RE: [Marketing Mail] [Caution: Message contains Suspicious URL content] Medicare Secondary Payer

[Guest guest]

I’ve been told in the past that Medicare has the right to deny since primary denied. Even if Medicare were to pay, I would think they’d only pay as secondary

which would leave the patient with a very large out of pocket expense.

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]

On Behalf Of pequena1784

Sent: Tuesday, May 22, 2012 2:44 PM

To: TxFinancialCoordinators

Subject: [Marketing Mail] [Caution: Message contains Suspicious URL content] Medicare Secondary Payer

I have a patient that was listed with us for heart transplant prior to us receiving CMS certification. This patient has United Healthcare primary and Medicare Secondary. Originally when we first listed the patient UHC told us

He would be considered Out of network since we are no a center of exellence with Optum Health. They did however state that he his transplant (once we received certification) would be paid at the Out of network rate of 50%. Now they are stating he has a Mandatory

in network policy and if he chooses to stay on our list and subsequently gets the transplant UHC will deny the claim. My question is will his Medicare also deny or will they still pay 80% leaving the patient with 20% of charges?

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[Guest guest]

The patient's spouse was told by Medicare that they would cover the 80%. Is this

accurate or will it be at a lesser percentage?

>

> I've been told in the past that Medicare has the right to deny since primary

denied. Even if Medicare were to pay, I would think they'd only pay as

secondary which would leave the patient with a very large out of pocket expense.

>

> From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of pequena1784

> Sent: Tuesday, May 22, 2012 2:44 PM

> To: TxFinancialCoordinators

> Subject: [Marketing Mail] [Caution: Message contains Suspicious URL content]

Medicare Secondary Payer

>

>

>

> I have a patient that was listed with us for heart transplant prior to us

receiving CMS certification. This patient has United Healthcare primary and

Medicare Secondary. Originally when we first listed the patient UHC told us He

would be considered Out of network since we are no a center of exellence with

Optum Health. They did however state that he his transplant (once we received

certification) would be paid at the Out of network rate of 50%. Now they are

stating he has a Mandatory in network policy and if he chooses to stay on our

list and subsequently gets the transplant UHC will deny the claim. My question

is will his Medicare also deny or will they still pay 80% leaving the patient

with 20% of charges?

>

>

> ________________________________

> 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.

>