New Caregiver to this Board

[Constantlearner]

Everything I’ve learned about dialysis of any value came from the people in the waiting room for dialysis waiting for their appt. This is how I found out about this board.
I am early retired and due to a medical error, my VERY active 86 y/o mother now has Stage 5 Renal Failure. Lesson learned, ALWAYS accompany elder parent to all dr visits. Now her life consists of 3x/week 3.5 hours a day.
Because of this and her insurance, she can no longer travel. NOBODY will tell me how much it will cost her should she go “out of network” and pay the 20% after Medicare. I called this insurance and complained that they are literally taking away an elder person’s lifestyle by having only FOUR choices of dialysis “in network” locations for the entire State. None of which are by my cabin OR my main home. So she can’t visit me again.
At first she didn’t think she wanted this lifestyle and only agreed to 2 months to “please us kids” but now a habit is forming and she is doing better. Again thanks to the people I talk to in the waiting room. Looking forward to getting great advice here.

[cassandra]

Welcome to the site constantlearner


 


I hope you'll find all the info you want here.


Take care, Cas

[iolaire]

Welcome to the group. Medicare pays a fixed rate for dialysis, I'm sure someone knows the current number. So that 20% cost should be a fixed cost. I think it's in the $50-70 range. Once you know the real number you should be able to figure out what your out of network payment rate is for your insurance.  You might also be on the hook for copayment on some labs as well but luckily the Medicare lab rates seem very low.

[Simon Dog]

NOBODY will tell me how much it will cost her should she go “out of network” and pay the 20% after Medicare.

As a Medicare patient the clinics must accept the Medicare rate, and charge her only 20% of that.   This generally runs a bit under $300 per treatment.  You should be able to contact the facility administrator and find out how much  they bill Medicare for a treatment.

Figure about $60 per treatment for the 20%, +/- a bit.

[Michael Murphy]

Sit down with the social worker or the insurance person at you mothers clinic, have them explain he options.  Now is the time to do this because it the option time for most people's insurance selection.  With the 80 percent rule on Medicare the cost is between 450 and 500 per month.  Check with your current insurance and see if they have agreements withe Fresinius or Davila the two biggest national chains.  If they do they should pay at out of state affiliated sites.  Remember to check the ratings of sites (google CMS dialysis ratings) to find if the clinic has problems.

[Charlie B53]

Welcome to our IHD 'Family'. A number of our members are also 'Caregivers' so you fit right in.

I am no help when it comes to Insurance or cost questions.  Other than I have made sure my Wife (Retired) has a Medigap policy that covers ALL of the co-pays that Medicare Parts A and B leave unpaid, so we have no co-pays other than her prescriptions.  Which are enough all by themselves.

I am far more interested in the 'medical errors' that have caused your Mother to be reliant on Dialysis.  Is this 'shock' to the kidneys?  If so then there is a slim possibility of recovery, to an extent.  Biopsy may be useful in determining the extent of permanent scarring, permanent damage.

Until then, Prayers for Mother are foremost in my Heart.

Take Care,

Charlie B53

[Simon Dog]

I am far more interested in the 'medical errors' that have caused your Mother to be reliant on Dialysis.

If it was truly a "medical error" rather than just a "bad outcome and known risk" that led to dialysis, the co-pay for Medicare treatments should be pocket change compared the malpractice settlement her attorney should be able to negotiate.

[Vt Big Rig]

Welcome to the site and best of luck eith your Mom.