RE: Coordination of Benefits

[Guest guest]

This is the way I understand it: Aged Medicare should be secondary now b/c the group is >20. The Renal COB would only apply in this particular scenario (benny over 65) if the beneficiary were the active worker, so I would say Medicare will not be primary unless he exits this group plan all together and either goes to a small group or a supplement. I think this is one of the very few instances where Renal COB rules do NOT trump other COB rules.

on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 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 Drayton, PamelaSent: Thursday, January 17, 2008 8:32 AMTo: TxFinancialCoordinators Subject: Coordination of BenefitsImportance: High

I have patient who is 67 years old who previously had a kidney txp 7/2/81. Pt had and lost Medicare in 1984 (3 years post txp). Pt became eligible for Medicare 8/1/05 when he reached the aged of 65. He is also covered through his wife who has BCBS through a large group with more than 20 employees. Wife is still currently working. Pts kidney is failing though he is not back on dialysis yet and currently being worked up for another potential transplant. Which plan is primary – Medicare of BCBS?

Pamela N. Drayton

Data/Financial Coordinator-Renal Txp Dept F-4

Newark Beth Israel Medical Center

Newark, NJ 07112

phone

fax

Pdraytonsbhcs

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[Guest guest]

Assuming wife’s insurance is primary

and pt’s Medicare is secondary now, it will continue to be secondary

through the 30-month ESRD period.

Fred L. Forsthoffer, MBA

Financial Analyst

Banner Good Samaritan Transplant Services

,

, F-

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Drayton, Pamela

Sent: Thursday, January 17, 2008

9:32 AM

To:

TxFinancialCoordinators

Subject:

Coordination of Benefits

Importance: High

I have

patient who is 67 years old who previously had a kidney txp 7/2/81.

Pt had and lost Medicare in 1984 (3 years post txp). Pt became eligible

for Medicare 8/1/05 when he reached the aged of 65. He is also covered

through his wife who has BCBS through a large group with more than 20

employees. Wife is still currently working. Pts kidney

is failing though he is not back on dialysis yet and currently being worked up

for another potential transplant. Which plan is primary – Medicare

of BCBS?

Pamela N.

Drayton

Data/Financial

Coordinator-Renal Txp Dept F-4

Newark Beth

Israel Medical Center

Newark, NJ

07112

phone

fax

Pdraytonsbhcs

________________________________________________________________

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[Guest guest]

Hello,

My feeling would be if the patient got a txp in 1981 and he has not resumed

dialysis, and has Medicare due to age, then renal cob rules do not apply at all.

Medicare due to age would be secondary to his wife's EGHI with more than 20

employees. When he gets another txp, or resumes dialysis, there would be

another 30 month cob period as long as his wife is still actively employed.

Marcia J. Fisher

Sr. Transplant Financial Coordinator

Michigan Transplant Center

This message is confidential, intended for the named recipient(s). If you

receive this message in error, please notify the sender by email or at

, and delete this email. Thank you.

>>> " on, :LPH Trnsplnt " 1/17/2008 11:46 AM >>>

This is the way I understand it: Aged Medicare should be secondary now b/c the

group is >20. The Renal COB would only apply in this particular scenario (benny

over 65) if the beneficiary were the active worker, so I would say Medicare

will not be primary unless he exits this group plan all together and either goes

to a small group or a supplement. I think this is one of the very few

instances where Renal COB rules do NOT trump other COB rules.

on

Financial Counselor

Legacy Transplant Services

1040 NW 22nd Ave Ste 480

Portland OR 97210

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

Coordination of Benefits

Importance: High

I have patient who is 67 years old who previously had a kidney txp 7/2/81. Pt

had and lost Medicare in 1984 (3 years post txp). Pt became eligible for

Medicare 8/1/05 when he reached the aged of 65. He is also covered through his

wife who has BCBS through a large group with more than 20 employees. Wife is

still currently working. Pts kidney is failing though he is not back on

dialysis yet and currently being worked up for another potential transplant.

Which plan is primary - Medicare of BCBS?

Pamela N. Drayton

Data/Financial Coordinator-Renal Txp Dept F-4

Newark Beth Israel Medical Center

Newark, NJ 07112

phone

fax

Pdraytonsbhcs (DOT) com

________________________________________________________________

Important news about our email communications

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s.zixcorp.com/sbhcs/

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<http://userawareness.zixcorp.com/sbhcs/partners/receiving.php>

s.zixcorp.com/sbhcs/partners/receiving.php

IMPORTANT NOTICE:

This communication, including any attachment, contains information that may be

confidential or privileged, and is intended solely for the entity or individual

to whom it is addressed. If you are not the intended recipient, you should

contact the sender and delete the message. Any unauthorized disclosure,

copying, or distribution of this message is strictly prohibited. Nothing in

this email, including any attachment, is intended to be a legally binding

signature.

**********************************************************

Electronic Mail is not secure, may not be read every day, and should not be used

for urgent or sensitive issues

[Guest guest]

Hello,

My feeling would be if the patient got a txp in 1981 and he has not resumed

dialysis, and has Medicare due to age, then renal cob rules do not apply at all.

Medicare due to age would be secondary to his wife's EGHI with more than 20

employees. When he gets another txp, or resumes dialysis, there would be

another 30 month cob period as long as his wife is still actively employed.

Marcia J. Fisher

Sr. Transplant Financial Coordinator

Michigan Transplant Center

This message is confidential, intended for the named recipient(s). If you

receive this message in error, please notify the sender by email or at

, and delete this email. Thank you.

>>> " on, :LPH Trnsplnt " 1/17/2008 11:46 AM >>>

This is the way I understand it: Aged Medicare should be secondary now b/c the

group is >20. The Renal COB would only apply in this particular scenario (benny

over 65) if the beneficiary were the active worker, so I would say Medicare

will not be primary unless he exits this group plan all together and either goes

to a small group or a supplement. I think this is one of the very few

instances where Renal COB rules do NOT trump other COB rules.

on

Financial Counselor

Legacy Transplant Services

1040 NW 22nd Ave Ste 480

Portland OR 97210

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

Coordination of Benefits

Importance: High

I have patient who is 67 years old who previously had a kidney txp 7/2/81. Pt

had and lost Medicare in 1984 (3 years post txp). Pt became eligible for

Medicare 8/1/05 when he reached the aged of 65. He is also covered through his

wife who has BCBS through a large group with more than 20 employees. Wife is

still currently working. Pts kidney is failing though he is not back on

dialysis yet and currently being worked up for another potential transplant.

Which plan is primary - Medicare of BCBS?

Pamela N. Drayton

Data/Financial Coordinator-Renal Txp Dept F-4

Newark Beth Israel Medical Center

Newark, NJ 07112

phone

fax

Pdraytonsbhcs (DOT) com

________________________________________________________________

Important news about our email communications

Saint Barnabas Health Care System has implemented secure messaging services.

To learn more about SBHCS Secure Messaging, go to:

http://userawarenes <http://userawareness.zixcorp.com/sbhcs/>

s.zixcorp.com/sbhcs/

If you need assistance with retrieving a secure email, please email

sbhcsaccounts@... or visit http://userawarenes

<http://userawareness.zixcorp.com/sbhcs/partners/receiving.php>

s.zixcorp.com/sbhcs/partners/receiving.php

IMPORTANT NOTICE:

This communication, including any attachment, contains information that may be

confidential or privileged, and is intended solely for the entity or individual

to whom it is addressed. If you are not the intended recipient, you should

contact the sender and delete the message. Any unauthorized disclosure,

copying, or distribution of this message is strictly prohibited. Nothing in

this email, including any attachment, is intended to be a legally binding

signature.

**********************************************************

Electronic Mail is not secure, may not be read every day, and should not be used

for urgent or sensitive issues

[Guest guest]

Hello,

My feeling would be if the patient got a txp in 1981 and he has not resumed

dialysis, and has Medicare due to age, then renal cob rules do not apply at all.

Medicare due to age would be secondary to his wife's EGHI with more than 20

employees. When he gets another txp, or resumes dialysis, there would be

another 30 month cob period as long as his wife is still actively employed.

Marcia J. Fisher

Sr. Transplant Financial Coordinator

Michigan Transplant Center

This message is confidential, intended for the named recipient(s). If you

receive this message in error, please notify the sender by email or at

, and delete this email. Thank you.

>>> " on, :LPH Trnsplnt " 1/17/2008 11:46 AM >>>

This is the way I understand it: Aged Medicare should be secondary now b/c the

group is >20. The Renal COB would only apply in this particular scenario (benny

over 65) if the beneficiary were the active worker, so I would say Medicare

will not be primary unless he exits this group plan all together and either goes

to a small group or a supplement. I think this is one of the very few

instances where Renal COB rules do NOT trump other COB rules.

on

Financial Counselor

Legacy Transplant Services

1040 NW 22nd Ave Ste 480

Portland OR 97210

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

Coordination of Benefits

Importance: High

I have patient who is 67 years old who previously had a kidney txp 7/2/81. Pt

had and lost Medicare in 1984 (3 years post txp). Pt became eligible for

Medicare 8/1/05 when he reached the aged of 65. He is also covered through his

wife who has BCBS through a large group with more than 20 employees. Wife is

still currently working. Pts kidney is failing though he is not back on

dialysis yet and currently being worked up for another potential transplant.

Which plan is primary - Medicare of BCBS?

Pamela N. Drayton

Data/Financial Coordinator-Renal Txp Dept F-4

Newark Beth Israel Medical Center

Newark, NJ 07112

phone

fax

Pdraytonsbhcs (DOT) com

________________________________________________________________

Important news about our email communications

Saint Barnabas Health Care System has implemented secure messaging services.

To learn more about SBHCS Secure Messaging, go to:

http://userawarenes <http://userawareness.zixcorp.com/sbhcs/>

s.zixcorp.com/sbhcs/

If you need assistance with retrieving a secure email, please email

sbhcsaccounts@... or visit http://userawarenes

<http://userawareness.zixcorp.com/sbhcs/partners/receiving.php>

s.zixcorp.com/sbhcs/partners/receiving.php

IMPORTANT NOTICE:

This communication, including any attachment, contains information that may be

confidential or privileged, and is intended solely for the entity or individual

to whom it is addressed. If you are not the intended recipient, you should

contact the sender and delete the message. Any unauthorized disclosure,

copying, or distribution of this message is strictly prohibited. Nothing in

this email, including any attachment, is intended to be a legally binding

signature.

**********************************************************

Electronic Mail is not secure, may not be read every day, and should not be used

for urgent or sensitive issues

[Guest guest]

,

The end of the initial ESRD 30-month coordination period doesn't change because the patient received a transplant, Medicare should still become primary 10/07.

Because the transplant failed and the patient returned to dialysis, while the patient was still covered by ESRD Medicare, they do not start a new 30-month coordination period, their coverage continues with Medicare being primary.

If it had been past the 3-years post transplant so that they were no longer eligible for ESRD Medicare, and then the transplant failed and they returned to dialysis, then the new eligibility and the new 30-month coordination period would have started when they returned to dialysis, there shouldn't be any 3-month waiting period before the eligibility begins again.

Hope this helps you out.

Tyler

Sacred Heart Med Ctr

Spokane, WA

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of gina_manleySent: Tuesday, April 22, 2008 10:14 AMTo: TxFinancialCoordinators Subject: Coordination of benefits

Hello All,Two questions. 1. Patient has Aetna primary, Medicare secondary. Medicare was due to become primary as of 10/07. Patient transplanted 3/07. Did Medicare become primary 3/07 or 10/07? Patient is only eligible because of ESRD.2. Same patient as above. Transplant failed 3/08. Do we go back to start with the coordination of benefits or is Medicare still prime?Patient was on dialysis prior to transplant and returned to dialysis 3/08. ManleyFinancial Coordinator Hahnemann University Hospital.Manleytenethealth

[Guest guest]

,

The end of the initial ESRD 30-month coordination period doesn't change because the patient received a transplant, Medicare should still become primary 10/07.

Because the transplant failed and the patient returned to dialysis, while the patient was still covered by ESRD Medicare, they do not start a new 30-month coordination period, their coverage continues with Medicare being primary.

If it had been past the 3-years post transplant so that they were no longer eligible for ESRD Medicare, and then the transplant failed and they returned to dialysis, then the new eligibility and the new 30-month coordination period would have started when they returned to dialysis, there shouldn't be any 3-month waiting period before the eligibility begins again.

Hope this helps you out.

Tyler

Sacred Heart Med Ctr

Spokane, WA

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of gina_manleySent: Tuesday, April 22, 2008 10:14 AMTo: TxFinancialCoordinators Subject: Coordination of benefits

Hello All,Two questions. 1. Patient has Aetna primary, Medicare secondary. Medicare was due to become primary as of 10/07. Patient transplanted 3/07. Did Medicare become primary 3/07 or 10/07? Patient is only eligible because of ESRD.2. Same patient as above. Transplant failed 3/08. Do we go back to start with the coordination of benefits or is Medicare still prime?Patient was on dialysis prior to transplant and returned to dialysis 3/08. ManleyFinancial Coordinator Hahnemann University Hospital.Manleytenethealth

[Guest guest]

,

The end of the initial ESRD 30-month coordination period doesn't change because the patient received a transplant, Medicare should still become primary 10/07.

Because the transplant failed and the patient returned to dialysis, while the patient was still covered by ESRD Medicare, they do not start a new 30-month coordination period, their coverage continues with Medicare being primary.

If it had been past the 3-years post transplant so that they were no longer eligible for ESRD Medicare, and then the transplant failed and they returned to dialysis, then the new eligibility and the new 30-month coordination period would have started when they returned to dialysis, there shouldn't be any 3-month waiting period before the eligibility begins again.

Hope this helps you out.

Tyler

Sacred Heart Med Ctr

Spokane, WA

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of gina_manleySent: Tuesday, April 22, 2008 10:14 AMTo: TxFinancialCoordinators Subject: Coordination of benefits

Hello All,Two questions. 1. Patient has Aetna primary, Medicare secondary. Medicare was due to become primary as of 10/07. Patient transplanted 3/07. Did Medicare become primary 3/07 or 10/07? Patient is only eligible because of ESRD.2. Same patient as above. Transplant failed 3/08. Do we go back to start with the coordination of benefits or is Medicare still prime?Patient was on dialysis prior to transplant and returned to dialysis 3/08. ManleyFinancial Coordinator Hahnemann University Hospital.Manleytenethealth