I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: swramsay on April 04, 2009, 08:46:50 AM
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Several weeks ago, I noticed the exorbitant charges for dialysis that my insurance company was
paying at 100%. They were paying about $55,000 a month for my treatments
which included meds. I found out the unit I was going to for 6 months was
not contracted with my insurance yet they paid 100% of their charges because
of some rule 89 loophole about dialysis. They were getting paid $1500 for
each dialysis session. That does not include administrative or nursing costs
nor meds (which are very high). I finally got clarification yesterday that a
unit that I could have easily gone to instead was contracted with my
insurance company and instead of $1500 per treatment, I would have paid $294
per treatment for in-center dialysis. Now that I'm doing home dialysis, the
base charge will be only $86 per treatment. If I had stayed at the
non-contracted unit, the charges would have remained the same. Now that I
have switched, I will be saving the insurance company over $22,000 a month!
No one will do anything about the charges to my lifetime max that have
already occurred but at least they won't evaporate as quickly. There is a law
that private insurance has to pay for the first 30 months before Medicare
picks it up. Hopefully, I will still have some insurance left now at the end
of that coordination period!
You think they will give me a pen or something?
p.s. Looks like we got the approval for home hemo under the 'home care' category.
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Isn't that just nuts? We will never know how much dialysis "really" costs. If they can get it they will take it. Greed is the ruin of health care.
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My mom got a bill from my dialysis center that was $22,000 A WEEK! Crazy...
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Medicare approves about $140 per treatment (without meds) and pays 80% of that.
Commercial insurers usually pay anywhere from $300 to $900 (or more) per treatment.
What centers charge--the sky seems to be the limit.
8)
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the 'usual and customary' charge for dialysis is currently (about) $1400+ it increases a bit each year. I've been in dialysis billing now for over 3 years. I originally was a specialist for Medicare billing and over the past year and a half, working with commercial insurances and other government programs.
let me just say it's like a three ring circus and i think i'm juggling with 30 bowling pins- i work closely with a registration rep and she's on the phone all day trying to figure out just exactly what each patient's policy covers and doesn't cover and then calculating COB (Coordination of benefits) which is different for each patient and there's all these criteria you have to check and re-check and then re-check again and it can change in the blink of an eye.... i know it may seem like i'm complaining but i'm not, i'm healthy and do not need to have dialysis but so many people do, i just figure if i can make someone's life less stressful, maybe it helps if they dont have to call up their insurance company and try to figure the craziness out for themselves.
Back to insurance- you are entitled to Medicare when you are diagnosed with ESRD, there is a 3 month waiting period with Hemo patients and none for PD patients- after that it is a 30 month COB period (which the government is looking to extend it) IF for any reason you have reached your yearly or lifetime max, Medicare WILL cover you. Mainly why I wanted to post this is to let you know that even if you reach your Max, Medicare will cover you.... it's called billing Medicare conditionally, as long as you've applied for Medicare already, you will be covered if you max out your insurance. I have insurances that are contracted and a small few that are non contracted.... you would think if you send in a claim to a contracted insurance company it'd get paid and be all nice and neat, well, the insurance companies stink.... i always say 'any reason to deny a claim, it will be denied'- i am still trying to get claims from '07 and '08 paid..... i see the revenue end of this game and with the current ecomony situation, across the board the medical institutions are in for a long road ahead with so many people losing their health benefits... it's too early to be so 'blahh'.....
well, have a great day!!