RE: Donor Financial Agreements

[Guest guest]

Yes I would love to see a copy of one as well..... I feel that it would give boundaries and defined expectations

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Campos, Irad JerusaSent: Thursday, January 31, 2008 11:43 AMTo: TxFinancialCoordinators Subject: Donor Financial Agreements

Hello all!!

Our program has always tried to implement a financial agreement for donors to sign when they start their evaluation. Does anyone have a copy that you are willing to share with me please? I'd like to see as many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you hold with the donor when you first meet with him/her? By rundown I mean: what subjects do you discuss with the donor, what warnings do you give them, etc.

Thanks!Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campostenethealth

The information in this communication is confidential and is directed only to the intended recipient. Please do not forward this communication without my permission. If you have received this communication in error, please notify me immediately and delete/destroy this communication.

The information transmitted in this electronic communication is intended only

for the person or entity to whom it is addressed and may contain confidential

and/or privileged material. Any review, retransmission, dissemination or other

use of or taking of any action in reliance upon this information by persons or

entities other than the intended recipient is prohibited. If you received this

information in error, please contact the Compliance HelpLine at and

properly dispose of this information.

[Guest guest]

Yes I would love to see a copy of one as well..... I feel that it would give boundaries and defined expectations

-----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of Campos, Irad JerusaSent: Thursday, January 31, 2008 11:43 AMTo: TxFinancialCoordinators Subject: Donor Financial Agreements

Hello all!!

Our program has always tried to implement a financial agreement for donors to sign when they start their evaluation. Does anyone have a copy that you are willing to share with me please? I'd like to see as many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you hold with the donor when you first meet with him/her? By rundown I mean: what subjects do you discuss with the donor, what warnings do you give them, etc.

Thanks!Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campostenethealth

The information in this communication is confidential and is directed only to the intended recipient. Please do not forward this communication without my permission. If you have received this communication in error, please notify me immediately and delete/destroy this communication.

The information transmitted in this electronic communication is intended only

for the person or entity to whom it is addressed and may contain confidential

and/or privileged material. Any review, retransmission, dissemination or other

use of or taking of any action in reliance upon this information by persons or

entities other than the intended recipient is prohibited. If you received this

information in error, please contact the Compliance HelpLine at and

properly dispose of this information.

[Guest guest]

Hi Jerusa,

We don’t have our Living Donors sign

any sort of financial agreement. I meet with them once the surgery is

scheduled and explain the recipient’s benefits to them and how billing

will work. Irregardless of what the donor’s insurance covers, or the

recipients commercial insurance, if the recipient has Medicare the Living Donor

is not responsible for anything related to the donation process. The only time

we have a true financial discussion is if the recipient has no insurance and is

paying for the transplant, then we do the negotiation with the recipient to

include the donors eval & hospital stay, I do make the recipient aware of

any future complications with the donor is their responsibility.

Pat Kreci

Transplant Financial Coordinator

Southwest Fla Regional

Medical Center

Ft Myers, FL

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Campos, Irad Jerusa

Sent: Thursday, January 31, 2008

11:43 AM

To: TxFinancialCoordinators

Subject:

Donor Financial Agreements

Hello all!!

Our program has always tried to implement a financial

agreement for donors to sign when they start their evaluation. Does

anyone have a copy that you are willing to share with me please? I'd like

to see as many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you

hold with the donor when you first meet with him/her? By rundown I mean:

what subjects do you discuss with the donor, what warnings do you give them,

etc.

Thanks!

Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campostenethealth

The

information in this communication is confidential and is directed only to the

intended recipient. Please do not forward this communication without my

permission. If you have received this communication in error, please notify me

immediately and delete/destroy this communication.

[Guest guest]

Hi Jerusa,

We don’t have our Living Donors sign

any sort of financial agreement. I meet with them once the surgery is

scheduled and explain the recipient’s benefits to them and how billing

will work. Irregardless of what the donor’s insurance covers, or the

recipients commercial insurance, if the recipient has Medicare the Living Donor

is not responsible for anything related to the donation process. The only time

we have a true financial discussion is if the recipient has no insurance and is

paying for the transplant, then we do the negotiation with the recipient to

include the donors eval & hospital stay, I do make the recipient aware of

any future complications with the donor is their responsibility.

Pat Kreci

Transplant Financial Coordinator

Southwest Fla Regional

Medical Center

Ft Myers, FL

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Campos, Irad Jerusa

Sent: Thursday, January 31, 2008

11:43 AM

To: TxFinancialCoordinators

Subject:

Donor Financial Agreements

Hello all!!

Our program has always tried to implement a financial

agreement for donors to sign when they start their evaluation. Does

anyone have a copy that you are willing to share with me please? I'd like

to see as many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you

hold with the donor when you first meet with him/her? By rundown I mean:

what subjects do you discuss with the donor, what warnings do you give them,

etc.

Thanks!

Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campostenethealth

The

information in this communication is confidential and is directed only to the

intended recipient. Please do not forward this communication without my

permission. If you have received this communication in error, please notify me

immediately and delete/destroy this communication.

[Guest guest]

This will be useful for me too. Thanks

>>> " Campos, Irad Jerusa " 01/31/08 11:43 AM >>>

Hello all!!

Our program has always tried to implement a financial agreement for

donors to sign when they start their evaluation. Does anyone have a

copy that you are willing to share with me please? I'd like to see as

many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you hold with the

donor when you first meet with him/her? By rundown I mean: what

subjects do you discuss with the donor, what warnings do you give them,

etc.

Thanks!

Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campos@...

The information in this communication is confidential and is directed

only to the intended recipient. Please do not forward this communication

without my permission. If you have received this communication in error,

please notify me immediately and delete/destroy this communication.

[Guest guest]

This will be useful for me too. Thanks

>>> " Campos, Irad Jerusa " 01/31/08 11:43 AM >>>

Hello all!!

Our program has always tried to implement a financial agreement for

donors to sign when they start their evaluation. Does anyone have a

copy that you are willing to share with me please? I'd like to see as

many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you hold with the

donor when you first meet with him/her? By rundown I mean: what

subjects do you discuss with the donor, what warnings do you give them,

etc.

Thanks!

Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campos@...

The information in this communication is confidential and is directed

only to the intended recipient. Please do not forward this communication

without my permission. If you have received this communication in error,

please notify me immediately and delete/destroy this communication.

[Guest guest]

Greetings from NY….

To be compliant with

the informed consent process, I meet with the donors as a part of their initial

evaluation. They are required to sign the attached form & it is

placed in their chart. It is my understanding that this is now required

by CMS & they will be looking for this when they do their audit at some

point.

I explain what is

covered by Organ Acquisition testing, hospital stay, post f/u, etc… in

addition to what they would be responsible for, such as TV &

telephone services in the hospital room, private room fee if they would like a

private room, and incidentals such as travel, lodging, meals, parking. I also

now provide them with info about the NLDAC fund that is available to apply to &

potentially receive assistance with these incidentals, and how to go about

doing this.

Donors need to be

explained the risks that are involved with donation as it pertains to their

ability to obtain health or life insurance. Unfortunately, there is not a

whole lot of concrete examples out there of what these risks are—but I do

explain the notion of what a pre-existing condition is, how some one might be

subject to a pre-existing waiting period (goes w/o insurance for greater than

63 days) and inform them that if they are a candidate for donation & later

on any complications arise as a result of their donation, they will always be

covered by this hospital for services they may need, ie: hernia repair,

abdominal pain work up, evaluate fluid build up, etc… even if they have

to go to some other hospital, we pay for it. There is no medical exam

involved in obtaining health insurance usually, and we wouldn’t bill

their insurance for anything related to their donation, so really it seems a

moot point. We do ask that our donors have their own private health

insurance in case any other medical problem(s) are found during the course of

their evaluation that we would not be able to cover treatment of.

As for the life

insurance thing… I cannot find any literature that supports the notion

that a life insurance company may turn someone down if they have in the past

donated an organ (or portion of)… since the liver regenerates &

really all that is left is a scar from the surgery & a weakened abdominal

wall—I usually give the example that someone who was a smoker would

likely be considered more of a high-risk to a life insurance company than

someone who donated a portion of their liver. I don’t work with the

kidney donors—so I am not sure specifically how that plays out in the

kidney world… what a life insurance company thinks about someone who has

one kidney….

If any one has any

literature they would like to share that they have about the potential risks as

it pertains to getting life insurance or health insurance, I would love to see

it!

Meredith Gray

Liver Transplant Financial Coordinator

University of Rochester Strong

Memorial Hospital

601

Elmwood Avenue Box 602

Rochester,

NY 14642

(fax)

(pager)

This message

contains information which may be confidential and privileged. Unless you are the

addressee (or authorized to receive for the addressee), you may not use, copy

or disclose to anyone the message or any information contained in the message

(including attachments). If you have received the message in error, please

advise sender by reply email and delete the message. Thank you!

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Campos, Irad Jerusa

Sent: Thursday, January 31, 2008

11:43 AM

To: TxFinancialCoordinators

Subject:

Donor Financial Agreements

Hello all!!

Our program has always tried to implement a financial

agreement for donors to sign when they start their evaluation. Does

anyone have a copy that you are willing to share with me please? I'd like

to see as many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you

hold with the donor when you first meet with him/her? By rundown I mean:

what subjects do you discuss with the donor, what warnings do you give them,

etc.

Thanks!

Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campostenethealth

The

information in this communication is confidential and is directed only to the

intended recipient. Please do not forward this communication without my

permission. If you have received this communication in error, please notify me

immediately and delete/destroy this communication.

[Guest guest]

Greetings from NY….

To be compliant with

the informed consent process, I meet with the donors as a part of their initial

evaluation. They are required to sign the attached form & it is

placed in their chart. It is my understanding that this is now required

by CMS & they will be looking for this when they do their audit at some

point.

I explain what is

covered by Organ Acquisition testing, hospital stay, post f/u, etc… in

addition to what they would be responsible for, such as TV &

telephone services in the hospital room, private room fee if they would like a

private room, and incidentals such as travel, lodging, meals, parking. I also

now provide them with info about the NLDAC fund that is available to apply to &

potentially receive assistance with these incidentals, and how to go about

doing this.

Donors need to be

explained the risks that are involved with donation as it pertains to their

ability to obtain health or life insurance. Unfortunately, there is not a

whole lot of concrete examples out there of what these risks are—but I do

explain the notion of what a pre-existing condition is, how some one might be

subject to a pre-existing waiting period (goes w/o insurance for greater than

63 days) and inform them that if they are a candidate for donation & later

on any complications arise as a result of their donation, they will always be

covered by this hospital for services they may need, ie: hernia repair,

abdominal pain work up, evaluate fluid build up, etc… even if they have

to go to some other hospital, we pay for it. There is no medical exam

involved in obtaining health insurance usually, and we wouldn’t bill

their insurance for anything related to their donation, so really it seems a

moot point. We do ask that our donors have their own private health

insurance in case any other medical problem(s) are found during the course of

their evaluation that we would not be able to cover treatment of.

As for the life

insurance thing… I cannot find any literature that supports the notion

that a life insurance company may turn someone down if they have in the past

donated an organ (or portion of)… since the liver regenerates &

really all that is left is a scar from the surgery & a weakened abdominal

wall—I usually give the example that someone who was a smoker would

likely be considered more of a high-risk to a life insurance company than

someone who donated a portion of their liver. I don’t work with the

kidney donors—so I am not sure specifically how that plays out in the

kidney world… what a life insurance company thinks about someone who has

one kidney….

If any one has any

literature they would like to share that they have about the potential risks as

it pertains to getting life insurance or health insurance, I would love to see

it!

Meredith Gray

Liver Transplant Financial Coordinator

University of Rochester Strong

Memorial Hospital

601

Elmwood Avenue Box 602

Rochester,

NY 14642

(fax)

(pager)

This message

contains information which may be confidential and privileged. Unless you are the

addressee (or authorized to receive for the addressee), you may not use, copy

or disclose to anyone the message or any information contained in the message

(including attachments). If you have received the message in error, please

advise sender by reply email and delete the message. Thank you!

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Campos, Irad Jerusa

Sent: Thursday, January 31, 2008

11:43 AM

To: TxFinancialCoordinators

Subject:

Donor Financial Agreements

Hello all!!

Our program has always tried to implement a financial

agreement for donors to sign when they start their evaluation. Does

anyone have a copy that you are willing to share with me please? I'd like

to see as many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you

hold with the donor when you first meet with him/her? By rundown I mean:

what subjects do you discuss with the donor, what warnings do you give them,

etc.

Thanks!

Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campostenethealth

The

information in this communication is confidential and is directed only to the

intended recipient. Please do not forward this communication without my

permission. If you have received this communication in error, please notify me

immediately and delete/destroy this communication.

[Guest guest]

Greetings from NY….

To be compliant with

the informed consent process, I meet with the donors as a part of their initial

evaluation. They are required to sign the attached form & it is

placed in their chart. It is my understanding that this is now required

by CMS & they will be looking for this when they do their audit at some

point.

I explain what is

covered by Organ Acquisition testing, hospital stay, post f/u, etc… in

addition to what they would be responsible for, such as TV &

telephone services in the hospital room, private room fee if they would like a

private room, and incidentals such as travel, lodging, meals, parking. I also

now provide them with info about the NLDAC fund that is available to apply to &

potentially receive assistance with these incidentals, and how to go about

doing this.

Donors need to be

explained the risks that are involved with donation as it pertains to their

ability to obtain health or life insurance. Unfortunately, there is not a

whole lot of concrete examples out there of what these risks are—but I do

explain the notion of what a pre-existing condition is, how some one might be

subject to a pre-existing waiting period (goes w/o insurance for greater than

63 days) and inform them that if they are a candidate for donation & later

on any complications arise as a result of their donation, they will always be

covered by this hospital for services they may need, ie: hernia repair,

abdominal pain work up, evaluate fluid build up, etc… even if they have

to go to some other hospital, we pay for it. There is no medical exam

involved in obtaining health insurance usually, and we wouldn’t bill

their insurance for anything related to their donation, so really it seems a

moot point. We do ask that our donors have their own private health

insurance in case any other medical problem(s) are found during the course of

their evaluation that we would not be able to cover treatment of.

As for the life

insurance thing… I cannot find any literature that supports the notion

that a life insurance company may turn someone down if they have in the past

donated an organ (or portion of)… since the liver regenerates &

really all that is left is a scar from the surgery & a weakened abdominal

wall—I usually give the example that someone who was a smoker would

likely be considered more of a high-risk to a life insurance company than

someone who donated a portion of their liver. I don’t work with the

kidney donors—so I am not sure specifically how that plays out in the

kidney world… what a life insurance company thinks about someone who has

one kidney….

If any one has any

literature they would like to share that they have about the potential risks as

it pertains to getting life insurance or health insurance, I would love to see

it!

Meredith Gray

Liver Transplant Financial Coordinator

University of Rochester Strong

Memorial Hospital

601

Elmwood Avenue Box 602

Rochester,

NY 14642

(fax)

(pager)

This message

contains information which may be confidential and privileged. Unless you are the

addressee (or authorized to receive for the addressee), you may not use, copy

or disclose to anyone the message or any information contained in the message

(including attachments). If you have received the message in error, please

advise sender by reply email and delete the message. Thank you!

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Campos, Irad Jerusa

Sent: Thursday, January 31, 2008

11:43 AM

To: TxFinancialCoordinators

Subject:

Donor Financial Agreements

Hello all!!

Our program has always tried to implement a financial

agreement for donors to sign when they start their evaluation. Does

anyone have a copy that you are willing to share with me please? I'd like

to see as many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you

hold with the donor when you first meet with him/her? By rundown I mean:

what subjects do you discuss with the donor, what warnings do you give them,

etc.

Thanks!

Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campostenethealth

The

information in this communication is confidential and is directed only to the

intended recipient. Please do not forward this communication without my

permission. If you have received this communication in error, please notify me

immediately and delete/destroy this communication.

[Guest guest]

Hi Meredith,

I suggest that you add to the educational

information for the live donor that if invasive diagnostic testing is completed

such as a colonoscopy or Cath is completed and there is Medical Intervention,

such as a polyp removal or a stent implant, that they, the Live Donor will be

financially responsible.

Hope this helps,

Thanks,

Bill

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Gray, Meredith M

Sent: Thursday, January 31, 2008

6:32 PM

To: TxFinancialCoordinators

Subject: RE:

Donor Financial Agreements

Greetings from NY….

To be compliant with the informed consent process, I meet

with the donors as a part of their initial evaluation. They are required

to sign the attached form & it is placed in their chart. It is my

understanding that this is now required by CMS & they will be looking for

this when they do their audit at some point.

I explain what is covered by Organ Acquisition testing,

hospital stay, post f/u, etc… in addition to what they would be

responsible for, such as TV & telephone services in the hospital room,

private room fee if they would like a private room, and incidentals such as

travel, lodging, meals, parking. I also now provide them with info about

the NLDAC fund that is available to apply to & potentially receive

assistance with these incidentals, and how to go about doing this.

Donors need to be explained the risks that are involved

with donation as it pertains to their ability to obtain health or life

insurance. Unfortunately, there is not a whole lot of concrete examples

out there of what these risks are—but I do explain the notion of what a

pre-existing condition is, how some one might be subject to a pre-existing

waiting period (goes w/o insurance for greater than 63 days) and inform them

that if they are a candidate for donation & later on any complications

arise as a result of their donation, they will always be covered by this

hospital for services they may need, ie: hernia repair, abdominal pain work up,

evaluate fluid build up, etc… even if they have to go to some other

hospital, we pay for it. There is no medical exam involved in obtaining

health insurance usually, and we wouldn’t bill their insurance for

anything related to their donation, so really it seems a moot point. We

do ask that our donors have their own private health insurance in case any

other medical problem(s) are found during the course of their evaluation that

we would not be able to cover treatment of.

As for the life insurance thing… I cannot find any

literature that supports the notion that a life insurance company may turn

someone down if they have in the past donated an organ (or portion of)…

since the liver regenerates & really all that is left is a scar from the

surgery & a weakened abdominal wall—I usually give the example that

someone who was a smoker would likely be considered more of a high-risk to a

life insurance company than someone who donated a portion of their liver.

I don’t work with the kidney donors—so I am not sure specifically

how that plays out in the kidney world… what a life insurance company

thinks about someone who has one kidney….

If any one has any literature they would like to share

that they have about the potential risks as it pertains to getting life

insurance or health insurance, I would love to see it!

Meredith

Gray

Liver

Transplant Financial Coordinator

University

of Rochester

Strong Memorial Hospital

601 Elmwood Avenue Box 602

Rochester,

NY 14642

(fax)

(pager)

This message contains information

which may be confidential and privileged. Unless you are the addressee (or

authorized to receive for the addressee), you may not use, copy or disclose to

anyone the message or any information contained in the message (including

attachments). If you have received the message in error, please advise

sender by reply email and delete the message. Thank you!

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of Campos, Irad

Jerusa

Sent: Thursday, January 31, 2008

11:43 AM

To: TxFinancialCoordinators

Subject:

Donor Financial Agreements

Hello

all!!

Our program

has always tried to implement a financial agreement for donors to sign when

they start their evaluation. Does anyone have a copy that you are willing

to share with me please? I'd like to see as many as possible so we can

make one of our own.

Also, can

anyone give me a rundown of the conversation you hold with the donor when you

first meet with him/her? By rundown I mean: what subjects do you discuss

with the donor, what warnings do you give them, etc.

Thanks!

Jerusa

Irad Jerusa Campos

Financial

Counselor

USC

Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campostenethealth

The

information in this communication is confidential and is directed only to the

intended recipient. Please do not forward this communication without my

permission. If you have received this communication in error, please notify me

immediately and delete/destroy this communication.

[Guest guest]

We have several depending on if it is MEDICARE with Medicaid or Medicare with Supplement and so on, but this is our general Financial Agreement used for commercial insurance. Hope this helps.

Christie Houghton Transplant Financial Coordinator Nazih Zuhdi Transplant Institute Integris Baptist Medical Center 3300 NW Expressway Oklahoma City, OK 73112 Office: Fax: 405.713-7690

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Campos, Irad JerusaSent: Thursday, January 31, 2008 10:43 AMTo: TxFinancialCoordinators Subject: Donor Financial Agreements

Hello all!!

Our program has always tried to implement a financial agreement for donors to sign when they start their evaluation. Does anyone have a copy that you are willing to share with me please? I'd like to see as many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you hold with the donor when you first meet with him/her? By rundown I mean: what subjects do you discuss with the donor, what warnings do you give them, etc.

Thanks!Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campostenethealth

The information in this communication is confidential and is directed only to the intended recipient. Please do not forward this communication without my permission. If you have received this communication in error, please notify me immediately and delete/destroy this communication.

This e-mail may contain identifiable health information that is subject to protection under state and federal law. This information is intended to be for the use of the individual named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited and may be punishable by law. If you have received this electronic transmission in error, please notify us immediately by electronic mail (reply).

This e-mail may contain identifiable health information that is subject to protection under state and federal law. This information is intended to be for the use of the individual named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited and may be punishable by law. If you have received this electronic transmission in error, please notify us immediately by electronic mail (reply).

[Guest guest]

We have several depending on if it is MEDICARE with Medicaid or Medicare with Supplement and so on, but this is our general Financial Agreement used for commercial insurance. Hope this helps.

Christie Houghton Transplant Financial Coordinator Nazih Zuhdi Transplant Institute Integris Baptist Medical Center 3300 NW Expressway Oklahoma City, OK 73112 Office: Fax: 405.713-7690

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Campos, Irad JerusaSent: Thursday, January 31, 2008 10:43 AMTo: TxFinancialCoordinators Subject: Donor Financial Agreements

Hello all!!

Our program has always tried to implement a financial agreement for donors to sign when they start their evaluation. Does anyone have a copy that you are willing to share with me please? I'd like to see as many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you hold with the donor when you first meet with him/her? By rundown I mean: what subjects do you discuss with the donor, what warnings do you give them, etc.

Thanks!Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campostenethealth

The information in this communication is confidential and is directed only to the intended recipient. Please do not forward this communication without my permission. If you have received this communication in error, please notify me immediately and delete/destroy this communication.

This e-mail may contain identifiable health information that is subject to protection under state and federal law. This information is intended to be for the use of the individual named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited and may be punishable by law. If you have received this electronic transmission in error, please notify us immediately by electronic mail (reply).

This e-mail may contain identifiable health information that is subject to protection under state and federal law. This information is intended to be for the use of the individual named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited and may be punishable by law. If you have received this electronic transmission in error, please notify us immediately by electronic mail (reply).

[Guest guest]

We have several depending on if it is MEDICARE with Medicaid or Medicare with Supplement and so on, but this is our general Financial Agreement used for commercial insurance. Hope this helps.

Christie Houghton Transplant Financial Coordinator Nazih Zuhdi Transplant Institute Integris Baptist Medical Center 3300 NW Expressway Oklahoma City, OK 73112 Office: Fax: 405.713-7690

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Campos, Irad JerusaSent: Thursday, January 31, 2008 10:43 AMTo: TxFinancialCoordinators Subject: Donor Financial Agreements

Hello all!!

Our program has always tried to implement a financial agreement for donors to sign when they start their evaluation. Does anyone have a copy that you are willing to share with me please? I'd like to see as many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you hold with the donor when you first meet with him/her? By rundown I mean: what subjects do you discuss with the donor, what warnings do you give them, etc.

Thanks!Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campostenethealth

The information in this communication is confidential and is directed only to the intended recipient. Please do not forward this communication without my permission. If you have received this communication in error, please notify me immediately and delete/destroy this communication.

This e-mail may contain identifiable health information that is subject to protection under state and federal law. This information is intended to be for the use of the individual named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited and may be punishable by law. If you have received this electronic transmission in error, please notify us immediately by electronic mail (reply).

This e-mail may contain identifiable health information that is subject to protection under state and federal law. This information is intended to be for the use of the individual named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited and may be punishable by law. If you have received this electronic transmission in error, please notify us immediately by electronic mail (reply).

[Guest guest]

Christie,

Thank you for the Financial Agreement. It is very helpful Can I also

have the one with Medicare with Medicaid and Medicare with Supplement.

Thank you

Chinyanganya Lydia MBA,LPN

Transplant Financial Coordinator

Inova Fairfax Hospital

Ph:

Fax:

________________________________

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Houghton,

Christie A

Sent: Monday, February 11, 2008 12:21 PM

To: TxFinancialCoordinators

Subject: RE: Donor Financial Agreements

We have several depending on if it is MEDICARE with Medicaid or Medicare

with Supplement and so on, but this is our general Financial Agreement

used for commercial insurance. Hope this helps.

Christie Houghton

Transplant Financial Coordinator

Nazih Zuhdi Transplant Institute

Integris Baptist Medical Center

3300 NW Expressway

Oklahoma City, OK 73112

Office:

Fax: 405.713-7690

________________________________

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Campos,

Irad Jerusa

Sent: Thursday, January 31, 2008 10:43 AM

To: TxFinancialCoordinators

Subject: Donor Financial Agreements

Hello all!!

Our program has always tried to implement a financial agreement for

donors to sign when they start their evaluation. Does anyone have a

copy that you are willing to share with me please? I'd like to see as

many as possible so we can make one of our own.

Also, can anyone give me a rundown of the conversation you hold with the

donor when you first meet with him/her? By rundown I mean: what

subjects do you discuss with the donor, what warnings do you give them,

etc.

Thanks!

Jerusa

Irad Jerusa Campos

Financial Counselor

USC Abdominal Organ Transplant Program

Ph#

Fx#

jerusa.campos@...

The information in this communication is confidential and is directed

only to the intended recipient. Please do not forward this communication

without my permission. If you have received this communication in error,

please notify me immediately and delete/destroy this communication.

________________________________

This e-mail may contain identifiable health information that is subject

to protection under state and federal law. This information is intended

to be for the use of the individual named above. If you are not the

intended recipient, be aware that any disclosure, copying, distribution

or use of the contents of this information is prohibited and may be

punishable by law. If you have received this electronic transmission in

error, please notify us immediately by electronic mail (reply).

________________________________

This e-mail may contain identifiable health information that is subject

to protection under state and federal law. This information is intended

to be for the use of the individual named above. If you are not the

intended recipient, be aware that any disclosure, copying, distribution

or use of the contents of this information is prohibited and may be

punishable by law. If you have received this electronic transmission in

error, please notify us immediately by electronic mail (reply).

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