Re: Re[8]: new kid on the block

[Guest guest]

Hi everyone,

I would llike to hear about how other programs qualify patients for transplant.

We often have patients who we know in advance have state spend downs and

Medicare that only pays at 80%. Would these patients be accepted for transplant

at your institutions? How do you qualify patients? Is it a violation of any reqs

to refuse these patients on the basis of finances. Is this discriminatory? I

check to see if they qualify for assistance programs but if they don't I'm the

one who picks up the pieces and there is only so much one person can do.

I would appreciate any advice on this.

Thank You,

>>> paula_summa@... 07/12/00 01:42PM >>>

,

Most insurance companies do not cover the donor evaluation or surgery,

so you are not wrong in billing Medicare. BUT if the recipient's

insurance DOES cover the donor, then they need to be billed first. At

the time I intially verify benefits prior to beginning the eval, I

confirm whether or not there is donor coverage. Some will cover with a

denial from the donor's insurance, some won't cover at all. With our

global contracts, we specify donor coverage, as well. So.... I suppose

the answer to your question is: it all depends on the individual

circumstances.

I have always understood that the recipient's primary insurance should

be billed for the donor eval and surgery first, and only if there's no

coverage, can it be put thru kidney acquisition (KA). This is the way

we've always done it.... altho I have heard from others that they put

everything thru KA.

a

______________________________ Reply Separator _________________________________

Subject: Re: Re[6]: new kid on the block

Author: <TxFinancialCoordinatorsegroups> at INTERNET

Date: 07/12/2000 1:11 PM

Help . I am confused. I think we must be doing this all wrong. We pay for all do

nor evaluations from the kidney acquistion cost center, for both patients who a

re Medicare primary, which we have very few of since we transplant most

patientsbefore they even start dialysis, and those that have commercial

insurance primary and don't yet qualify for Medicare. Should we be billing the

recipients insu rance of the workup of the donor and use the kidney acquisitiion

for Medicare pa tients only? These procedures were in place when I got here.

Thank you

>>> paula_summa@... 07/12/00 11:47AM >>>

I disagree with you on the Medicare issue. I firmly beleive that the

recipient should opt for Medicare (both A & prior to tx. If they

have a living donor which is not covered by the recipients primary

insurance, they MUST have Medicare B in order to bill thru kidney

acquisition for the donor eval. We had discussed this very same issue

several months ago, and the general concesus was that it's important

for the recipient to have Medicare during the eval process and not to

wait until after the tx. The small amount they have to pay for the

Part B premuims is well worth it. Medicare part B also covers the

immunosuppressives if their primary insurance has limited Rx coverage

and it also covers the living donors post tx followups both

out-patient charges as well as professional fees (as we've been

discussing).

I tell my patients the importance of having Medicare, especially if

they have any potential living donors. Providers have been " burned " a

few times when the recipient did not have Medicare B, then tx occured

with a living donor, and their primary insurance denied donor charges.

It can turn out to be a mess.

a

______________________________ Reply Separator _________________________________

Subject: RE: Re[4]: new kid on the block

Author: <TxFinancialCoordinatorsegroups> at INTERNET

Date: 07/12/2000 11:07 AM

I guess my question is what the benefits are after transplant since commercial i

s still primary in most cases.

>>> kchriste@... 07/12/00 10:54AM >>>

This is my argument exactly with the patients, but most of the time they

cannot afford the premium, so that is why I tell them they could than wait

until a transplant occurs. I have Medicare applications waiting in their

file and submit it to our clinic on the day they are transplanted.

Karla

> RE: Re[2]: new kid on the block

> >

> >

> > Hi Again

> >

> > I have an issue that just came up on a donor with an open wound that the

>

> > insurance company of the recepient is refusing to pay. Have any of you

> run

> >

> > into this. According to the patient he states his insurance also refuses

> > to

> > pay. I think the transplant center is ultimately responsible but for how

>

> > long?

> >

> > Thanks

> >

> >

> >

> > >>> LAguiar@... 07/06/00 09:25AM >>>

> > Hi a & welcome back!

> >

> > Of course, the first thing is to try to read thru all these email

> messages

> >

> > from

> > all you fellow TFCs!

> >

> > That's as it should be! :-)

> >

> > So... just a reminder to all to please at least write your name at the

> > bottom of your messages. (thanks!)

> >

> > Good point, a. In case anyone forgets, though, if you check

> > the

> > message board on our eGroups site, the author's name (or e-mail address)

> > is

> > listed beside each message. I also want to encourage anyone who hasn't

> > already done so to please check the site & complete your individual

> entry

> > in

> > the data base so we can all know who we are!

> >

> > Is anyone keeping a list of all these great suggestions??? ???

> >

> > Yup, I've got them. Which brings up another friendly

> > reminder-anyone who hasn't completed the poll re: next year's Forum on

> the

> >

> > eGroups site, please try to do so by the end of the week. Your feedback

> > is

> > VERY important in planning these sessions!!

> >

> > Thanks,

> >

> > J. Aguiar

> > Beth Israel Deaconess, Boston

> >

> > ------------------------------------------------------------------------

>

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> > Vince and Peyton Manning hang out? Where else?

> > Click now and find 'em all here!

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