Guest guest Posted July 24, 2008 Report Share Posted July 24, 2008 Think about it, if the medical necessity isn’t met by Cigna, it might not be met by Blue Cross. Why would Cigna not feel he is a candidate ? I don’t think Blue Cross would cover if Cigna denies based on medical necessity. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt Sent: Wednesday, July 23, 2008 3:36 PM To: TxFinancialCoordinators Subject: puzzler Hi TFCs, we have a pt whose primary payer (CIGNA) might disagree that the pt is not a suitable candidate for kidney transplant, and deny our request for precert. If the secondary payer (BC) approves the request, is BC obligated to pay primary for the transplant? Appreciate any thoughts/experience. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorrisolhs (DOT) org " I ain't a Communist necessarily, but I been in the red all my life. " - Woody Guthrie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2008 Report Share Posted July 24, 2008 Your doctors will have to appeal the decision. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Kreci, Sent: Thursday, July 24, 2008 9:13 AMTo: TxFinancialCoordinators Subject: RE: puzzler Think about it, if the medical necessity isn’t met by Cigna, it might not be met by Blue Cross. Why would Cigna not feel he is a candidate ? I don’t think Blue Cross would cover if Cigna denies based on medical necessity. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Wednesday, July 23, 2008 3:36 PMTo: TxFinancialCoordinators Subject: puzzler Hi TFCs, we have a pt whose primary payer (CIGNA) might disagree that the pt is not a suitable candidate for kidney transplant, and deny our request for precert. If the secondary payer (BC) approves the request, is BC obligated to pay primary for the transplant? Appreciate any thoughts/experience. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorrisolhs (DOT) org "I ain't a Communist necessarily, but I been in the red all my life." - Woody Guthrie =================================== P Please consider the environment before printing this e-mail Cleveland Clinic is ranked one of the top hospitals in America by U.S. News World Report (2007). Visit us online at http://www.clevelandclinic.org for a complete listing of our services, staff and locations. Confidentiality Note: This message is intended for use only by the individual or entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please contact the sender immediately and destroy the material in its entirety, whether electronic or hard copy. Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2008 Report Share Posted July 24, 2008 I would verify why exactly they are questioning the medical necessity. Are they looking for a specific clearance ex: cardiac or pulmonary or additional infromation? If that is not the case then set up a call physician to physician to discuss. Joni McMahon Financial Coordinator Transplant Services UMass Memorial Medical Center Worcester, MA 01655 fax From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Kreci, Sent: Thursday, July 24, 2008 9:13 AMTo: TxFinancialCoordinators Subject: RE: puzzlerThink about it, if the medical necessity isn’t met by Cigna, it might not be met by Blue Cross. Why would Cigna not feel he is a candidate ? I don’t think Blue Cross would cover if Cigna denies based on medical necessity.From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Wednesday, July 23, 2008 3:36 PMTo: TxFinancialCoordinators Subject: puzzlerHi TFCs, we have a pt whose primary payer (CIGNA) might disagree that the pt is not a suitable candidate for kidney transplant, and deny our request for precert. If the secondary payer (BC) approves the request, is BC obligated to pay primary for the transplant? Appreciate any thoughts/experience. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorrisolhs (DOT) org "I ain't a Communist necessarily, but I been in the red all my life." - Woody Guthrie The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, transmission, re-transmission, 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 in error, please contact the sender and delete the material from any computer. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2008 Report Share Posted July 24, 2008 thanks to all for your advice and suggestions. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorriso@... "I ain't a Communist necessarily, but I been in the red all my life." - Woody Guthrie -----Original Message-----From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of McMahon, JoanneSent: Thursday, July 24, 2008 6:29 AMTo: TxFinancialCoordinators Subject: RE: puzzler I would verify why exactly they are questioning the medical necessity. Are they looking for a specific clearance ex: cardiac or pulmonary or additional infromation? If that is not the case then set up a call physician to physician to discuss. Joni McMahon Financial Coordinator Transplant Services UMass Memorial Medical Center Worcester, MA 01655 fax From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Kreci, Sent: Thursday, July 24, 2008 9:13 AMTo: TxFinancialCoordinators Subject: RE: puzzler Think about it, if the medical necessity isn’t met by Cigna, it might not be met by Blue Cross. Why would Cigna not feel he is a candidate ? I don’t think Blue Cross would cover if Cigna denies based on medical necessity. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Wednesday, July 23, 2008 3:36 PMTo: TxFinancialCoordinators Subject: puzzler Hi TFCs, we have a pt whose primary payer (CIGNA) might disagree that the pt is not a suitable candidate for kidney transplant, and deny our request for precert. If the secondary payer (BC) approves the request, is BC obligated to pay primary for the transplant? Appreciate any thoughts/experience. on Financial Counselor Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 toll free fax lmorrisolhs (DOT) org "I ain't a Communist necessarily, but I been in the red all my life." - Woody Guthrie The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, transmission, re-transmission, 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 in error, please contact the sender and delete the material from any computer. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.