RE: Please Help!!!

[Guest guest]

I believe UHC has to compare the actual dollars paid by Medicare, not the percentage, in determining their responsibility. But it sounds like the UHC may be a “maintenance of benefits” plan, not a “coordination of benefits” plan? If so the pt would probably still have OOP even if they do kick in some? A supplement would help here. 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 cartejomSent: Friday, March 02, 2012 7:00 AMTo: TxFinancialCoordinators Subject: Please Help!!! Hey there everyone!I have a question for you all:I have a patient that has Medicare primary now and United Health Care secondary. We are out of network for UHC and they are not willing to do a contract with us for anything because the plan is secondary. I was told today by a representative from UHC that because Medicare would pay more on all services covering 80%,UHC will not cover more of the expense because they would only cover 60% on their own. I have two questions: 1. If this is true- do the deductibles and out of pocket maximums come into play for UHC? Their out of network out of pocket max is $2500 so I'm wondering if Medicare covers 80% then the patient is responsible for 20% up to $2500? Or is that now how this works?2. If the first question isn't true, could a patient in this position benefit from a supplemental plan?I really appreciate your help on this! We have had the patient on our list for years and want to help him the best way I can.Thank you!!Jodi MacFarland-Financial CoordinatorSaint 's Kidney Transplant

[Guest guest]

Thank you ! If the patient did get a supplemental plan would Medicare be primary, supplemental plan secondary, and UHC after that? Thanks again, Jodi Jodi MacFarland-Transplant Financial CoordinatorSaint 's Kidney Transplant Center310 Lafayette SE Ste 315Grand Rapids, MI 49503Phone: Fax: cartejom@...www.mercyhealthgrandrapids.com>>> "on, :LPH Trnsplnt" 03/02/2012 12:39 PM >>> I believe UHC has to compare the actual dollars paid by Medicare, not the percentage, in determining their responsibility. But it sounds like the UHC may be a “maintenance of benefits†plan, not a “coordination of benefits†plan? If so the pt would probably still have OOP even if they do kick in some? A supplement would help here. 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 cartejomSent: Friday, March 02, 2012 7:00 AMTo: TxFinancialCoordinators Subject: Please Help!!! Hey there everyone!I have a question for you all:I have a patient that has Medicare primary now and United Health Care secondary. We are out of network for UHC and they are not willing to do a contract with us for anything because the plan is secondary. I was told today by a representative from UHC that because Medicare would pay more on all services covering 80%,UHC will not cover more of the expense because they would only cover 60% on their own. I have two questions: 1. If this is true- do the deductibles and out of pocket maximums come into play for UHC? Their out of network out of pocket max is $2500 so I'm wondering if Medicare covers 80% then the patient is responsible for 20% up to $2500? Or is that now how this works?2. If the first question isn't true, could a patient in this position benefit from a supplemental plan?I really appreciate your help on this! We have had the patient on our list for years and want to help him the best way I can.Thank you!!Jodi MacFarland-Financial CoordinatorSaint 's Kidney Transplant

[Guest guest]

I believe so but I would run that past your local SHIBA aka SHIP folks From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Jodi Macfarland Sent: Friday, March 02, 2012 9:44 AMTo: TxFinancialCoordinators Subject: RE: Please Help!!! Thank you ! If the patient did get a supplemental plan would Medicare be primary, supplemental plan secondary, and UHC after that? Thanks again, Jodi Jodi MacFarland-Transplant Financial CoordinatorSaint 's Kidney Transplant Center310 Lafayette SE Ste 315Grand Rapids, MI 49503Phone: Fax: cartejom@...www.mercyhealthgrandrapids.com>>> " on, :LPH Trnsplnt " 03/02/2012 12:39 PM >>> I believe UHC has to compare the actual dollars paid by Medicare, not the percentage, in determining their responsibility. But it sounds like the UHC may be a “maintenance of benefits†plan, not a “coordination of benefits†plan? If so the pt would probably still have OOP even if they do kick in some? A supplement would help here. 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 cartejomSent: Friday, March 02, 2012 7:00 AMTo: TxFinancialCoordinators Subject: Please Help!!! Hey there everyone!I have a question for you all:I have a patient that has Medicare primary now and United Health Care secondary. We are out of network for UHC and they are not willing to do a contract with us for anything because the plan is secondary. I was told today by a representative from UHC that because Medicare would pay more on all services covering 80%,UHC will not cover more of the expense because they would only cover 60% on their own. I have two questions: 1. If this is true- do the deductibles and out of pocket maximums come into play for UHC? Their out of network out of pocket max is $2500 so I'm wondering if Medicare covers 80% then the patient is responsible for 20% up to $2500? Or is that now how this works?2. If the first question isn't true, could a patient in this position benefit from a supplemental plan?I really appreciate your help on this! We have had the patient on our list for years and want to help him the best way I can.Thank you!!Jodi MacFarland-Financial CoordinatorSaint 's Kidney Transplant