Re: Medicare Enrollment Question for Kidney Transplant patients

[Guest guest]

How old is your patient? If medicare doesnt pay for the transplant they will

never pay for immunos

Whitney Folsom, TFC

ETMC Transplant Program

1100 E Lake St ste 340

Tyler, TX 75701

phone

fax

wlfolsom@...

>>> " m.inniss " 3/20/2012 2:07 PM >>>

Hello All,

Good Afternoon.

Regarding Medicare, can a patient opt NOT to enroll or is it mandatory to get

Medicare for Kidney Transplant Patients (when they also have commercial

insurance coverage)? We were under the impression that they were required to

enroll or else run into issues if the 30 months go by and their private insurer

discovers that they were eligible.

Is there a CMS policy that addresses this issue specifically that someone can

provide/point me in the direction of?

Any guidance that anyone can provide on this topic would be greatly appreciated.

Best,

nne

Children's Hospital of Philadelphia

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[Guest guest]

Yes a patient can opt out but it’s never advisable in my experience. Among many risks, they could indeed find themselves at the end of the COB w/a group plan that refuses to pay primary b/c Medicare could be in the primary position. The COB rule is Medicare’s. What the EGHP does at the end of the COB period is dictated by the insurance company. Medicare can be persuaded to send a nastygram to payers who refuse to continue on as primary but there’s no enforcement. Not all payers do this but since you don’t know who the payer for that patient will be at that point, it’s a big risk. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of m.innissSent: Tuesday, March 20, 2012 12:08 PMTo: TxFinancialCoordinators Subject: Medicare Enrollment Question for Kidney Transplant patients Hello All,Good Afternoon.Regarding Medicare, can a patient opt NOT to enroll or is it mandatory to get Medicare for Kidney Transplant Patients (when they also have commercial insurance coverage)? We were under the impression that they were required to enroll or else run into issues if the 30 months go by and their private insurer discovers that they were eligible.Is there a CMS policy that addresses this issue specifically that someone can provide/point me in the direction of?Any guidance that anyone can provide on this topic would be greatly appreciated.Best,nneChildren's Hospital of Philadelphia

[Guest guest]

It was not specific to a particular patient, but this would be for patients

younger than 19.

nne Inniss

Children's Hospital of Philadelphia

>

> How old is your patient? If medicare doesnt pay for the transplant they will

never pay for immunos

>

> Whitney Folsom, TFC

> ETMC Transplant Program

> 1100 E Lake St ste 340

> Tyler, TX 75701

> phone

> fax

> wlfolsom@...

>

> >>> " m.inniss " 3/20/2012 2:07 PM >>>

> Hello All,

> Good Afternoon.

> Regarding Medicare, can a patient opt NOT to enroll or is it mandatory to get

Medicare for Kidney Transplant Patients (when they also have commercial

insurance coverage)? We were under the impression that they were required to

enroll or else run into issues if the 30 months go by and their private insurer

discovers that they were eligible.

>

> Is there a CMS policy that addresses this issue specifically that someone can

provide/point me in the direction of?

>

> Any guidance that anyone can provide on this topic would be greatly

appreciated.

>

> Best,

> nne

> Children's Hospital of Philadelphia

>

>

>

> ===========================================================

> This message is confidential, intended only

> for the named recipient(s) and may contain

> information that is privileged or exempt from

> disclosure under applicable law. If you are

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> of this message is strictly prohibited. If you

> received this message in error, or are not the

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>

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> Thank you.

> ===========================================================

>

[Guest guest]

I agree that all patients should enroll in Medicare at time of transplant if not

at time of dialysis. I had a patient drop her medicare because she didnt like

paying the premium. She was admitted to the hospital the day after dropping it

and now she has a large balance to pay

Whitney Folsom, TFC

ETMC Transplant Program

1100 E Lake St ste 340

Tyler, TX 75701

phone

fax

wlfolsom@...

>>> " m.inniss " 3/20/2012 3:00 PM >>>

It was not specific to a particular patient, but this would be for patients

younger than 19.

nne Inniss

Children's Hospital of Philadelphia

>

> How old is your patient? If medicare doesnt pay for the transplant they will

never pay for immunos

>

> Whitney Folsom, TFC

> ETMC Transplant Program

> 1100 E Lake St ste 340

> Tyler, TX 75701

> phone

> fax

> wlfolsom@...

>

> >>> " m.inniss " 3/20/2012 2:07 PM >>>

> Hello All,

> Good Afternoon.

> Regarding Medicare, can a patient opt NOT to enroll or is it mandatory to get

Medicare for Kidney Transplant Patients (when they also have commercial

insurance coverage)? We were under the impression that they were required to

enroll or else run into issues if the 30 months go by and their private insurer

discovers that they were eligible.

>

> Is there a CMS policy that addresses this issue specifically that someone can

provide/point me in the direction of?

>

> Any guidance that anyone can provide on this topic would be greatly

appreciated.

>

> Best,

> nne

> Children's Hospital of Philadelphia

>

>

>

> ===========================================================

> This message is confidential, intended only

> for the named recipient(s) and may contain

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> of this message is strictly prohibited. If you

> received this message in error, or are not the

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>

> ETMC has implemented secure messaging for

> certain types of messages. For more information

> about our secure messaging system, go to:

>

> http://www.etmc.org/mail/

>

> Thank you.

> ===========================================================

>

===========================================================

This message is confidential, intended only

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information that is privileged or exempt from

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===========================================================

[Guest guest]

Thank you all for your insight! This is very helpful.

nne

> >

> > How old is your patient? If medicare doesnt pay for the transplant they will

never pay for immunos

> >

> > Whitney Folsom, TFC

> > ETMC Transplant Program

> > 1100 E Lake St ste 340

> > Tyler, TX 75701

> > phone

> > fax

> > wlfolsom@

> >

> > >>> " m.inniss " <innissm@> 3/20/2012 2:07 PM >>>

> > Hello All,

> > Good Afternoon.

> > Regarding Medicare, can a patient opt NOT to enroll or is it mandatory to

get Medicare for Kidney Transplant Patients (when they also have commercial

insurance coverage)? We were under the impression that they were required to

enroll or else run into issues if the 30 months go by and their private insurer

discovers that they were eligible.

> >

> > Is there a CMS policy that addresses this issue specifically that someone

can provide/point me in the direction of?

> >

> > Any guidance that anyone can provide on this topic would be greatly

appreciated.

> >

> > Best,

> > nne

> > Children's Hospital of Philadelphia

> >

> >

> >

> > ===========================================================

> > This message is confidential, intended only

> > for the named recipient(s) and may contain

> > information that is privileged or exempt from

> > disclosure under applicable law. If you are

> > not the intended recipient(s), you are notified

> > that the dissemination, distribution or copying

> > of this message is strictly prohibited. If you

> > received this message in error, or are not the

> > named recipient(s), please notify the sender

> > and delete this e-mail from your computer.

> >

> > ETMC has implemented secure messaging for

> > certain types of messages. For more information

> > about our secure messaging system, go to:

> >

> > http://www.etmc.org/mail/

> >

> > Thank you.

> > ===========================================================

> >

>

>

>

>

> ===========================================================

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> Thank you.

> ===========================================================

>