RE: 2 questions

[Guest guest]

HI ,

I will put my answers with the questions.

Thanks,

Bill

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

Sent: Tuesday, January 29, 2008

12:08 PM

To: TxFinancialCoordinators

Subject:

2 questions

Hello-

I have 2 questions:

The first is how do centers handle this situation:

Living kidney donor/ recipient

Recipients' insurance states " must bill donors insurance first for payment

or denial " and will not pay the donor charges

Do you call the donors insurance for a denial?

[ Vaughan] Call the donor’s insurance

and request a denial, there is a section of the Social Security Act that

supports the fact that the Donor has no financial responsibility.

Do you ask that they fax you/mail you a denial?

[ Vaughan] Ask for something in

writing by what ever mode that you can obtain it.

Do you tell the recipients insurance that according to Medicare, donors

policy should be treated as if they have Part B?

[ Vaughan] Yes, and in most cases

they know that, but their job is to not pay claims. You have to push to

get the physician fees for the donor paid. Also, bring contracting into

the process, they are the ones that should have had it set up properly in the

beginning (if they knew the rules).

How do you get these types of claims processed?

[ Vaughan] Just like any other

bill, the appropriate party bills for services following the appropriate rules.

What about altruistic billing? How do you handle that?

[ Vaughan] A Donor is a Donor, there

is no difference in the way that they are to be handled.

The second part of my question is in regards to indigent recipients.

How is it handled when patient have a large out of pocket expense?

If the patient states that they are able to afford these costs, do you

assume that they are being truthful?

[ Vaughan] You have the right

to request financial data based on the hospital policies. You do not have

to take them at their word.

What if their insurance states 50% 75% coverage and patient states no

problem? Do you take their word?

[ Vaughan] Just like above.

What if the rx coverage has a $3,000 calendar year limit and pt states no

problem?

Thanks

Donovan

Transplant Financial Coordinator

SUNY Upstate Medical

University

750 East Street

Syracuse, New

York 13210

Phone: 315 464-6290

Fax: 315 464-6288

Donovanlupstate (DOT) edu

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