for which patient has nowhere else to go.Others offer BDCT level coverage superior to the CME or out of Network level. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of lisa.christiansen@...Sent: Tuesday, June 19, 2012 5:03 PMTo: TxFinancialCoordinators Subject: RE: Non par with BDCT and post-Tx f/u Care with Immunos So you are able to still do the transplant even if you are non BDCT? I am being told that there is NO coverage for the transplant if it is done at a non BDCT facility. I am also being told they will not cover any of the post transplant care if the transplant was done at a non BDCT center. Is this different depending on the State? Thanks! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Farid, FahmySent: Tuesday, June 19, 2012 10:21 AMTo: TxFinancialCoordinators Subject: Non par with BDCT and post-Tx f/u Care with Immunos Good morning fellow TFC’s, I have a patient listed for Liver Tx. He has much higher IN Network BDCT level of coverage. We are non-BDCT par, so OON benefits at 50% after $500 DED but no OOP at our facility.We asked for IN Network exception. It was denied. We appealed and denial was upheld. Pt is auth’ed for OLT, though.Unable to negotiate OON deal. Patient is willing to pay difference of our local BC contracted rate. My question is regarding the post-Tx f/u care coverage. At which rate (regular medical services at 80%) will it be covered?How about Immunos? Has anyone had a similar case with BDCT? Thank you,Fahmy.CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you.

[Guest guest]

Thanks again everyone! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Farid, FahmySent: Tuesday, June 19, 2012 5:07 PMTo: TxFinancialCoordinators Subject: RE: Non par with BDCT and post-Tx f/u Care with Immunos Not exactly, it varies according to the policy, type of employer, etc…. There are policies that have BDCT mandatory requirements for which patient has nowhere else to go.Others offer BDCT level coverage superior to the CME or out of Network level. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of lisa.christiansen@...Sent: Tuesday, June 19, 2012 5:03 PMTo: TxFinancialCoordinators Subject: RE: Non par with BDCT and post-Tx f/u Care with Immunos So you are able to still do the transplant even if you are non BDCT? I am being told that there is NO coverage for the transplant if it is done at a non BDCT facility. I am also being told they will not cover any of the post transplant care if the transplant was done at a non BDCT center. Is this different depending on the State? Thanks! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Farid, FahmySent: Tuesday, June 19, 2012 10:21 AMTo: TxFinancialCoordinators Subject: Non par with BDCT and post-Tx f/u Care with Immunos Good morning fellow TFC’s, I have a patient listed for Liver Tx. He has much higher IN Network BDCT level of coverage. We are non-BDCT par, so OON benefits at 50% after $500 DED but no OOP at our facility.We asked for IN Network exception. It was denied. We appealed and denial was upheld. Pt is auth’ed for OLT, though.Unable to negotiate OON deal. Patient is willing to pay difference of our local BC contracted rate. My question is regarding the post-Tx f/u care coverage. At which rate (regular medical services at 80%) will it be covered?How about Immunos? Has anyone had a similar case with BDCT? Thank you,Fahmy.CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you.

[Guest guest]

If the policy states BDCT or local BX and you are contracted

with local, you are ok. Otherwise, you cannot proceed if it restricts to

BDCT facilities only.

Debbie Mast

Database Administrator/Financial Manager

Solid Organ Transplant/VAD Program

Stanford Hospital and Clinics

750 Welch Road, Suite 220

Palo Alto, CA 94304

Heart, Lung, Heart/Lung, Liver, Kidney, Pancreas, Intestinal

Transplant Programs

Trustee, TFCA

Phone: Fax:

www.donateLIFEcalifornia.org/stanfordmed

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of lisa.christiansen@...

Sent: Tuesday, June 19, 2012 2:03 PM

To: TxFinancialCoordinators

Subject: RE: Non par with BDCT and post-Tx f/u

Care with Immunos

So you are able to still do the

transplant even if you are non BDCT? I am being told that there is NO coverage

for the transplant if it is done at a non BDCT facility. I am also being told

they will not cover any of the post transplant care if the transplant was done

at a non BDCT center. Is this different depending on the State?

Thanks!

M. Christiansen, BAS, RN

Transplant Financial Case Manager

DeVos Heart and Lung Transplant

Program

100 Michigan NE

MC 231

Grand Rapids, MI 49503

Phone: Pager: Fax:

lisa.christiansen@...

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Farid,

Fahmy

Sent: Tuesday, June 19, 2012 10:21 AM

To: TxFinancialCoordinators

Subject: Non par with BDCT and post-Tx f/u

Care with Immunos

Good

morning fellow TFC’s,

I

have a patient listed for Liver Tx.

He

has much higher IN Network BDCT level of coverage. We are non-BDCT par, so OON

benefits at 50% after $500 DED but no OOP at our facility.

We

asked for IN Network exception. It was denied. We appealed and denial was

upheld. Pt is auth’ed for OLT, though.

Unable

to negotiate OON deal.

Patient

is willing to pay difference of our local BC contracted rate.

My

question is regarding the post-Tx f/u care coverage. At which rate (regular

medical services at 80%) will it be covered?

How

about Immunos?

Has

anyone had a similar case with BDCT?

Thank

you,

Fahmy.

CONFIDENTIAL: The information contained in

this communication, including its attachments may contain confidential

information and is intended only for the individual (s) or entity (ies) to whom

it is addressed . The information contained in this communication may also be

protected by legal privilege , federal law or other applicable law. If you are

not the intended recipient of this communication , you are hereby notified that

any distribution, dissemination or duplication of this communication is

strictly prohibited. If you have received this communication in error please

immediately delete and destroy all copies of this message and please

immediately notify us of the error by separate communication . Thank you.

[Guest guest]

,

This is a decision that the employer group makes. So you have to check with the insurance and then follow their instructions. If they mandate that the patient

go to a BDCT center, you have to send the patient there. If they are okay with them using their “local” Blue Cross benefits, they can see you.

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]

On Behalf Of lisa.christiansen@...

Sent: Tuesday, June 19, 2012 3:03 PM

To: TxFinancialCoordinators

Subject: RE: Non par with BDCT and post-Tx f/u Care with Immunos

So you are able to still do the transplant even if you are non BDCT? I am being told that there is NO coverage for the transplant if

it is done at a non BDCT facility. I am also being told they will not cover any of the post transplant care if the transplant was done at a non BDCT center. Is this different depending on the State?

Thanks!

M. Christiansen, BAS, RN

Transplant Financial Case Manager

DeVos Heart and Lung Transplant Program

100 Michigan NE

MC 231

Grand Rapids, MI 49503

Phone:

Pager: Fax:

lisa.christiansen@...

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]

On Behalf Of Farid, Fahmy

Sent: Tuesday, June 19, 2012 10:21 AM

To: TxFinancialCoordinators

Subject: Non par with BDCT and post-Tx f/u Care with Immunos

Good morning fellow TFC’s,

I have a patient listed for Liver Tx.

He has much higher IN Network BDCT level of coverage. We are non-BDCT par, so OON benefits at 50% after $500 DED but no OOP at our facility.

We asked for IN Network exception. It was denied. We appealed and denial was upheld. Pt is auth’ed for OLT, though.

Unable to negotiate OON deal.

Patient is willing to pay difference of our local BC contracted rate.

My question is regarding the post-Tx f/u care coverage. At which rate (regular medical services at 80%) will it be covered?

How about Immunos?

Has anyone had a similar case with BDCT?

Thank you,

Fahmy.

CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information

contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this

communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you.

[Guest guest]

All,We did a lot of these before we were a BDCT, and I would like to point out one of the things that can hang you up. Even if the patient can come to your facility out of network, check the BCBS contract with the facility. We had to get an amendment that included transplant in our local contract. We were told that even though they could come to us out of network, since our local contract did not specifiy transplants, we had to get that added before we could even take them out of network. Tina M. Shearer Donate Life TennesseeTransplant Financial Coordinator Cannon Center for Blood Cancers2300 St3N Parkview/BMTNashville, TN 37203 phone fax From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of McCardellSent: Tuesday, June 19, 2012 5:15 PMTo: TxFinancialCoordinators Subject: RE: Non par with BDCT and post-Tx f/u Care with Immunos , This is a decision that the employer group makes. So you have to check with the insurance and then follow their instructions. If they mandate that the patient go to a BDCT center, you have to send the patient there. If they are okay with them using their “local” Blue Cross benefits, they can see you. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of lisa.christiansen@...Sent: Tuesday, June 19, 2012 3:03 PMTo: TxFinancialCoordinators Subject: RE: Non par with BDCT and post-Tx f/u Care with Immunos So you are able to still do the transplant even if you are non BDCT? I am being told that there is NO coverage for the transplant if it is done at a non BDCT facility. I am also being told they will not cover any of the post transplant care if the transplant was done at a non BDCT center. Is this different depending on the State? Thanks! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Farid, FahmySent: Tuesday, June 19, 2012 10:21 AMTo: TxFinancialCoordinators Subject: Non par with BDCT and post-Tx f/u Care with Immunos Good morning fellow TFC’s, I have a patient listed for Liver Tx. He has much higher IN Network BDCT level of coverage. We are non-BDCT par, so OON benefits at 50% after $500 DED but no OOP at our facility.We asked for IN Network exception. It was denied. We appealed and denial was upheld. Pt is auth’ed for OLT, though.Unable to negotiate OON deal. Patient is willing to pay difference of our local BC contracted rate. My question is regarding the post-Tx f/u care coverage. At which rate (regular medical services at 80%) will it be covered?How about Immunos? Has anyone had a similar case with BDCT? Thank you,Fahmy.CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you.

[Guest guest]

The benefit reimbursement may be at a lower rate otherwise you should be ok. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of McCardellSent: Tuesday, June 19, 2012 5:15 PMTo: TxFinancialCoordinators Subject: RE: Non par with BDCT and post-Tx f/u Care with Immunos , This is a decision that the employer group makes. So you have to check with the insurance and then follow their instructions. If they mandate that the patient go to a BDCT center, you have to send the patient there. If they are okay with them using their “local” Blue Cross benefits, they can see you. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of lisa.christiansen@...Sent: Tuesday, June 19, 2012 3:03 PMTo: TxFinancialCoordinators Subject: RE: Non par with BDCT and post-Tx f/u Care with Immunos So you are able to still do the transplant even if you are non BDCT? I am being told that there is NO coverage for the transplant if it is done at a non BDCT facility. I am also being told they will not cover any of the post transplant care if the transplant was done at a non BDCT center. Is this different depending on the State? Thanks! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Farid, FahmySent: Tuesday, June 19, 2012 10:21 AMTo: TxFinancialCoordinators Subject: Non par with BDCT and post-Tx f/u Care with Immunos Good morning fellow TFC’s, I have a patient listed for Liver Tx. He has much higher IN Network BDCT level of coverage. We are non-BDCT par, so OON benefits at 50% after $500 DED but no OOP at our facility.We asked for IN Network exception. It was denied. We appealed and denial was upheld. Pt is auth’ed for OLT, though.Unable to negotiate OON deal. Patient is willing to pay difference of our local BC contracted rate. My question is regarding the post-Tx f/u care coverage. At which rate (regular medical services at 80%) will it be covered?How about Immunos? Has anyone had a similar case with BDCT? Thank you,Fahmy.CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you.