how is home PD supplies and liquids charged

[marlinfshr]

I just had a consultation with the PD surgeon today and they are supposed to call me Monday to set up an appointment. I'm still on the fence, though I'll probably give this a try. Even though I don't like the idea of daily exchanges every several hours, I don't like the idea of sitting on a machine in a clinic for 4 hours every other day either. Especially with one nurse complaining every time I move and setting off the alarm. What am I supposed to do? Sit perfectly still for 4 hours. Maybe she should be hooked up to the stupid machine in these uncomfortable chairs to see what it's really like.

Sorry for going into a mini rant. One thing I haven't seen discussed is how are the boxes of liquids charged. I am not on medicare as I still have my BCBS individual insurance which has been covering everything except medication. I never got a pharmacy plan so all prescriptions I pay out of pocket. Are these fluids and supplies billed as if your dializing in center? Or are they treated like regular prescription drugs ordered through a pharmacy? In one case my insurance would cover it as it covers my in center treatments at Davita. The other case my insurance won't pay a dime because I have no prescription plan. That would definitely affect my decision.

I guess this is one thing I really have to ask my insurance company about before I get the tube inserted.

[Tío Riñon]

Like you, marlinfshr, I didn't appreciate having to go to a treatment center 3 times a week and spend 4 horrendous hours in a chair, plus deal with the after affects.  I switched to PD and have been pretty happy with it.  Based on what you've shared, I believe you will appreciate it too.

As far as your coverage goes, I too have BCBS, but mine is a group policy (and probably from another state).  However, I have found that the policy covers everything related to dialysis (and transplants) and given that PD is generally cheaper than HD, I'm sure they'll work with you.  In fact, I've listed at two transplant clinics and they've been very happy with the coverage too.  I encourage you to talk to BCBS to confirm your converage, but I suspect you won't have much to worry about except for your prescription coverage.  I would definitely consult your social worker to see what options you have since you'll often times have prescriptions on PD.  You'll want to avoid paying full price as some of them can be quite expensive!

Finally, keep in mind that your insurance company is only obligated to cover your dialysis for 30 months from when you started.  After that period, you are required to get Medicare and they will serve as your primary insurance and BCBS will become your secondary. 

Good luck!  Let us know how things turn out.

[JLM]

I think they are charged as medical supplies, as I get an EOB from Medicare

[Sydnee]

We have BCBS of Alabama (Ed's employer coverage) but they have prescription drug coverage through CVS. This is how it works for us.

Ed has been on PD since August of 2012 FMC bills just BCBS for PD and supplies that are shipped directly to us. FMC pays the whole bill after the OOP (out of pocket) is satisfied.
We know that NONE of the bill goes to CVS nor did we get told that we should have gotten the supplies through them. Since we had that problem at the EYE DR we know how that would have worked. Ed gets injections  into his eyes, In January BCBS said that they would not pay for the "prescription drug" that Ed got that month. (like he could get it at the the pharmacy and take it at home) After quite a while on the phone with BCBS (they felt that we needed to mail order the drug) we got them to pay for that 1 shot but we then had to call CVS and get payments for future injections figured out. We ended up being about to get the shots pre-authorized (rather than having to mail order the shots.) 

So atleast for us PD is NOT prescription drugs.

[amanda100wilson]

dialysis fluid is not charged for as a pharmacy prescription.

[adairpete]

The PD fluids are not charged like prescription drugs, but like a medical treatment.  PD is much less expensive than hemo (when I was on private insurance anyway, charges are different now that I'm on medicare).  When I was doing hemo it was $3-$5,000 per session (depending on what drugs they gave) versus ~$10,000 per month for the PD supplies (this was with Aetna private insurance).

[Simon Dog]

Did your insurance carrier actually pay $3K-$5K per session or was that the asking price?  FMC bills my carrier over $3K/session for HD, but accepts a negotiated "paid in full" price of $339/session.

When I was on PD, the billing was "per treatment" and the supplies included as part of the treatment charge.  Unlike a regular Rx, there was not a charge per bag of solution delivered.

[tito]

When I go to my house in México, supplies delivered to my door for a week cost about $300 (not insured in México). Maybe this is the Mexican price? Anyway, Medicare and Harvard Pilgrim Health pay for all of my supplies in the US.

I will be moving to México - so much cheaper. Going to the dentist  there later this week. A root canal with crown is about $600 in México (over $2000 in the US). A cleaning with exam is $25. I need a dental clearance letter to get back on the list at Columbia Presbyterian in NY. Live the rest of the year in Boston, and I will be staying close to home so I can get a transplant.