I don't meet the 30 month coordination period of benefits...Shoot!

[rsudock]

Hey IHD Fam,
 
So I am struggling to get these anti rejection drugs filled every month and I need some advice from folks who actually have to navigate this system.

So this october will only be 12 months that I have been on medicare. As you know I got the transplant in June by July I let the COBRA go b/c I couldn't afford it b/c I was in the 5 month waiting period for SSD. (Don't ya just love waiting periods?!) Anyway Medicare says that I need another primary insurance b/c they are not primary yet since it hasn't been 30 months....does Medicaid count as primary insurance? When I do lab work, doctor's visits, etc...should I have them bill Medicaid as primary and then Medicare....I will keep investigating, but I trust you folks more then these healthy folks on the phone!

xo,
R

[Meinuk]

Hi Rsudock,

Call youe Network, ask to speak with the Patient Services Coordinator and tell them that you are having prooblems with your Medicare Common Working File, and that you are Medicare Primary due to Transplant, and you have no other coverage.

To find your Network:  http://www.esrdncc.org/

Ask them to investigate.  It soulds like there is a glitch in your enrollment.

You should have Medicare for the 36 months after transplant.  The 30 month Coordination of Benefits (COB) period is for dialysis.

Feel free to PM me if you have detailed questions.

(sorry about the original typo in your name...)

[rsudock]

so I called the "coordination of benefits" personnel and asked what I was suppose to do...I explained that I no longer have private insurance since July 2, 2011 and she said (you won't believe this) "No problem I will update that Medicare is primary and Medicaid will be secondary." ME - "Are you sure that is right? I mean that is way to easy...I figured you were going to tell me sorry go and get a job at McDonald's to get insurance." Lady -" (chuckling at me) No ma'am we can not force you to have private insurance. If you do not have private insurance we become primary." 

OMG!! Can it really be that easy??? I am not going to hold my breath...thanks for listening to my freak out. I hope someday this may help others....

PS- Thanks for the info ANNA...if I continue to have problems I will call.  I didn't know the 30 month COB was for dialysis only...I have never seen that on the Medicare info I read....interesting....

xo,
R

[Meinuk]

Some private insurance companies have a clause in their policies that continue the COB period after transplant.  I have never seen this challenged, and I  successfully fought my insurance company on that one.  (I was transplanted after 22 months on dialysis, and a year after my transplant they tried to not pay for anything ESRD related - I had fun fighting that one).

Here is more that you will ever want to know about Medicare and Coordination of Benefits (not just ESRD)....

What is the Common Working File (CWF) that I wrote about?
The CWF is the system that CMS uses to verify a resident’s entitlement to and correct use of Medicare benefits. When a person signs up for Medicare, the government establishes a record of him or her in the CWF. The CWF therefore contains each resident’s national Medicare record.

Here is what CMS has on Coordination of Benefits:
http://www.cms.gov/BeneficiaryAdvocateServices/01_overview.asp