I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Home Dialysis - NxStage Users => Topic started by: vcarmody on May 10, 2011, 07:44:16 PM
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I was wondering if anyone out there every looked at what your center is charging your insurance company for each NxStage treatment? The other day we had a nurse here from the insurance company going over my husbands medical history. My husband mentioned how when he was in center they only charge 360.00 a treatment 3X's a week but now that we are at home the center charges 720.00 a treatment and his insurance pay 100% all 720.00! She seemed shocked. we explained to her we questioned it and we were advised by the billing office that they called his insurance company and they said that is how much they can bill, so that it what they are billing. Is anyone else getting charged anywhere near that amount?
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I was wondering if anyone out there every looked at what your center is charging your insurance company for each NxStage treatment? The other day we had a nurse here from the insurance company going over my husbands medical history. My husband mentioned how when he was in center they only charge 360.00 a treatment 3X's a week but now that we are at home the center charges 720.00 a treatment and his insurance pay 100% all 720.00! She seemed shocked. we explained to her we questioned it and we were advised by the billing office that they called his insurance company and they said that is how much they can bill, so that it what they are billing. Is anyone else getting charged anywhere near that amount?
That is highway robber. No wonder we are having such a difficult time getting insurance companies to advance home dialysis. Doubling the payment between home and incenter is just ridiculous since you don't have the overhead nor labor costs of incenter. Greed continues to abound in example after example in the American dialysis world.
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Sadly it's not the only industry....Greed is everywhere it seems.... I long for the old days.....LOL
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Hubby's NxStage runs around $75to 78 thousand dollars a month! I don't understand why either! Usually EPO is high when given but he hasnt had to have Epo since 12/2010. I do like the NxStage system, but they may very well be eliminated in the future, due to their extravagant prices. It definately should be cheaper than In-Center, cause like you said, they don't have the overhead and upkeep to deal with! Is $75,000.00 a month alot or what? Lord, I barely make a 1/4 of that at work!
It is ridiculous, but husband wants it, so he shall get it until we can't afford it any more.
lmunchkin
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Hubby's NxStage runs around $75to 78 thousand dollars a month! I don't understand why either! Usually EPO is high when given but he hasnt had to have Epo since 12/2010. I do like the NxStage system, but they may very well be eliminated in the future, due to their extravagant prices. It definately should be cheaper than In-Center, cause like you said, they don't have the overhead and upkeep to deal with! Is $75,000.00 a month alot or what? Lord, I barely make a 1/4 of that at work!
It is ridiculous, but husband wants it, so he shall get it until we can't afford it any more.
lmunchkin
Sorry, but I suspect that the bill you are seeing is what the dialysis unit is charging your insurance, not what NxStage charges your dialysis unit. The machine is several hundred dollars to lease and about $1500 dollars a month for the supplies. NxStage does not charge nearly $80,000 dollars a month to dialysis units from all that I know. The figures above are from a CA nephrologist who gave me an estimate of his costs for NxStage. Check with your unit and it is my opinion from what you have related that the unit is making a bundle off of your work at home. That is ridiculous indeed, but it is the American dialysis system at work.
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I was wondering if anyone out there every looked at what your center is charging your insurance company for each NxStage treatment? The other day we had a nurse here from the insurance company going over my husbands medical history. My husband mentioned how when he was in center they only charge 360.00 a treatment 3X's a week but now that we are at home the center charges 720.00 a treatment and his insurance pay 100% all 720.00! She seemed shocked. we explained to her we questioned it and we were advised by the billing office that they called his insurance company and they said that is how much they can bill, so that it what they are billing. Is anyone else getting charged anywhere near that amount?
Yes, from your opening post, it is NOT NxStage with such ridiculous charges, it is your dialysis unit itself that is billing your insurance. I am quite certain NxStage has nothing to do with this act of thievery. That is your dialysis unit at work.
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It is 720.00 a treatment we do 5 a week so that is 3,600.00 just for dialysis. His Neph. charges 500 a month. EPO and blood work is additional. These are not charges from NxStage but from his center. We seen what NxStage Charges for the rental and supplies and it is not even 3500.00 a month. It seems like robbery to me and I can see why the insurance company was questioning us. That is why I wanted to see what the centers are charging others that are doing NxStage.
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From nephrologists I have talked to, I believe it is in the area of $2000-2500/month, but I have never seen an actual bill from NxStage. It is certainly not anywhere near $80,000 a month. At $75,000 a month, that is $900,000/year. WOW, complete lunacy in American medicine. Why would an insurance company pay such adulterated rates? The actual costs involved from NxStage who do make a profit on their product would provide enough supplies for nearly 40 patients a year. Instead, those resources go for only one patient and the rest is in the pocket of your dialysis provider. I feel no pity and nor sorrow for dialysis units that engage in such practices. This is the underlying problem of dialysis in America, greed and unmitigated profiteering.
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Otto's private ins was charged $60,000 a MONTH!!!! yep thats right. That is why they didnt want him to go back in center and probley why the social worker told him not to worry about getting medicare :banghead;
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I wish we didn't have to get Medicare, were paying the premium for it and we have two private insurances, but we were told we had to get it. Seems to me to be a total waste of money we don't have. Wish I could cancel it.
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I wish we didn't have to get Medicare, were paying the premium for it and we have two private insurances, but we were told we had to get it. Seems to me to be a total waste of money we don't have. Wish I could cancel it.
I suspect what is being "billed" is quite different from what Medicare or the insurance company ultimately pays. Generally the amount billed could be $50k plus a month, while the actual negotiated amount could be $2500. The following table in 2006 dollars, in a paper published in 2009 showed that the average payment is about $250 per treatment.
http://www.nephronline.com/article.asp?IndexID=172
(http://shup.com/Shup/506624/figure_2.jpg)
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Yes, but then the dialysis unit posts the difference between billed and collected as a loss for income tax purposes. Even if they don't get paid, they still reap a benefit from this high charges.
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Sample monthly billing for in-clinic big chain dialysis, circa 2010. This is NOT NxStage. Anyone with NsStage billing willing to post a snapshot is welcome.
(http://shup.com/Shup/506659/RetailChaininclincdialysis2010.gif)
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Sample monthly billing for in-clinic big chain dialysis, circa 2010. This is NOT NxStage. Anyone with NsStage billing willing to post a snapshot is welcome.
(http://shup.com/Shup/506659/RetailChaininclincdialysis2010.gif)
I wish that was the case, his insurance pays 100% of what ever they decided to bill. He has Anthem BC/BS. I get all his EOB's so I know excatly what they get. The only money they didn't get was his 3,000.00 deductible. His Neph bills him $500.00 a month and he only gets $247.00, and the lab only gets a portion of what they bill, but his center gets 100% on everything they bill. And I am still shocked that they did not supply him with a dialysis chair or a blood pressure cuff, they made me get them pay for them and then submit the bill on my own to his insurance company. Yup, that is wrong with our health care system.
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You are exactly right, Hemodoc. The bill is not from Nxstage, it is from Fresenius! The crazy thing is, they don't do a damn thing! Excuse my French, but I speak the truth! We go to the clinic once a month, for them to do "vitals" on my husband. Ask him how he is feeling, and if I need anything like flow sheets and other materials used for "my sending labs".
I do everything and get paid nothing, but they do nothing and get paid alot! Not that I want to get paid, but there has got to be something we can do. Is there anything like maybe get with a congressman or Senator to have them look into this. I realize Medicare doesnt pay hardly anything on the bill and they write off alot, but other insurances are being "ripped off". I'm not crazy bout Insurances company's, but I can certainly understand the raising of ins. rates due to these prices.
Hemodoc, is there anyone we can go to about this?
lmunchkin
p.s. I think NxStage has an awesome product here, and kudo's to their R&D division for their hard work on making home dialysis easier for those who use it! It is a "kick butt" machine and once learned, is done with such ease!
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Sample monthly billing for in-clinic big chain dialysis, circa 2010. This is NOT NxStage. Anyone with NsStage billing willing to post a snapshot is welcome.
(http://shup.com/Shup/506659/RetailChaininclincdialysis2010.gif)
The problem is this: Medicare paid only $2753 out of $49070. The $2753 is not enough to cover the cost of the clinic. Where does the clinic get the money to cover the shortage? The only way the clinic can make a profit is to "rob" the private insurance. The charge of the clinic to the private insurance is not based on the "cost". It bases on how much the insurance can pay. Why the private insurances allow this practice is beyond my believe. When I was on PD, my clinic charged my insurance about 4 to 5 times of my reasonable cost, and my insurances paid all of them with a little discount. The worst, my clinic almost doubled my charges during a two-year period. I think any health reform would fail if such a robbery is still allowed.
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Sample monthly billing for in-clinic big chain dialysis, circa 2010. This is NOT NxStage. Anyone with NsStage billing willing to post a snapshot is welcome.
The problem is this: Medicare paid only $2753 out of $49070. The $2753 is not enough to cover the cost of the clinic. Where does the clinic get the money to cover the shortage? The only way the clinic can make a profit is to "rob" the private insurance. The charge of the clinic to the private insurance is not based on the "cost". It bases on how much the insurance can pay. Why the private insurances allow this practice is beyond my believe. When I was on PD, my clinic charged my insurance about 4 to 5 times of my reasonable cost, and my insurances paid all of them with a little discount. The worst, my clinic almost doubled my charges during a two-year period. I think any health reform would fail if such a robbery is still allowed.
As I wrote earlier, any posting of a snap shot of actual payments by the insurance company to the clinic is welcome. I don't believe any US health insurance company will pay much beyond what Medicare pays. Insurance companies are in the business of making money in the US (in other countries, they are non-profit), and not go out of business. No insurance companies will pay $50,000 when Medicare is paying $3000. That is why Medicare and CMS is so important in keeping the cost down when no other market forces could.
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Sample monthly billing for in-clinic big chain dialysis, circa 2010. This is NOT NxStage. Anyone with NsStage billing willing to post a snapshot is welcome.
The problem is this: Medicare paid only $2753 out of $49070. The $2753 is not enough to cover the cost of the clinic. Where does the clinic get the money to cover the shortage? The only way the clinic can make a profit is to "rob" the private insurance. The charge of the clinic to the private insurance is not based on the "cost". It bases on how much the insurance can pay. Why the private insurances allow this practice is beyond my believe. When I was on PD, my clinic charged my insurance about 4 to 5 times of my reasonable cost, and my insurances paid all of them with a little discount. The worst, my clinic almost doubled my charges during a two-year period. I think any health reform would fail if such a robbery is still allowed.
As I wrote earlier, any posting of a snap shot of actual payments by the insurance company to the clinic is welcome. I don't believe any US health insurance company will pay much beyond what Medicare pays. Insurance companies are in the business of making money in the US (in other countries, they are non-profit), and not go out of business. No insurance companies will pay $50,000 when Medicare is paying $3000. That is why Medicare and CMS is so important in keeping the cost down when no other market forces could.
Attached is one of his E.O.B.'s It will only let me attach one page the second page is to big. It is for 6 treatments at $720.00 a treatment, but it shows his insurance pays 100% of the charge. That is 225,000 a year for just the treatments that I administer at home, that does not include blood work, EPO, Iron Infusion and his Neph, they are all billed separately. I guess NO insurance company, does not include them all. They have been paying this same amount for almost a year and half.
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[[/quote]
As I wrote earlier, any posting of a snap shot of actual payments by the insurance company to the clinic is welcome. I don't believe any US health insurance company will pay much beyond what Medicare pays. Insurance companies are in the business of making money in the US (in other countries, they are non-profit), and not go out of business. No insurance companies will pay $50,000 when Medicare is paying $3000. That is why Medicare and CMS is so important in keeping the cost down when no other market forces could.
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If you believe private insurances pay the same as Medicare, you probably have not had private insurances as primary. The dialysis com. most likely bill private insurances the same rates as Medicare. However, Medicare has a huge discount, as this example, $2753 out of $49070. One of my private insurance has no discount, and another has about 10% discount. For the lab, for the same test, my dialysis would charge about 4 times as high as my primary doctor office. For a lot of dialysis clinic, close to 90% of patients are with Medicare, and it has to rob a huge amount of money from the few private insurance patients. For the PD, Medicare would probably pay less than $100,000 a year for a patient. My private insurances had to pay about $500,000 a year for me. I used not many supplies and did not need much help from my clinic.
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I know of just one time that the rate paid by a private insurer for dialysis made it into the public record http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/law-suit-reveal.html (http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/law-suit-reveal.html)
the BCBS lawsuit confirms what I have heard from dialyzors and the self insurance industry - I've spoken at their convention twice - that charges can run five figures per treatment, over one million a year.
Greg I believe the dynamic at work is that the insurers' business model is to make a small profit on a big number. If the industry margin is 3% then to increase profits (and your CEO pay) you need to increase your expenses so then because your expenses went up you can increase your revenue (raise your prices) and earn 3% of a larger number. That's the underlying perversion of the private insurance system we have in this country. Not only does private insurance not keep costs down, their incentive is to see costs increase.
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Good point and good article, Bill. The lawsuit illustrates that at least one insurance company is no longer willing to pay whatever the service provider demands.
Thank you V for posting the attached PDF documents. This is a good thread on how medical care cost can spiral out of control based on the "charge anything you want and may be they will pay it" mentality. But if I were a health insurance company, I would think that the end of the bubble is very near and reforms will be demanded and implemented.
2008/01/law-suit-reveal.html
"Without a contract for NRA to provide dialysis to BCBSG benificiaries NRA is out of network, so they can charge whatever they want and BCBSG can pay whatever they want. It turns into a negotiation by other means (means like a lawsuit)."
I know of just one time that the rate paid by a private insurer for dialysis made it into the public record http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/law-suit-reveal.html (http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/law-suit-reveal.html)
the BCBS lawsuit confirms what I have heard from dialyzors and the self insurance industry - I've spoken at their convention twice - that charges can run five figures per treatment, over one million a year.
Greg I believe the dynamic at work is that the insurers' business model is to make a small profit on a big number. If the industry margin is 3% then to increase profits (and your CEO pay) you need to increase your expenses so then because your expenses went up you can increase your revenue (raise your prices) and earn 3% of a larger number. That's the underlying perversion of the private insurance system we have in this country. Not only does private insurance not keep costs down, their incentive is to see costs increase.
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BCBSG has some market clout - the people who are really taken advantage of are those in small pools, particularly people at companies that self insurer.
I think we should all be concerned about a system with a business model that looks remarkably like a lottery. Nationally there aren't a lot of people who use dialysis and have private insurance through a small private insurance pool. And then among that subgroup, dialyze through a large for profit dialysis organization. The $ paid by V's insurers are actually low compared to what's charged/paid by insurers without provider contracts.
The other issue here is geography because the going rates vary by location. In states with fewer people caring private insurance (SC for example) or where insurers generally pay less (CA for example) the average reimbursement at a unit will be less. The difference in dialysis between states is all about the differences in reimbursement - from Medicaid to private payers - all states are not equal.
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Bill,
This makes sense for my case. I am among self insurers. When BCBSG was the administrator, it paid 100% of the charges (without any discount). After administration changed to another company, we got about 10% discount. When I called the dialysis company (one of two largest dialysis com. in the U.S.) billing office to ask the base for my charges, they said they did not know. The computer generated the charges, and the charges were based on the insurances the patients had. One more example for the high charge: I usually got EPO indenpent of my clinic. One time when the recall problem caused my shortage of EPO, I asked my clinic to help to get some. The clinic director asked the Pharmacy (belonging to the same dialysis com.) about the cost and told me it was $590, which was about right based on what I paid through other pharmacies. However, when the dialysis com. billed my insurance, I saw the cost was $2700 plus $47 shipping. It is consistent that charges are about 4 to 5 times as the normal cost.
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One more example for the high charge: I usually got EPO indenpent of my clinic. One time when the recall problem caused my shortage of EPO, I asked my clinic to help to get some. The clinic director asked the Pharmacy (belonging to the same dialysis com.) about the cost and told me it was $590, which was about right based on what I paid through other pharmacies. However, when the dialysis com. billed my insurance, I saw the cost was $2700 plus $47 shipping. It is consistent that charges are about 4 to 5 times as the normal cost.
And the actual cost of EPO to dialysis facilities is about $12.00 per 1,000 units.
8)
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And the actual cost of EPO to dialysis facilities is about $12.00 per 1,000 units.
8)
This is probably the Medicare price. The $590 price from the Pharmacy is for 40,000 units, slightly higher than the Medicare price (12*40=$480). The $2700 charge is over 5 times of Medicare price then. When I had transplant, the hospital might charge higher price to my insurances than Medicare, like 20% or 30% higher. When the dialysis com. charges more than 500% higher than Medicare, it is something I feel like a "robbery".
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While this chart (on page 16) is almost 10 years old, you can see that the 4 largest dialysis chains had good profit margins for EPO and other drugs, even between the Medicare approved reimbursement verses what it cost them.
This actual drug cost is referred to as Average Acquisition Cost or Average Sales Price (ASP).
http://oig.hhs.gov/oei/reports/oei-03-04-00120.pdf