Guest guest Posted February 8, 2012 Report Share Posted February 8, 2012 I have seen commercial insurers put a block on immunos when patients have Medicare and it is primary. I would think Part B would pick up the immunos if the primary payer doesn’t offer any coverage for them. However, I would question the commercial insurer as to why they have excluded immunos. Is it because of Medicare Part B coverage? What if a patient is NOT Medicare eligible due to a lack of work history credits or does not have a Medicare covered transplant? How would they handle immunos in this situation? It’s a little strange to cover a transplant and not the immunos needed to sustain it. Amy J. Murray Transplant Financial Coordinator Via Christi Hospital Transplant Institute 929 N. St. Francis, Suite M157 Wichita, KS 67214 PH: FX: Amy.Murray@... _________________________________________________________________________________________________________________________ “NOTICE – This e-mail message may contain privileged, confidential, or sensitive information intended only for the use of the intended recipient. If you are not the intended recipient of this e-mail, you are hereby notified that any use, dissemination, distribution or reproduction of this e-mail is prohibited. If you have received this e-mail in error, please notify Via Christi Health immediately, and delete this e-mail and all attachments from your computer system. Any views expressed in this e-mail are those of the individual sender and may not necessarily reflect the views of Via Christi Health”. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Julius Eason Sent: Wednesday, February 08, 2012 3:05 PM To: 'TxFinancialCoordinators ' Subject: Immuno Coverage The senario is this: We have a patient whose commerical insurer has excluded immunosuppressant medications from his formulary as not a benefit. When patient qualifies for Medicare Part A and B, even though his commercial coverage will be primary through the coordination period, will PArt B pick up his immunos. Julius Eason Transplant Financial Coordinator Multi-Organ Transplant Department Beaumont Health System jeason@... (P) (F) “NOTICE – This e-mail message may contain privileged, confidential, or sensitive information intended only for the use of the identified recipient. If you are not the intended recipient of this e-mail, you are hereby notified that any use, dissemination, distribution, or reproduction of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender immediately, and delete this e-mail and all attachments from your computer system. Any views or opinions expressed in this e-mail are those of the individual sender and do not necessarily reflect the views of the organization.” Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2012 Report Share Posted February 8, 2012 Yes, Julius, Part B will step in but the pharmacy may be asked to provide the proof of denial from Primary each time they submit claim. Keep in mind this will leave the pt w/20% coinsurance for immunos L onLegacy Transplant ServicesGood Samaritan Medical CenterPortland OR From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Julius EasonSent: Wednesday, February 08, 2012 1:05 PMTo: 'TxFinancialCoordinators 'Subject: Immuno Coverage The senario is this: We have a patient whose commerical insurer has excluded immunosuppressant medications from his formulary as not a benefit. When patient qualifies for Medicare Part A and B, even though his commercial coverage will be primary through the coordination period, will PArt B pick up his immunos. Julius EasonTransplant Financial CoordinatorMulti-Organ Transplant DepartmentBeaumont Health Systemjeason@...(P) (F) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2012 Report Share Posted February 9, 2012 Julius, If immunosuppressants are excluded under the prescription plan, they should be covered under the major medical policy. There is no way a commercial plan will pay for a transplant and not cover immunosuppressants. Unfortunately, this probably means the patient will have to pay up front and submit for reimbursement under their group health plan and then Medicare B secondary until the COB time is up. Maddox Transplant Financial Coordinator Via Christi Hospital Transplant Institute 929 N St Francis, Suite M157 Wichita KS 67214 PH FX shannon.maddox@... “NOTICE – This e-mail message may contain privileged, confidential, or sensitive information intended only for the use of the intended recipient. If you are not the intended recipient of this e-mail you are hereby notified that any use, dissemination, distribution or reproduction of this e-mail is prohibited. If you have received this e-mail in error, please notify Via Christi Hospital immediately, and delete this e-mail and all attachments from your computer system. Any views expressed in this e-mail are those of the individual sender and may not necessarily reflect the views of Via Christi Hospital”. “NOTICE – This e-mail message may contain privileged, confidential, or sensitive information intended only for the use of the identified recipient. If you are not the intended recipient of this e-mail, you are hereby notified that any use, dissemination, distribution, or reproduction of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender immediately, and delete this e-mail and all attachments from your computer system. Any views or opinions expressed in this e-mail are those of the individual sender and do not necessarily reflect the views of the organization.” Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2012 Report Share Posted February 9, 2012 I would also dig deeper into the coverage to find out how you would file/ request a benefit exception – include a letter of medical necessity from the physicianand include the dollars wasted on the transplant without coverage of the immunos. If it is a self funded group, the patient could go back to the HR department to see if anything can be done to facilitate an exception, or even a change inthe plan design in the future. Deidra M. SimanoTransplant Operations AnalystDepartment of Transplant SurgeryDartmouth-Hitchcock LebanonPhone: (603) 653.3689 / Fax: (603) 676.4287Transplant Secretary (603) 653.3931Dartmouth-Hitchcock.org From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]On Behalf Of MaddoxSent: Thursday, February 09, 2012 9:23 AMTo: 'TxFinancialCoordinators 'Subject: Re: Immuno Coverage Julius, If immunosuppressants are excluded under the prescription plan, they should be covered under the major medical policy. There is no way a commercial plan will pay for a transplant and not cover immunosuppressants. Unfortunately, this probably means the patient will have to pay up front and submit for reimbursement under their grouphealth plan and then Medicare B secondary until the COB time is up. Maddox Transplant Financial Coordinator Via Christi Hospital Transplant Institute 929 N St Francis, Suite M157 Wichita KS 67214 PH FX shannon.maddox@... “NOTICE – This e-mail message may contain privileged, confidential, or sensitive information intended only for the use of the intendedrecipient. If you are not the intended recipient of this e-mail you are hereby notified that any use, dissemination, distribution or reproduction of this e-mail is prohibited. If you have received this e-mail in error, please notify Via Christi Hospitalimmediately, and delete this e-mail and all attachments from your computer system. Any views expressed in this e-mail are those of the individual sender and may not necessarily reflect the views of Via Christi Hospitalâ€. “NOTICE – This e-mail message may contain privileged, confidential, or sensitive information intended only for the use of the identified recipient. If you are not the intended recipient of this e-mail, you are hereby notified that any use,dissemination, distribution, or reproduction of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender immediately, and delete this e-mail and all attachments from your computer system. Any views or opinions expressedin this e-mail are those of the individual sender and do not necessarily reflect the views of the organization.â€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 forany 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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