Guest guest Posted May 11, 2012 Report Share Posted May 11, 2012 Hello, Is anyone else experiences problems with Blue Cross Blue Shield plans covering immunosuppressive medications? The problem I seem to be having is when the BC BS plan is secondary to Medicare and the prescription plan under Blue Cross Blue Shield request to be billed primary. They are denying claims and leaving our patients with huge bills. Any suggestions or comments??? Thanks, Sam Vazquez Kidney Transplant Financial Coordinator Providence Sacred Heart Medical Center Kidney Transplant Program 105 W Eighth Ave Suite 1000 Spokane, WA 99204 Tel: / Fax: samantha.vazquez@... This electronic transmission and any documents accompanying this electronic transmission may contain information that is confidential and/or legally privileged. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on or regarding the contents of this electronically transmitted information is strictly prohibited. If you have received this e-mail in error, please notify the sender and delete this message immediately. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2012 Report Share Posted May 15, 2012 One other thing that I forgot to mention – It is possible that the Medicare supplement may only reimburse the patient. I recently found out that Vermont Medicomp reimburses the patient directly, even though the claim crosses over from Medicare. This is the only one that I am aware of so far. So these patients must pay the 20% and wait for the reimbursement. Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Battin, Daryl J. Sent: Tuesday, May 15, 2012 8:56 AM To: TxFinancialCoordinators Subject: RE: Immuno's being covered Thank you Deidra! Having these codes and knowing where to enter them is something that pharmacies may need help with. I had a patient with a BCBS of Massachusetts Medicare supplemental plan and the patient’s local CVS pharmacy could not run it to pick up the 20%. I called our hospital pharmacy who told me where (what field in their billing) to have the CVS enter the BCBS ID number – 30168 – and it worked. The pharmacy said they had not used this process before .... Daryl Battin ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ms. Daryl Battin, MSW/LICSW Financial Coordinator/Social Worker Department of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805 Ph: Page: FAX: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Deidra M. Simano Sent: Tuesday, May 15, 2012 8:34 AM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered [1 Attachment] I have been working closely with our outpatient pharmacy to avoid those discharge medication issues that can be so much of a nightmare. They use something called a COBA code – if the pharmacy bills Medicare B for immunos with the appropriate COBA code on their claim, then it should process with no copay for the patient – when appropriate. I have attached a list of insurances with the COBA codes that our pharmacy biller gave to me. They are a separate business entity from us and do not have access to our system for the most up to date insurance information. I have started providing them with the patient’s insurance information on the day of transplant, which has helped things go more smoothly. Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt Sent: Friday, May 11, 2012 4:24 PM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered I’ve been told by our pharmacy that if the crossover claim info is set up in Medicare, the 20% coinsurance billing should go through without problem. This could be nonsense but it does SOMETIMES seem to be a solution. 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 Vazquez, L. Sent: Friday, May 11, 2012 1:06 PM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered I will call the commercial plan and ask them if the patient pays the 20% , will they work with them to reimburse them back. Thanks so much for all the answers Sam Vazquez Kidney Transplant Financial Coordinator Providence Sacred Heart Medical Center Kidney Transplant Program 105 W Eighth Ave Suite 1000 Spokane, WA 99204 Tel: / Fax: samantha.vazquez@... This electronic transmission and any documents accompanying this electronic transmission may contain information that is confidential and/or legally privileged. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on or regarding the contents of this electronically transmitted information is strictly prohibited. If you have received this e-mail in error, please notify the sender and delete this message immediately. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Battin, Daryl J. Sent: Friday, May 11, 2012 1:03 PM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered When Medicare is primary to a commercial insurance, there very often is not a Medicare crossover process for the commercial insurance (compared to Medicare supplemental plans) to pay the pharmacy for the 20%. So the patient ends up paying the 20% and then working with the commercial insurance to reimburse that 20%. They often have to wait until they get their Medicare EOB stating what Medicare has paid before they can submit for reimbursement to their commercial plan. This ends up being something we have to prepare patients to have the funds to cover. Daryl Battin ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ms. Daryl Battin, MSW/LICSW Financial Coordinator/Social Worker Department of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805 Ph: Page: FAX: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Vazquez, L. Sent: Friday, May 11, 2012 3:27 PM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered They do have Medicare Part B primary. Blue Cross Blue Shield of New York is stating the prescription portion needs to cover as they will not. Then when you contact the prescription benefits, they state they are to be billed primary or they will not pay and as you all know, we cannot do this. Vazquez Kidney Transplant Financial Coordinator Providence Sacred Heart Medical Center Kidney Transplant Program 105 W Eighth Ave Suite 1000 Spokane, WA 99204 Tel: / Fax: samantha.vazquez@... This electronic transmission and any documents accompanying this electronic transmission may contain information that is confidential and/or legally privileged. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on or regarding the contents of this electronically transmitted information is strictly prohibited. If you have received this e-mail in error, please notify the sender and delete this message immediately. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Danner, Sara Sent: Friday, May 11, 2012 12:26 PM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered Immunos shouldn’t be billed to prescription plan at all. Part B and BC/BS medical coverage should be paying. Does patient have Part B? From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Vazquez, L. Sent: Friday, May 11, 2012 2:22 PM To: TxFinancialCoordinators Subject: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered Hello, Is anyone else experiences problems with Blue Cross Blue Shield plans covering immunosuppressive medications? The problem I seem to be having is when the BC BS plan is secondary to Medicare and the prescription plan under Blue Cross Blue Shield request to be billed primary. They are denying claims and leaving our patients with huge bills. Any suggestions or comments??? Thanks, Sam Vazquez Kidney Transplant Financial Coordinator Providence Sacred Heart Medical Center Kidney Transplant Program 105 W Eighth Ave Suite 1000 Spokane, WA 99204 Tel: / Fax: samantha.vazquez@... This electronic transmission and any documents accompanying this electronic transmission may contain information that is confidential and/or legally privileged. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on or regarding the contents of this electronically transmitted information is strictly prohibited. If you have received this e-mail in error, please notify the sender and delete this message immediately. This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. This message is intended for the sole use of the addressee, and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you are not the addressee you are hereby notified that you may not use, copy, disclose, or distribute to anyone the message or any information contained in the message. If you have received this message in error, please immediately advise the sender by reply email and delete this message. See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities. THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. This message is intended for the sole use of the addressee, and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you are not the addressee you are hereby notified that you may not use, copy, disclose, or distribute to anyone the message or any information contained in the message. If you have received this message in error, please immediately advise the sender by reply email and delete this message. IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2012 Report Share Posted May 15, 2012 One other thing that I forgot to mention – It is possible that the Medicare supplement may only reimburse the patient. I recently found out that Vermont Medicomp reimburses the patient directly, even though the claim crosses over from Medicare. This is the only one that I am aware of so far. So these patients must pay the 20% and wait for the reimbursement. Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Battin, Daryl J. Sent: Tuesday, May 15, 2012 8:56 AM To: TxFinancialCoordinators Subject: RE: Immuno's being covered Thank you Deidra! Having these codes and knowing where to enter them is something that pharmacies may need help with. I had a patient with a BCBS of Massachusetts Medicare supplemental plan and the patient’s local CVS pharmacy could not run it to pick up the 20%. I called our hospital pharmacy who told me where (what field in their billing) to have the CVS enter the BCBS ID number – 30168 – and it worked. The pharmacy said they had not used this process before .... Daryl Battin ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ms. Daryl Battin, MSW/LICSW Financial Coordinator/Social Worker Department of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805 Ph: Page: FAX: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Deidra M. Simano Sent: Tuesday, May 15, 2012 8:34 AM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered [1 Attachment] I have been working closely with our outpatient pharmacy to avoid those discharge medication issues that can be so much of a nightmare. They use something called a COBA code – if the pharmacy bills Medicare B for immunos with the appropriate COBA code on their claim, then it should process with no copay for the patient – when appropriate. I have attached a list of insurances with the COBA codes that our pharmacy biller gave to me. They are a separate business entity from us and do not have access to our system for the most up to date insurance information. I have started providing them with the patient’s insurance information on the day of transplant, which has helped things go more smoothly. Deidra M. Simano Transplant Operations Analyst Department of Transplant Surgery Dartmouth-Hitchcock Lebanon Phone: (603) 653.3689 / Fax: (603) 676.4287 Transplant Secretary (603) 653.3931 Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt Sent: Friday, May 11, 2012 4:24 PM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered I’ve been told by our pharmacy that if the crossover claim info is set up in Medicare, the 20% coinsurance billing should go through without problem. This could be nonsense but it does SOMETIMES seem to be a solution. 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 Vazquez, L. Sent: Friday, May 11, 2012 1:06 PM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered I will call the commercial plan and ask them if the patient pays the 20% , will they work with them to reimburse them back. Thanks so much for all the answers Sam Vazquez Kidney Transplant Financial Coordinator Providence Sacred Heart Medical Center Kidney Transplant Program 105 W Eighth Ave Suite 1000 Spokane, WA 99204 Tel: / Fax: samantha.vazquez@... This electronic transmission and any documents accompanying this electronic transmission may contain information that is confidential and/or legally privileged. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on or regarding the contents of this electronically transmitted information is strictly prohibited. If you have received this e-mail in error, please notify the sender and delete this message immediately. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Battin, Daryl J. Sent: Friday, May 11, 2012 1:03 PM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered When Medicare is primary to a commercial insurance, there very often is not a Medicare crossover process for the commercial insurance (compared to Medicare supplemental plans) to pay the pharmacy for the 20%. So the patient ends up paying the 20% and then working with the commercial insurance to reimburse that 20%. They often have to wait until they get their Medicare EOB stating what Medicare has paid before they can submit for reimbursement to their commercial plan. This ends up being something we have to prepare patients to have the funds to cover. Daryl Battin ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ms. Daryl Battin, MSW/LICSW Financial Coordinator/Social Worker Department of Transplantation Lahey Clinic, 41 Mall Road, Burlington MA 01805 Ph: Page: FAX: From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Vazquez, L. Sent: Friday, May 11, 2012 3:27 PM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered They do have Medicare Part B primary. Blue Cross Blue Shield of New York is stating the prescription portion needs to cover as they will not. Then when you contact the prescription benefits, they state they are to be billed primary or they will not pay and as you all know, we cannot do this. Vazquez Kidney Transplant Financial Coordinator Providence Sacred Heart Medical Center Kidney Transplant Program 105 W Eighth Ave Suite 1000 Spokane, WA 99204 Tel: / Fax: samantha.vazquez@... This electronic transmission and any documents accompanying this electronic transmission may contain information that is confidential and/or legally privileged. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on or regarding the contents of this electronically transmitted information is strictly prohibited. If you have received this e-mail in error, please notify the sender and delete this message immediately. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Danner, Sara Sent: Friday, May 11, 2012 12:26 PM To: TxFinancialCoordinators Subject: RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered Immunos shouldn’t be billed to prescription plan at all. Part B and BC/BS medical coverage should be paying. Does patient have Part B? From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Vazquez, L. Sent: Friday, May 11, 2012 2:22 PM To: TxFinancialCoordinators Subject: [Marketing Mail] [Caution: Message contains Suspicious URL content] Immuno's being covered Hello, Is anyone else experiences problems with Blue Cross Blue Shield plans covering immunosuppressive medications? The problem I seem to be having is when the BC BS plan is secondary to Medicare and the prescription plan under Blue Cross Blue Shield request to be billed primary. They are denying claims and leaving our patients with huge bills. Any suggestions or comments??? Thanks, Sam Vazquez Kidney Transplant Financial Coordinator Providence Sacred Heart Medical Center Kidney Transplant Program 105 W Eighth Ave Suite 1000 Spokane, WA 99204 Tel: / Fax: samantha.vazquez@... This electronic transmission and any documents accompanying this electronic transmission may contain information that is confidential and/or legally privileged. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on or regarding the contents of this electronically transmitted information is strictly prohibited. If you have received this e-mail in error, please notify the sender and delete this message immediately. This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. This message is intended for the sole use of the addressee, and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you are not the addressee you are hereby notified that you may not use, copy, disclose, or distribute to anyone the message or any information contained in the message. If you have received this message in error, please immediately advise the sender by reply email and delete this message. See our web page at http://www.lahey.org for a full directory of Lahey sites, staff, services and career opportunities. THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. This message is intended for the sole use of the addressee, and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you are not the addressee you are hereby notified that you may not use, copy, disclose, or distribute to anyone the message or any information contained in the message. If you have received this message in error, please immediately advise the sender by reply email and delete this message. IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE: This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for any purpose is strictly prohibited. If you have received this communication in error, please delete the message and notify the sender so that we may correct our records. Quote Link to comment Share on other sites More sharing options...
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