Changing tx center after transplant

[MooseMom]

I was not sure whether to put this question in the transplant section or the insurance section.  Please feel free to move this if you'd like.

For a very mysterious reason that I am not privy to, I am finding it more and more difficult to get my insurance to pay for appointments that I have with my tx clinic.  I am out of area, and I have an HMO, so I get referrals for everything.  This past year, my tx team wanted to do a biopsy, so I got my referral and went to UW-Madison, my tx clinic.  I ended up not needing the biopsy, but I still incurred about $1,000 worth of charges.

To make a very long story short, my insurance paid, then they told UW that I didn't have coverage, and now they want their money back.  UW refused, but BCBS is recouping their money electronically.

Over the past few years, I have been having an increasing amount of difficulty in getting claims to UW paid, and it is complicated by the shenanigans of my PCP's financial arm.

So my question is this...I am becoming worried that UW might refuse to have me as their patient any longer because they are having trouble getting paid.  My PCP referred me to Madison, and Madison even told me that they get a lot of patients from my PCP's office referred to them.  I'm worried that if UW has a contract with my PCP, they'll drop my PCP, and as such, drop me.

Does that happen?  If so, how does a tx patient go about getting a new tx center?  I mean, it's Madison that has my donor's tissue along with mine; is it an easy enough process to just transfer all of that to a different center?  I mean, it must happen if, say, a tx patient moves?

Have any of you ever had to change tx programs AFTER being transplanted?

Thanks so much for any information.  I am just baffled.  I have all of my paperwork in order, all of my referrals, but it feels like decisions about my coverage are being made on the fly and without informing me.  I've never heard of an insurance company paying a claim and then deciding coverage wasn't in place and then taking their money back from the care provider. 

I really don't want to have to change centers, but what if my center drops me as a patient?  None of this is my fault.  I don't understand it.

[Michelle2016]

I visit my nephrologist every three months after few months of my kidney tx in 2001. I have nothing to do with my tx center.  Why do you have things to do with your tx center after years of your tx? Please educate me. I know I can learn things from others everyday throu my life.

Take care.

[Michelle2016]

I had a biopsy at different hospital, instead of my tx center due to the insurance coverage.

[MooseMom]

Michelle, I've never seen my regular neph after receiving my tx.  I get monthly labs done locally, but the results are sent to my PCP and to my transplant coordinator.  My "regular neph" even told me that once I was transplanted, he wouldn't be seeing me again, which made me sad.

It just has never occurred to me to see anyone other than my tx team for a tx related issue.  My local hospital is not a tx hospital, so I don't know if they would agree to do a biopsy on an allograft.

May I ask...why did you need a biopsy, and were you comfortable having it done by someone other than a doc from your tx hospital?

[iolaire]

I was transferred back to my nephrologist after about four months. But I actually stayed with the transplant nephrologist because that office is on public transportation on the way to work.

[MooseMom]

I was transferred back to my nephrologist after about four months. But I actually stayed with the transplant nephrologist because that office is on public transportation on the way to work.

That's convenient!  I wish it were the same in my case!

So, your neph and your tx neph are located close to you, I'm assuming.  Is your tx neph in your local hospital, or is it further away?  If you had to have a procedure that was tx related, could you go to your local hospital, or would you specifically go to your tx hospital?

[tigtink]

I was told at my University of Michigan appointment that they have an agreement with University of Toledo transplant center. They said if I had my transplant done at Toledo, U. of MI transplant center could take over my care after the first year following the transplant center. You may want to contact a center in your network and find out if they will accept you for follow-up care.

[KarenInWA]

At my transplant center (the "other" UW - University of Washington!) they send you back to your regular neph as soon as you are stabilized, but continue to see you on at least a yearly basis. I know I *just* hit 3 months post today (yay!) and was told by my tx dr to keep my March 20th appt I already had set up with my regular neph from months ago. (I was going back and forth between reg neph and tx neph with my first kidney). I know I will be seen at 6 months for sure, and will be going back in 2 weeks as it stands right now.

As for changing centers, I believe it should be pretty easy. I know of one person who had to change centers locally to me because of a billing/collections issue with their original one. That's not fun. *Insert feelings about the state of American healthcare here*

With this being my 2nd transplant, I learned that the tx neph who is on in-patient duty that week gets you as their patient. So I don't have the same dr as before (not the one who did the bad biopsy, but the one who replaced the bad biopsy doc!). I liked my previous tx dr, but the one I have now is the head of the dept, so I really can't complain. I feel I am in good hands, and I know I was with the last one, too.

KarenInWA

[Michelle2016]

I had a biopsy due to BK virus.

Biopsy(liver, kidney, lung, any body part, and bone marrow) is a very simple procedure at any hospital. It lasts only about 30 min. However it should be done by interventional radiologist., instead Of by nephrologists. A Interventional radiologist does about at least 15 biopsy procedures every week in any hospitals. I’m working in this medical field.

Take care.

[Michelle2016]

All of the doctors (surgeons, nephrologist, cardiologists....) in the hospitals are contracted with the hospitals.  For example, my nephrologist has his own nephrology group and offices.  Like other doctors, he also visits patients in the hospitals.

Every year, there are 500 transplants in our local  tx center. After tx, the patient is assigned to the specialist (doctors) to follow up.

After my tx, my tx center assigned me to my current nephrologist. I have visited him at his office (Not tx. Center) since 2001.

Take care.

[MooseMom]

Thanks for the replies, everyone.  I appreciate it.

I don't think my tx center will drop me.  They understand I'm doing what I can to make sure they are paid.  They are being very patient.  Besides, it's not for the billing department to decide if I'm a "good enough patient."  I'm just being paranoid.

[MooseMom]

I was told at my University of Michigan appointment that they have an agreement with University of Toledo transplant center. They said if I had my transplant done at Toledo, U. of MI transplant center could take over my care after the first year following the transplant center. You may want to contact a center in your network and find out if they will accept you for follow-up care.

That's a very good idea!  I may well have to do that, but hopefully not.

[MooseMom]

KarenInWA, well that's just good news all around!  Congrats to you!!

[cassandra]

Congrats and fantastic news to read Karen!!!


Have some extra drinks on me girl!!


            


Love, luck and strength, Cas

[Tío Riñon]

Hey MooseMom!  I'm in the process of being re-evaluated for re-activation at the UW.  I was previously on their active list, but had to be deactivated while I handled some issues.  In any case, I'm from MN and inquired what would happen if I received my TX there (I'm multiple listed).  I was told that I would remain in the area while they confirmed the functioning of the kidney and stabilized my medications.  Once ready, they would transfer me to one of the TX clinics in MN.

I don't think you have anything to worry about.  UW is very proud of their standings and success rate.  I'm pretty sure they will hang in with you and your insurance company until it is time to transition you to another facility.  Good luck!

[iolaire]

I was transferred back to my nephrologist after about four months. But I actually stayed with the transplant nephrologist because that office is on public transportation on the way to work.

That's convenient!  I wish it were the same in my case!

So, your neph and your tx neph are located close to you, I'm assuming.  Is your tx neph in your local hospital, or is it further away?  If you had to have a procedure that was tx related, could you go to your local hospital, or would you specifically go to your tx hospital?

I'm in D.C. Area so everything is close. My only nephrologist was in northern va and transplant in D.C. But that nephrologist left the large group practice a few weeks before I tried to get back under him.  So the new nephrologist that also works with transplant is a block from both the transplant clinic and the hospital in the other direction.

I assume if say I moved to Richemond VA about two hours away I would get biopsy down there. 

[cattlekid]

Howdy MM!  I can speak from experience that UW is very patient with their billing.  They understand insurance shenanigans.  I had problems because I misinterpreted "eligible" for Medicare and had a few dicey weeks when I was waiting for Medicare to process a back payment.   I kept UW in the loop on about a bi-weekly basis (or whenever I received a new bill) and told them that they would get paid just as soon as I had the insurance straightened out.  I wasn't about to pay two insurance premiums and pay unnecessary co-pays on top of it.

My personal latest issue is Quest Diagnostics.  I used to get my labs done locally there and everything was sent to my local PCP and UW.  Now as of last November when I switched insurance due to a change in employer, Quest is now out of network.  They wanted me to use LabCorp, whose hours are horrendous for working stiffs like me and my PCP also said they were more or less incompetent.  So I now get my labs done at our local hospital.  If they are willing to eat that extra charge, more power to them I guess.  It just makes it easier for my PCP as the results go directly into MyChart instead of getting faxed.

[MooseMom]

Hiya, cattlekid.  I do remember your problems with Medicare.  You're right in the UW have pretty much seen everything when it comes to insurance shenanigans, although to be fair, in this particular case, BCBS are willing to pay; it's my PCP's financial management outfit that is really dragging their feet.  These charges were incurred in mid-May and then in early June for the biopsy that didn't happen, and here it is end of February, and my PCP's people are still making up reasons not to pay.  The latest one is despite the fact that I faxed them a copy of the referral they issued to me which included an authorization number, they are now claiming that the referral was not actually a referral, rather, it was merely an "internal memo".  They dared claim this to BCBS on a conference call.  Now, why would any office send a patient an "internal memo"?  Anyway, I am now on a first name basis with several people in UW's billing department, and messages go flying back and forth on MyChart, so I know they realize that I'm not trying to ignore them.

That is crappy news about not being able to use Quest Diagnostics anymore.  Like you, my labs are sent to my PCP and to UW, and I use Quest's patient portal to get my results.  I've been going to Quest since 2004, and it would really do my nut in if I couldn't use them anymore.  I thought our medical care was supposed to be between doctor and patient.  But no.  Insurance companies get the final say.

If my PCP knew what his practice's financial management company were doing, I'm sure he'd be appalled.  I'm sure he has to pay them to manage the finances of his clinic, and they are lying bastards, every one of them.  They have behaved with such dishonor and lack of integrity.  Anyway, I'm really glad you can get your labs done at your local hospital.  I have to go to mine for the blood draw for DSA since Quest suddenly decided last year they were no longer willing to do courtesy draws, so now for my annual appointment, I have to get jabbed twice.  PITA.