Medicare question

[donnia]

I have had medicare since December.  I have also had my primary insurance through my work.  I was supposed to have my transplant in March at Lubbock Covenant, but my primary would not cover it.  They only cover Baylor.  We started the testing on my donor at Baylor the first week of March.  Here it is almost May..... they don't even plan to do orientation on her until JUNE!!!!  The reasoning they give is because their 1 and 3 year outcome (85%) isn't as good as Baylors (97%).

Okay.... back to the real question.... My primary is set to lapse on April 30th (I was on catastrophic leave where I still got my full paycheck and my insurance... that runs out April 28th so no more paycheck and no more ins.... I am scared to death)!!!.  Does that mean medicare becomes my primary immediately?  

The reason I ask is because Medicare being my primary, I could get my transplant in the 2nd or 3rd week of May at Lubbock Covenant.  If I wait for Baylor, I probably wont even get my transplant until September or October.  I sooooo can not afford to be out of work for that long!!!!  I have known of MANY people who have gone through Lubbock Covenant and they all LOVE it.  Everyone there is soooo nice and helpful.... yes, even the transplant coordinators!  When I call Baylor, my coordinator greets me with..."hi Donnia, what do you need?".


I don't know what to do.  I am so frustrated!!!!

[dialysisbiller]

You need someone who is skilled in hospital Medicare. I wish I had an easy answer for you but I am not sure. I will ask one of our Registration specialists about when Medicare will become prime for you but I do need some informaton such as why you applied for Medicare, disability or ESRD? And when your primary coverage will expire? I can't guarantee anything but I will try to find out something.

[kellyt]

I should add for those of you who might not be aware of this    (dialysisbiller you may be able to explain this better than I can)

Back in the early 90's (or at least that's when I started working for a doctors office and it was the first time I had ever seen/heard of this) doctor's office's (or at least Specialists) had to sign contracts with insurance companies in order to be in their "network" and see their patients and accept that particular insurance.  By signing these contracts they obviously agree to "accept payment", whatever the insurance deems acceptable, and "write off the rest", or what you otherwise see on your EOB's labeled as "discounted".

When you go to a doctor's office and you have some strange insurance and they say "We don't accept XYZ insurance", that is why.  They didn't have many or any patients at that time when they signed the contracts and therefore they opted not to bother.  Or because that particular insurance company pays really low and they just told their patients with that insurance to find another doctor who accepts XYZ.  These contracts are resigned every 2 years or so, I think.  That way the doctor can opt out and lose those patients or sign up and gain some patients.

It's a dance that the doctor's are forced to dance in order to see patients with good insurance.

To my knowledge they even sign these contracts with Medicare and Medicaid (what doctor in their right mind would not accept Medicare?).  Some choose not to accept Medicaid, however.

dialysisbiller, am I correct or even close?  ha ha   You are right, it's very confusing.    As a patient the bottom line for me is "What is coming out of my pocket?"   It sucks to be in our situation (or any seriously illness situation) and also have to worry and deal with this B.S.

And I, too, and torn betwee national health care and leaving it the way it is or just fixing the system we have now.  Actually, that's my first choice.

[dialysisbiller]

confusing? downright insane if you ask me, and i don't know why the field of specialized billing interests me so!

[Zach]

To my knowledge they even sign these contracts with Medicare and Medicaid (what doctor in their right mind would not accept Medicare?). 

There are some doctors who are no longer accepting new Medicare patients as well.

[dialysisbiller]

that is a sad

new physician offices/doctors have to wait until they get their NPI- aka national provider identifier (PTAN, provider #) before they can treat a patient with medicare. (I worked for a PCP for a few years, before that, a DME company) the PCP I dealt alot with senior citizens so alot of medicare stuff and the DME 99% Medicare. Before we all had computers and I was printing out claims on a typewriter (does anyone remember the typewriter?) 

[kellyt]

ooops!   There are a few Medicare threads out there and I posted my above post to the wrong one.  Sorry!  We were discussing charges in the other thread.  Can this be moved?  Again, sorry!