CALIFORNIA - Pacificare Health Systems

PART B
174
Section 5 – Working With Your
Contracting Medical Providers
Network facility, which may be located
outside the Service Area based on a
number of factors, including, quality,
cost and outcomes. New Members,
already listed at a non-PacifiCare National
Preferred Transplant Network facility,
will be evaluated for continuity of care.
PacifiCare requires thirty (30) days
to obtain and review relevant clinical
information. Transplant benefits are
available only where a facility designated
by PacifiCare is utilized and the Member is
a recipient of the transplant.
The PacifiCare National Preferred
Transplant Network facilities that may be
available to Secure Horizons Medicare
Advantage Plan Members are the
following:
Northern California
BMT:
Stanford University Medical Center,
Alta Bates Medical Center
Heart: Stanford University Medical Center,
Sutter Memorial Hospital – Sacramento
Kidney: Stanford University Medical
Center, Sutter Memorial Hospital
– Sacramento, California Pacific Medical
Center
Kidney/Pancreas, Liver: Stanford University
Medical Center, California Pacific
Medical Center
Heart/Lung, Lung:
Stanford University Medical Center
Southern California
All transplants except Heart/Lung: St.
Vincent Medical Center, USC Medical
Center, UCLA Medical Center, Loma Linda
University Medical Center
Heart/Lung:
Stanford University Medical Center
San Diego
All transplants except Heart/Lung:
UCSD Medical Center
Heart/Lung:
Stanford University Medical Center
Please note: PacifiCare evaluates
each transplant case to determine the
appropriate transplant facility for each
Member. PacifiCare will select a transplant
facility within the above National Preferred
Transplant Network based on the medical
needs of the Member in consultation
with the Member’s treating Physician and
PacifiCare’s Transplant Medical Director.
Notwithstanding the foregoing, PacifiCare
reserves the right to utilize alternative
transplant facilities as authorized by
PacifiCare.
5. Continuity and Coordination of Care
PacifiCare’s Centralized Transplant Unit
(CTU) will continually work closely
with the Member, the Member’s family,
the Member’s treating Physicians and
facilities to monitor the continuity and
coordination of services during the
pretransplant evaluation, transplant
hospitalization, and post-transplant follow
care. This includes, but is not limited to,
reviewing requests from Primary Care
Physicians/treating Physician for transplant
services, facilitating placement on National
Preferred Transplant Network (NPTN)
Facility waiting lists, and coordinating
post-transplant services.
Following a determination by PacifiCare’s
CTU and the NPTN facility that a Member
is a candidate for a transplant, the Member
will be placed on the transplant waiting
list of the NPTN facility. For Members
who receive transplant services from
a NPTN facility outside of the Service
Area, PacifiCare will work closely with
the Member, the NPTN facility, and the
Member’s Primary Care Physician/treating
Physician to coordinate travel to the NPTN
facility, as appropriate and at no expense
to the Member.
Following transplant and the stabilization
of the Member, PacifiCare’s CTU will
coordinate post-transplant services
between the NPTN Facility and the