I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: donnia on April 02, 2007, 02:37:30 PM
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I hope this is the right place for this.
I just got off the phone with my insurance, they told me my co-pay is $30 per visit....thats almost $400 per month! Medicare wont kick in for 3 months after I start dialysis... I know medicare will be my secondary for the first 30 months... do they help pay anything while they are the secondary??? Gosh, I am really freaked out on how I am going to pay for this!!!
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when medicare kicks in it will pay 80%. we all probably started dialysis before medicare, unless we were already over 65. i didn't have any additional insurance, the center wrote off the first 3 months. Yours will probably accept the insurance you have, check with your center's social worker.
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The bills I received from my insurance company showed a co-pay but the dialysis unit never billed for it. They just took what they were paid. Now I am on medicare as my 30months is up.
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How much do you have to pay now that Medicare is your primary?
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I hope this is the right place for this.
I just got off the phone with my insurance, they told me my co-pay is $30 per visit....thats almost $400 per month! Medicare wont kick in for 3 months after I start dialysis... I know medicare will be my secondary for the first 30 months... do they help pay anything while they are the secondary??? Gosh, I am really freaked out on how I am going to pay for this!!!
One way people have minimized the copay is having the unit Bill monthly. The initial 3 month period before qualifying is waived if you start home dialysis training.
Are you getting any financial counseling from the unit?
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Not yet, I guess I need to contact them.... I just had my AV fistula done last week, so it will be a few months before I can start dialysis... but, I am trying to be prepared for everything.
So I should go to the unit and ask them for financial counseling? Okay. Thanks!!
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It would be in your best interest to get all the info you can now so your not surprised and overwhelmed when you do start.
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donnia, once medicare kicks in since you have a second insurance you shouldn't be billed anything. medicare will pay 80% and your private insurance will pick up the rest. the only time i have to pay anything is when i travel. i have medicare and Medicaid and the medicaid only pays within colorado. when i visit my family in oregon the hospital bills me for the 20% medicare doesn't pay which is only around $110 for a two-three week visit.
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I find it cruel to the point of lunacy that the richest country in the world imposes these bureaucratic complications and financial cruelties on people who already have to summon all their available resources of courage and fortitude to deal with their catastrophic medical problem. In Canada, in contrast, money and medicine have nothing to do with each other, for anyone, anywhere. When you need medical care, you just present the identity card you get free from the government for being a citizen or permanent resident, and that entitles you to everything you need. There are no cash registers, billing units, greedy doctors, cruel hospitals, elaborate bureaucracies, people going into bankruptcy from medical expenses, people putting off medical visits they can't afford until their condition becomes untreatable, no private insurance vultures living off the misery of others, nothing -- just a single plastic card and everyone's happy.
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... just a single plastic card and everyone's happy.
Really? Give me a break!
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When I lost my HMO and only had Medicare, I went into debt. I couldn't afford the co-pays and such of dialysis or doctor visits so the bill just sat there, un-paid, and now they all sit on my credit report. Some were written off, others weren't.
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-- just a single plastic card and everyone's happy.
Then why do so many rich Canadians end up down here getting medical treatment? Couldn't have anything to do with the fact that the waiting time for many cruical treatments is so long that they are afraid they will die before they make it to the top of the list?
http://www.heartland.org/Article.cfm?artId=18276
Our system may have a lot of hurdles, but we don't wait for 17 weeks after a referral!
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What has hurt us the most is my lost income, since i cant work anymore we are really feeling it. Granted i do get a small amount from the government but that is what i used to make in a week. I do however thank God for my hubby's insurance and Medicare, without it i am sure i wouldnt be here now. There would be no way we would be able to pay for dialysis even if it was 20%. just my :twocents; :-\
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What has hurt us the most is my lost income, since i cant work anymore we are really feeling it. Granted i do get a small amount from the government but that is what i used to make in a week. I do however thank God for my hubby's insurance and Medicare, without it i am sure i wouldn't be here now. There would be no way we would be able to pay for dialysis even if it was 20%. just my :twocents; :-\
That is more than your :twocents; It is a reality. I don't know what my future holds but I do know without my wife's insurance I'd be sunk.
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We are in Canada so the medical treatment is free?? Not totally. You still have to pay for travel to get these treatments. My insurance covers $600 per year for travel. Big deal!! When you have over an hours drive 3 times a week that covers expenses for about 1 month. I can claim the rest on income tax but still don't get back all we pay. Last year we spend over 4000 dollars just on gas - tht doesn't count the wear and tear on the car. Thank God we are doing home hemo now. Our car is four years old and has 165,000km on it. There is a long waiting period for referrals that's why you see people going out of the country. It is ridiculous to have to wait over a year to se a dermatologist or any other specialist.
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We are in Canada so the medical treatment is free?? Not totally. You still have to pay for travel to get these treatments. My insurance covers $600 per year for travel. Big deal!! When you have over an hours drive 3 times a week that covers expenses for about 1 month. I can claim the rest on income tax but still don't get back all we pay. Last year we spend over 4000 dollars just on gas - tht doesn't count the wear and tear on the car. Thank God we are doing home hemo now. Our car is four years old and has 165,000km on it. There is a long waiting period for referrals that's why you see people going out of the country. It is ridiculous to have to wait over a year to se a dermatologist or any other specialist.
That is the draw back on the kind of healthcare Canada has, people I think are abusing the system.
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i guess i live in a good state, i'm on disability and get medicaid. yes i have a very limited income, less than half of what i used to make, but i worked for almost 40 years, i fell that i have earned what i get.
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At the time I went on dialysis, I was well insured by both my employer and my husbands. I thought this was great and I would have no worries. However, for the first three months, Fresenius billed my insurance anywhere from $7300 - $9400 every 2 WEEKS for dialysis treatment (NOT including medication) !!!!!!
On top of that, I had to meet annual deductibles and still pay 20-30% before reaching out of pocket maximums totaling $6000. I would have been better off not working.
People with insurance get totally screwed as well.
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Not quite sure where you got your info from Stauffenberg. As a Canadian myself, I happen to know that I have to pay for that little card, and it isn't cheap. If you go to the doctor or emerg and you don't have one of those little cards you paid for, the bill will come in the mail. And yes, we do go to the states for some treatments, providing we have financial means to do it. Wait times here are ridiculous. We pay premiums just like the rest of you. On top of that I have to pay for a "special" Blue Cross because I am a dialysis patient so I can get some medications covered that a regular insurance company won't cover. That covers 80%. Need to by $2500 worth of Eprex every three month's? Then you better have another insurance company to cover the other 20%. Which I also have to pay for.
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Not quite sure where you got your info from Stauffenberg. As a Canadian myself, I happen to know that I have to pay for that little card, and it isn't cheap. If you go to the doctor or emerg and you don't have one of those little cards you paid for, the bill will come in the mail. And yes, we do go to the states for some treatments, providing we have financial means to do it. Wait times here are ridiculous. We pay premiums just like the rest of you. On top of that I have to pay for a "special" Blue Cross because I am a dialysis patient so I can get some medications covered that a regular insurance company won't cover. That covers 80%. Need to by $2500 worth of Eprex every three month's? Then you better have another insurance company to cover the other 20%. Which I also have to pay for.
Thank you Brenda and everyone else for setting the record straight.
:beer1;
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Brenda, I don't know where you live, but where I live in Canada, in Ontario, all I had to do to get my healthcard was fill out a form and wait for it to arrive in the mail. There were no fees attached. The Canadian healthcare system varies slightly among the provinces, within the limits set by the federal government, which does require that "all medically necessary services be free." When you say you pay for your healthcard, perhaps you mean through taxation. But the progressive taxation system pays for healthcare according to how rich the person is and thus how easily and painlessly he can afford to pay, rather than to how sick the person is -- as a private healthcare system does -- which does not take into account ability to pay. So under a socialist healthcare system dialysis is paid for by rich people having to settle for a 30-room mansion rather than a 34-room mansion, while under a non-socialist system, it is paid for by renal patients having to go into bankruptcy at the very moment they are in the fight of their lives against a deadly disease. You pick which system is more moral.
During the 9 years I spent on dialysis in Ontario I never paid anything for any special Blue Cross insurance such as you describe, and never even heard of it until now, and I never paid a cent for EPO. All medications administered in the hospital or in a dialysis clinic are absolutely free. It is only medications you take at home that are not covered -- though when England introduced its system of socialized medicine in 1948, even home medications were free. When I lives in England in the 1970s and 1980s, there was a standard price for all my prescriptions, which was 50 pence (then equal to $1.00 Canadian), regardless of how much the pills actually cost. For drugs I had to buy for chronic conditions, there was no charge at all.
Even now that I am off dialysis and living with a transplant, I do not pay a penny for my EPO (in the form of Aranesp), which the provincial government provides for free.
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-- just a single plastic card and everyone's happy.
Then why do so many rich Canadians end up down here getting medical treatment? Couldn't have anything to do with the fact that the waiting time for many cruical treatments is so long that they are afraid they will die before they make it to the top of the list?
http://www.heartland.org/Article.cfm?artId=18276
Our system may have a lot of hurdles, but we don't wait for 17 weeks after a referral!
With it's faults and abuse I think the US has a great system. It's not perfect but I am very grateful for the help I'm getting from the government. I rarely see a bill. No system can be perfect but I thank the USA for my care. Of course I paid into it since I was 16 by working.
Donna :)
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Well said by the angry Bear http://www.angrybear.blogspot.com/
Sure, the argument goes, the US health care system has some shortcomings - but at least it doesn't involve long waiting lists for elective procedures, as is the case with countries that have primarily government-run health care.
It turns out that this is largely a myth.
Let me leave aside the point that waiting lists exist in abundance in the US for elective procedures - it's just that when people are waiting in the US, they are waiting for a miraculous windfall of money to be able to afford the procedure, rather than waiting a few months until their number is called. No, right now I want to focus on the myth that government-financed health care necessarily entails waiting lists for elective procedures.
The data shows that many countries with "nationalized" health care systems have little or no waits for elective medical procedures. A 2003 OECD working paper entitled "Explaining Waiting Times Variations for Elective Surgery across OECD Countries" by Luigi Siciliani and Jeremy Hurst provides some survey evidence of actual waiting times in various OECD countries. The results of that survey are presented below. (here is the link to a gianormous PDF file http://www.oecd.org/dataoecd/31/10/17256025.pdf )
(http://angrybear.blogspot.com/healthstats3.jpg)
Note: figures for Canada and U.K. reflect median waiting times.
In all of the countries surveyed above (except the US), the government is responsible for the vast majority of health care spending. (See AB's post from yesterday for specific data on that.) Yet many of them have no waits for common elective procedures. Clearly government financing of health care does not, in and of itself, cause waiting lists for medical procedures. If a country has waiting lists for elective health care, that is due to some specific design flaws in its health care system, not because it is financed by the government.
The rest of the paper mentioned above goes on to take a look at the factors that lead to waiting lists. The authors run some econometric tests that conclude that long waits for elective surgeries tend to happen when 1) countries don't have enough acute care hospital beds (France and Germany have plenty, the UK doesn't); 2) countries have older populations (older populations create more demand for elective procedures); and 3) countries pay specialists a salary rather than according to a fee-for-service formula.
One last point of interest: what do consumers in other countries have to go through in order to receive these elective procedures? The following table shows out-of-pocket costs for elective procedures, and who makes the decision about whether an individual should receive the service.
(http://angrybear.blogspot.com/healthstats4.jpg)
In countries with government-financed health care, the decisions are made by doctors - often by the specialists themselves - and out-of-pocket expenses to individuals are negligible. Compare this to the case of the US, which is somewhat different in both dimensions. What would an American expect to pay out-of-pocket for elective hip replacement, and how many hoops would they expect to have to jump through to get approval from their HMO?
So the next time you hear that the US health care system is better than those of other countries because Americans don't have to wait for their health care, recognize this argument for the myth that it is.
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Not quite sure where you got your info from Stauffenberg. As a Canadian myself, I happen to know that I have to pay for that little card, and it isn't cheap. If you go to the doctor or emerg and you don't have one of those little cards you paid for, the bill will come in the mail. And yes, we do go to the states for some treatments, providing we have financial means to do it. Wait times here are ridiculous. We pay premiums just like the rest of you. On top of that I have to pay for a "special" Blue Cross because I am a dialysis patient so I can get some medications covered that a regular insurance company won't cover. That covers 80%. Need to by $2500 worth of Eprex every three month's? Then you better have another insurance company to cover the other 20%. Which I also have to pay for.
I stand corrected also, I wasn't aware of the premium associated with the card.
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Well aren't you Ontarians lucky. Free, free free. Guess I live in the wrong province. Not likely. Maybe you should educate our Alberta Government. Or maybe I'll just call the premier myself on one of my several mansion phones. Just for you Stauffenberg I read my paystub again today, $62.00 off each and every month for Alberta Health Care. Oh, and here's my Blue Cross bill, $41.00 per month, paid in full. Oh, and here's a bill for Phoslo $151.18 that nobody will pay for except my pocket. I have worked and worked hard everyday for all 13 years of my dialysis life. Not every dialysis patient in Canada goes bankrupt.
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so here is a question for you all....i am going away for a week in july and they tell me that my mainecare will not cover out of state and i will have to pay the 20%....so how much should that be around???? plz help if you can
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so here is a question for you all....i am going away for a week in july and they tell me that my mainecare will not cover out of state and i will have to pay the 20%....so how much should that be around???? plz help if you can
The Medicare composite rate (what you're paying 20% of) is case mix adjusted, and there is a geographic wage adjustment but the range should be $26 to $34 if you're an average guy, going to an average city.
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i have to pay the 20% when i visit my family in oregon. the last bill i received from the hospital there was $64 for two treatments.
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down here in australia,we recieve dialysis free,medications for pensioners are $5 per item,but you do pay a medicare levy in your taxes. :thumbup;
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I'm very fortunate in that my former employer is paying $900 a month for my COBRA coverage. I have no copays for anything dialysis related, including prescriptions, under this coverage.
I hope to be transplanted by the time my COBRA eligibility expires. If not, my Hubby will have to go back to a job with benefits.
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We have not been able to get insurance for many, many years but dialysis is not costing us anything. Mike started dialysis training for home dialysis on his first day of dialysis so the three month waiting time was waived. We went to a "not for profit" clinic so they accept what Medicare pays as payment in full.
Our costs were/are associated with the fact that the only clinic with NxStage in South Carolina is 200 miles away. We stayed in our camper in a campground for the three week training time and Mike has to drive there once a month to take his blood samples, get his check up, turn in his "flow sheets" and pick up supplies.
He was getting his BP meds free from his neph and through drug company programs, but now he is covered by Medicare so he now has to pay the co-pays.
BUT, the biggest expenses were in the two years before he started dialysis, especially those associated with getting his fistula and the frequent neph appointments.
In the US the cheapest way to go is to wait until your kidneys fail, have "emergency" placement of a catheter, get the fistula done ASAP, and start home training before the three month period is over. That way Medicare "back dates" and covers all of the expenses.
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I think we have many members here filed for bankcruptcy because of kidney failure. Let just hope, one of us here win the super lotto.
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just tell them you can pay them with a kidney if they want .......sorry i had to say that
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When i moved back to Pennsylvania from Nashville Tennessee i had two heart attacks. I didn't have a job yet so i had no insurance. On my first attack they Told me my kidney had failed again. I asked what my creatine was it was 3.4. I told them that since i was on before i would wait. I did not anything about medicare. When i received my transplant i was working at Prudential Insurance. They paid for everything. So when i moved back with out insurance i was concerned about what would happen. I received meds i needed from the docs. free samples. The collection calls came in. For months they called. Months turned to a year. The cost went up to 157,000$. I stayed off dialysis. It took 6 months to get medicare B. I was already on Medicare A because of ESRD. Unfortunately a human being can take only so many calls. So i went bankrupt. I lost what i had. But at least i am alive. I didn't know i was covered under the medicare A. I was told all renal patients are covered under that automatically. Now i collect s.s. I pay 90$ for medicare B. I also pay 228$ a month for bluecross a supplemental insurance. I also pay 68$ for medicare D that covers meds. The only bills i received were from my fistula doc. and my neph. docs. That was only 60$ ea. This past year was very quiet no calls. No more threats. Just dialysis and the wait for a new kidney.
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I guess in some ways im lucky and then not in others. I worked construction prior and I didnt report my income. So when I was put on dialysis I was unable to get medicare because I didnt have enough work credits. Unfortunently Medicare is what im being told is what will pay for any transplant surgeries so without medicare I cant even be put on a transplant list.
The way that im lucky is I am on medicaid, and the way its working out for me so far, is All my dialysis treatments are paid for, including doctors apt, prescriptions and even additional care for my rheumatoid arthritis.
So all in all, I guess I cant complain as noones hounding me for money... but I sure would like to be on a transplant list too.
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Being sick and get call from collection is suck.
So Pierrat, if they do not put you on the list, then will you ever get a chance for kidney transplant? Your story sounds very strange!
Which state are you currently reside?
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I'm very fortunate in that my former employer is paying $900 a month for my COBRA coverage. I have no copays for anything dialysis related, including prescriptions, under this coverage.
I hope to be transplanted by the time my COBRA eligibility expires. If not, my Hubby will have to go back to a job with benefits.
When my husband's Cobra was due to expire he was eligible for an 11 month Cobra extension as long as he had been approved for disability with Social Security Dept. Since the disability didn't kick in before the Cobra expired, he then became eligible for the HIPPA health insurance offered - which we now have through Blue Shield. I believe each state is required by the federal government to provide health insurance coverage to those people whose Cobra will expire, but it isn't cheap!
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I qualified for Medicare back in `94 ,long before my kidney failure. I did not have a supplimental at the time ,but around 1997 we purchased a supplimental policy.Back then ,companies would sell one to disabled persons under 62. Even though it costs us $178.00 each month above my medicare payments it has saved us a lot of very large copays. I don't get a bill for anything,my hospital bill of over $22,000 was covered. My doctor bills are covered as my pd supplies and my clinic visits and all lab work. I pay nothing.
If you have medicare ,a medicare suppliment is a must.
With the new drug plan,I pay $7 or less(generic) or $30( for name brand on list) or $60 for special drugs(like Fosrenol and Zemplar)
So ,I guess you could say I am making out like a bandit.
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Did someone say bandit? The cost of health care in U.S is outrageous. Bless you for having Medicare Supp.
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For the first 2 1/2 years of Dilaysis, Blue Shiled was primary and Medicare was secondary. Every 2-3 months I receive a bill from Medicare because I work full time. Early in the year it's anyway from $80-$100. As time goes on throughot the year, the co-pay goes up. My most recent bill was for $400. Now don't get me wrong, I'm appreciative of the help Medicare provides in the U.S. But sometimes I can't pay the bill and it starts to add up. At one point I was cancelled because I owed over $1400.
Fortunately our social worker is on the ball and actually cares about our emotional and financial well being. She clued me into the National Kidney Fund that helps patient's with their medical bills associatied with MediCare. Without that help I would be fighting debt and ruining my credit score.
I'm so grateful when I find good people in the medical industry who actually give a damn.