Guest guest Posted March 20, 2012 Report Share Posted March 20, 2012 We are being told by the home plan (Premera) that they process the donor charges under the donor benefits because the patients have the same home plan. Premera is attempting to take back their original payment that was processed under the recipients benefits and re-pay the claim via the donors benefits. I thought there was language around holding the donor harmless and not billing their insurance in transplant cases, but billing under the recipients benefits. We are wondering if anyone might have something that speaks to this requirement. Thanks for your help! Transplant Financial CoordinatorVirginia Mason Medical CenterRenal Pancreas Transplant Program1100 9th Ave m/s C1-TXSeattle, WA 98111Desk: Fax: ****************** CONFIDENTIALITY DISCLAIMER ****************** The information contained in this e-mail may be confidential. IF YOU RECEIVED THIS IN ERROR, please call the Virginia Mason Privacy Officer through the Virginia Mason Operator at . Thank you. Patients: E-mail is NOT considered secure. By choosing to communicate with Virginia Mason by e-mail, you will assume the risk of a confidentiality breach. Please do not rely on e-mail communication if you or a family member is injured or is experiencing a sudden change in health status. If you need emergency attention, call 911. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2012 Report Share Posted March 20, 2012 Hi if by that you mean both donor and recipient are Premera members, or even have the same EGHP, this is a common problem we have with the Blues. Their computer system seems to go hunting by name and if they find the donor is one of their insured, it will move the claim over to the donor’s policy. In reality there are no policies left that will cover a donor to donate, the benefits are always under the recipient’s policy – Premera doesn’t need to look any further than its own member handbooks to verify this. So it’s just an ugly mess that needs to be handled by hand at the payer’s end. Good luck! on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Tuesday, March 20, 2012 8:24 AMTo: 'TxFinancialCoordinators 'Subject: Donor Charges We are being told by the home plan (Premera) that they process the donor charges under the donor benefits because the patients have the same home plan. Premera is attempting to take back their original payment that was processed under the recipients benefits and re-pay the claim via the donors benefits. I thought there was language around holding the donor harmless and not billing their insurance in transplant cases, but billing under the recipients benefits. We are wondering if anyone might have something that speaks to this requirement. Thanks for your help! Transplant Financial CoordinatorVirginia Mason Medical CenterRenal Pancreas Transplant Program1100 9th Ave m/s C1-TXSeattle, WA 98111Desk: Fax: ****************** CONFIDENTIALITY DISCLAIMER ****************** The information contained in this e-mail may be confidential. IF YOURECEIVED THIS IN ERROR, please call the Virginia Mason Privacy Officerthrough the Virginia Mason Operator at . Thank you. Patients: E-mail is NOT considered secure. By choosing to communicatewith Virginia Mason by e-mail, you will assume the risk of a confidentialitybreach. Please do not rely on e-mail communication if you or a familymember is injured or is experiencing a sudden change in health status. If you need emergency attention, call 911. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2012 Report Share Posted March 20, 2012 Thanks ! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH TrnsplntSent: Tuesday, March 20, 2012 9:07To: TxFinancialCoordinators Subject: RE: Donor Charges Hi if by that you mean both donor and recipient are Premera members, or even have the same EGHP, this is a common problem we have with the Blues. Their computer system seems to go hunting by name and if they find the donor is one of their insured, it will move the claim over to the donor’s policy. In reality there are no policies left that will cover a donor to donate, the benefits are always under the recipient’s policy – Premera doesn’t need to look any further than its own member handbooks to verify this. So it’s just an ugly mess that needs to be handled by hand at the payer’s end. Good luck! on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of , Sent: Tuesday, March 20, 2012 8:24 AMTo: 'TxFinancialCoordinators 'Subject: Donor Charges We are being told by the home plan (Premera) that they process the donor charges under the donor benefits because the patients have the same home plan. Premera is attempting to take back their original payment that was processed under the recipients benefits and re-pay the claim via the donors benefits. I thought there was language around holding the donor harmless and not billing their insurance in transplant cases, but billing under the recipients benefits. We are wondering if anyone might have something that speaks to this requirement. Thanks for your help! Transplant Financial CoordinatorVirginia Mason Medical CenterRenal Pancreas Transplant Program1100 9th Ave m/s C1-TXSeattle, WA 98111Desk: Fax: ****************** CONFIDENTIALITY DISCLAIMER ****************** The information contained in this e-mail may be confidential. IF YOURECEIVED THIS IN ERROR, please call the Virginia Mason Privacy Officerthrough the Virginia Mason Operator at . Thank you. Patients: E-mail is NOT considered secure. By choosing to communicatewith Virginia Mason by e-mail, you will assume the risk of a confidentialitybreach. Please do not rely on e-mail communication if you or a familymember is injured or is experiencing a sudden change in health status. If you need emergency attention, call 911.****************** CONFIDENTIALITY DISCLAIMER ****************** The information contained in this e-mail may be confidential. IF YOU RECEIVED THIS IN ERROR, please call the Virginia Mason Privacy Officer through the Virginia Mason Operator at . Thank you. Patients: E-mail is NOT considered secure. By choosing to communicate with Virginia Mason by e-mail, you will assume the risk of a confidentiality breach. Please do not rely on e-mail communication if you or a family member is injured or is experiencing a sudden change in health status. If you need emergency attention, call 911. Quote Link to comment Share on other sites More sharing options...
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