Holds & BP
A PVF hold, Missing CLV, Missing MIRF, and OS hold are all examples of what kind of hold?
What is, "global hold"?
Tiny Tim had a SPN that was run in December. If the bills are not over a year old, we can run it again in this month.
What is March? (He can ask again in February.)
What is the "shareable motto" that we learned?
Which two types of Needs will we only share if they are related to illnesses and injuries, not cosmetic or corrective reasons?
What are "optical and audiological"?
Mr. & Mrs. Brady have 6 children and are in their 40s now. They are looking to use a hysterectomy as a means of family planning. Would we be able to share this?
In general, we do not share hysterectomies unless for a health reason. HOWEVER, another exception is if the woman is over 40, so this is a "maybe."
Marv Murchin submits a dental Need for a broken tooth that he claims he got from eating. When he is told that it is not shareable, he says that he recently "lost a job" and is under financial hardship. If you started a SPN, what hold would you need to make sure was on the Need?
What is "not a shareable Need"?
Tiny Tim's SPN was accidentally started as a shareable Need. To fix this, we would need to make sure these two things on the SPN tab and one thing on the Admin tab are checked.
What are, "This is an SPN Need," "Send to SPN," and "change submission type to 'mail'"?
Tony fell off the roof and broke his leg in two places. However, in recovery, he ends up having to go to a long-term acute care facility. Would this be shareable?
Yes, it would, and no counters or windows needed.
What is the difference between prosthetic and orthotic?
Prosthetic is replacing or augmenting a body part--like a prosthetic leg for one loss or a pacemaker.
Orthotic is supporting a weak body part, like a knee brace or shoe inserts.
Chicha and her husband Pacha are expecting their third child soon. They have been members for 4 years, and, as part of her routine check-ups during pregnancy, the doctor wants Chicha to get an STD screening. Would we be able to share?
Yes, we would for Maternity. We can also share if contracted due to a contaminated blood infusion, medical procedures, sexual assault, or if a spouse unknowingly receives it from another spouse.
Tiny Tim's brother Peter also has a SPN for the same exact thing as Peter. Instead of simply opening up a new SPN, we could also do this.
What is, "add Peter's SPN onto his family member's"?
These two centers have a 45-day counter for how long a stay here will be shareable.
What is "rehab center" and "nursing/rest home."
This is the sharing cap on medical equipment on Needs.
What is "$5,000"?
Chicha is going to do a homebirth with a midwife. The midwife's estimate is $7,000. Chicha wants to know if we would be able to share this early because her midwife wants payment up front. Can we?
Yes, we can. There are 3 maternity early sharing requirements:
1. Homebirth
2. A facility + provider estimate that is below $10,000
3. There is a discount on either the facility/provider estimate.
A member is trying to avoid proration. We might recommend this Dashboard resource to get this reward to avoid proration.
What is, "HCBB FPR"?
Tiny Tim has another shareable Need that has some bills that are not shareable, but the majority of the Need is. This is what we could do in that situation.
What is, "partially share the bills as an SPN"?
This would be shareable for 90 days, and at the end of it we would need a SOC to continue sharing for another 90 days.
Pharmacy-filled prescriptions, nebulizing solution, and other disposable things would be shareable under which counter?
Chicha and Pacha had their baby! The final bill came to $12,000, which was more than the estimate. What do we do?
We share the difference of $5,000. If there was less money on the final bill than the estimate, it would be a PRD/X$ situation.
Yes, we can share follow-ups for colonoscopies even if they are a few years out.
Bob Cratchit calls us and wonders why Tiny Tim's SPN Need checklist isn't on the Dashboard. Why would this be?
Because SPN checklists are by postal only, and all checks will be received in the mail as well.
What is the "NSU" (Needs Status Update)?
What are some reasons why we might share travel expenses?
1. Significant savings
2. All local options have been exhausted
3. Treatment is not available locally at all
4. Remember that preference is NOT necessity!
Another unexpected thing: Chicha had to go to the hospital due to a complication. Originally, the IUA had been waived due to her homebirth. She calls and wants to know what happens now.
We will reapply the IUA to the tail-end of the bills, UNLESS she can demonstrate a fair price and qualify for the FPR.