I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Home Dialysis - NxStage Users => Topic started by: *kana* on July 14, 2011, 04:10:27 PM
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Hello,
I was told today at clinic that the only people doing home Hemo with NxStage were those that had Medicare secondary and private primary and haven't gotten to the 30mth switch . Is that true or is anyone Medicare primary with private secondary? I see many of you that are on NXstage and have been for several years. Are you paying out of pocket for the 3 days that Medicare doesn't pick up or whats up? My nurse is kind of a dingbat and she might be telling me wrong info.
I need to call my Cigna company and verify that they wont pick up the other 3 days.
Thank you
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I don't know the answer to that, but you can go to www.homedialysis.org and pose your question. Go to the forums and you will see that Beth Witten, who is a licensed social worker, takes questions about insurance and Medicare. I'd like to know the answer, myself, so let us know what you find out.
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There are 15 Medicare Administrative Contractors (MAC) / Fiscal Intermediaries (FI) that actually pay the Medicare bills across the country - I hear all of them will pay for 14 or 15 treatments in a month, no medical justification needed. I also hear that 14 out 15 will pay 17 or 18 (and the 15th may be changing) also no MJ needed. I also hear that most, but not all, will pay all that are billed ... there does seem to be some variation once treatments billed are >18, and this is in flux so it can change at any time.
I've heard that with Medical justification - history of heart disease or a number of other medical diagnosis also qualify - all MAC/FIs are paying for all treatments.
But that shouldn't matter because 15 payments a month at the Medicare approved rate ~$230 is more than enough for a NxStage program to make economic sense. It would even pencil out at 13 payment based on the average reimbursement rate if the program has any private payers.
But that shouldn't matter because I think what you are describing shouldn't happen. I think the units are suppose to operate by offering the same care to all patients, I don't think Medicare allows one level of care for Medicare Beneficiaries and another level of care for everyone else. And this may be why most MAC/FIs pay, but there have been problems in the past and it wouldn't be too surprising if there have been some inconsistencies but I would expect to have access to more frequent home hemo no matter where I lived and I have been Medicare primary since 1988.
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Is there a difference in the Medicare amount approved per treatment for home hemo vs in center hemo? Does anyone know? I know the number of treatments can vary, but let's say Medicare approves 5 treatments per week for at home. Does the Medicare approved cost per treatment differ between in center and at home?
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I was on cigna when I started nd stage. It switched into Medicare as first with a secondary after the 30 months. I
I never had to pay any additional payments, thank god. I am with Davita and they have helped by getting the kidney foundation to help pay for the secondary insurance. Hope you get this worked out soon.
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Have just started Nx Stage. Medicare is primary with private insuance as secondary. No issues as far as I'm aware