Dialysis patients question coverage cuts

[okarol]

12 ON YOUR SIDE
Dialysis patients question coverage cuts


Posted: Jun 07, 2011 2:55 PM
Updated: Jun 07, 2011 3:00 PM
By Diane Walker - bio | email

VIDEO available at link at bottom

RICHMOND, VA (WWBT) – Many kidney dialysis patients need help paying their supplemental insurance which covers things that Medicare won't. But expensive premiums once paid by the American Kidney Fund (AKF) are being denied. Patients who have policies with companies charging more than $500 a month are being forced to get cheaper plans or pay the monthly premium out of pocket.

David Cujas' Medigap coverage, supplemental insurance is $1166 a month.   

"I don't know where the money came from initially but, I was very grateful to have it. All of a sudden you know it's stopping," he said.

West End Dialysis, Fresenius Medical Care applied for grant money on David's behalf and the American Kidney Fund paid his premiums. David called 12 after seeing my report on another dialysis patient, Barry Druin, who goes to DaVita Dialysis Clinic but faces the same dilemma.

"You have given him a death sentence. You can't stop the medication that's what keeps him alive," said Barry's wife Linda Druin.

Losing grant money for premiums frightens David too. The diabetic has had two heart surgeries and a partial leg amputation.  He recalls how he says the clinic's social worker informed him.

"She just looked at me square in the eye and said, ‘As of the end of June, you won't have a policy anymore.' While I was getting dialysis and said, ‘we are not paying for it anymore,'" David said. "I'm afraid of dying."

No one will be barred from dialysis. But the fund's vice president says patients need to ask for help finding cheaper coverage if they haven't been able to on their own. AKF tells me the number of patients nationwide with policies from companies charging expensive plans, is 8% of the people it serves. It won't pay those escalating prices for Medigap policies after June 30th. 

"That 500 dollar limit, whose rule is that?" asked David.   

The American Kidney Fund Vice President Tammy Ruggiero says it's staff is being prepped to better answer patients' questions and offer help finding alternative coverage. Both dialysis patients I spoke with say they have supplemental insurance through Blue Cross Blue Shield.

http://www.nbc12.com/story/14861114/dialysis-patients-question-coverage-cuts

[noahvale]

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[scooter26]

AKF works with providers to process requests for premium payments for ESRD patients.   The guideline regarding the cap of $500.00 for Medigap policies was not instigated by AKF but by the providers.  For instance the Davita policy now states that a request for assistance for a Medigap policy can no longer be submitted to AKF.   

Please understand that AKF has nothing to do with this new rule and can do nothing to change it.   THis decision was made by dialysis providers.

[cattlekid]

I'm not sure I understand.  Why couldn't an ESRD patient go directly to AKF for their request?  Why does the provider have to be the middleman?

AKF works with providers to process requests for premium payments for ESRD patients.   The guideline regarding the cap of $500.00 for Medigap policies was not instigated by AKF but by the providers.  For instance the Davita policy now states that a request for assistance for a Medigap policy can no longer be submitted to AKF.   

Please understand that AKF has nothing to do with this new rule and can do nothing to change it.   THis decision was made by dialysis providers.

[PatDowns]

Please help me out here since I'm confused as well.  An older patient at my dialysis center asked me to help her fill out an AKF Health Insurance Premium Program application.  She said that the AKF would pay secondary insurance premiums if financial qualifications were met.  Are you saying that the dialysis centers were funnelling "donations or grants" to the AKF to administer the program and then have the AKF pass the money back to them for their patients who signed up and qualified?

Sure, it sounds like a legal way to circumvent laws pertaining to dialysis facilities outright paying patient premiums just so they can be reimbursed for the 20% copay many patients do not have.  But from my understanding, other medical bills besides dialysis were covered as well.  Is this a wrong assumption?

So, basically then, DaVita and other providers who have been participating, have decided that premiums had reached a point of diminishing returns when an AKF administrative fee and higher rates were factored in.  Therefore, the $500 cap in "medical grants" to the AKF?

AKF works with providers to process requests for premium payments for ESRD patients.   The guideline regarding the cap of $500.00 for Medigap policies was not instigated by AKF but by the providers.  For instance the Davita policy now states that a request for assistance for a Medigap policy can no longer be submitted to AKF.   

Please understand that AKF has nothing to do with this new rule and can do nothing to change it.   THis decision was made by dialysis providers.

[scooter26]

"I'm not sure I understand.  Why couldn't an ESRD patient go directly to AKF for their request?  Why does the provider have to be the middleman"


I believe that the requests must come from the dialysis provider but I'm not 100% sure of that.  AKF would need to be contacted to verify the policy.