With changing regulations, Healthcare Reform, and other commercial and Federal updates, the Financial Coordinators are continuously learning and updating their knowledgebase.
Every member of the team takes a personal interest in the well-being and care of our patients.
Patients should feel comfortable asking questions when they don’t understand something or when they need additional clarification. We believe in a positive and support environment that encourages open communication.
/
The financial process begins when a patient
is referred for transplant consultation or evaluation. When the transplant team receives a referral for a potential
transplant patient, the next step in the process is financial verification and
approval. The TFC will keep the patient
and their physician apprised of any
financial issues. These may include re-direction to another transplant facility due
to contracting; limitation of benefits; or, counseling for obtaining initial insurance coverage. Once benefits are verified and authorizations are obtained, the patient is scheduled for any necessary consultations
and procedures. The TFC is always
available to counsel patients as needed during all phases of care. The TFC is also available to assist when adding, changing,
or losing insurance coverage. The TFC
should always be contacted when coverage issues arise. Continually working with the transplant coordinators and physicians,
the TFC ensures that any necessary
approvals are in place for services
requested for transplant care. While the patient explores the possibility of transplantation, and focuses on their
medical condition, the TFC will handle the insurance coordination. When all required testing is completed, a patient is presented
to the selection committee for candidacy.
If the committee is in agreement, a patient
is listed on the UNOS wait list. At that time the TFC will coordinate appropriate approvals for transplantation. This
approval process will involve all health
plans for which the patient is covered. Follow- up approvals are obtained, as necessary, for procedures, as well as maintaining current transplant approvals.
When can I call my financial coordinator?You should call your financial coordinator
any time you feel the need to discuss insurance, disability, or other financial concerns you may have. Always call if your insurance is ending, changing, or you are adding additional
coverage.
What do I do if I don't have any medical coverage?
Call your financial coordinator to discuss what options may be available to you including Medicare, Medi-cal, High Risk or possible employer coverage.
Should I take COBRA if my employment terminates?
Your Financial Coordinator can assist you with COBRA issues. Often patients do not feel
they can pay for COBRA but you should
always check with the financial counselor, as there may be assistance available to pay your premiums. Also, COBRA coverage can be extended for an eleven month period if you
are considered disabled within the first 60 days of COBRA coverage.
When should I apply for Social Security (SSI/SSDI)?
In most cases you want to apply for Social security when you first become disabled, as
it can be a long process. Please, however, contact your financial coordinator before
applying as there may be unusual
circumstances that may warrant starting another process first (i.e.: the need for other health coverage). You have to be disabled for 5 full calendar months in a row before you can be entitled to benefits. For ESRD (End Stage
Renal Disease) you should contact your
financial coordinator as it is more dependent
upon each individual's current coverage. / After I am accepted for Social Security will my Medicare automatically begin?
Medicare will typically begin for those patients that are applying for ESRD coverage either the month that they are transplanted or three months
after the first dialysis.
For those receiving Social Security for disability, Medicare will not begin for two years after the qualifying date of coverage.
Once I receive my Medicare card can I turn down the part B coverage?
The financial coordinators would not recommend
terminating the part B Medicare coverage.
This is your outpatient medical and physician
coverage. In many instances when you
terminate this coverage you no longer have any outpatient coverage for office visits, medications and other care. Always contact your financial coordinator if you are considering dropping this coverage.
When is Medicare my primary insurance coverage?
For those patients with ESRD, Medicare
becomes primary 30 months after initiation of dialysis, also called coordination of benefit
period. However, if you have an individual
plan, Medicare will become your primary coverage from its initiation. For those patients that are covered for disability, Medicare will remain secondary if you have a large active group employer plan (through yourself, a spouse, or a parent). Medicare will be primary from initiation if you are covered by an individual, small group,
retired, or COBRA plan.
Should I contact the financial coordinator after
I have changed insurance coverage?
You should ALWAYS contact your coordinator PRIOR to changing or terminating coverage as
they can help in choosing the best plan for
YOU. /
Can I give my new insurance information to the hospital or clinic?
You should always give your new insurance information to the hospital and clinic when you are being seen, but you also need to give it directly to the financial coordinator as it may not be received by the transplant team and proper approvals may no longer be in place.Please consider your Transplant Financial Coordinator your primary contact for insurance and financial needs. Share your information and concerns with your coordinator, as
she are available to assist you.
Your financial coordinator can often give you information and advice that is not available through other sources.