Medicare and NxStage

[HubbysPartner]

I have a question for anybody on NxStage that is on Medicare.  My hubby's neph told us that Medicare only allows 3 treatments per week for hemo regardless of the type of treatment.  We have private insurance, but were considering enrolling in Medicare as well to see if it would help with some of the payments.  However, I foresee a time when Medicare will be his primary insurance and I wonder if anyone can tell me how Medicare handles payments for NxStage treatments.  I don't need numbers, I'm just looking for the number of treatments they pay for each week.  Thanks.

[Malibu]

OMG.  I really don't think that is true.  If it is we are sunk.  We are on home hemo on NxStage and our only form of insurance is Medicare.  We did just apply for a secondary tho...  We have not received any bills, I'm beginning to think they've forgot about us.  Actually we did get a bill from Davita, I forgot about it.  It was for the first day of dialysis/training at our facility.  It was $3930.  I promptly asked them to send to Medicare!  Other than that I have not received anything.  I am sure my mailbox will be half fallen over with the weight of the bills now that I've said that.  I'm going to check now.  As soon as I get bills I'll let you know.

I know -- call NxStage, surely they have a billing department or someone there who can answer the question.  Pretty Please post it when you get it. 

[M3Riddler]

HubbysPartner,

Not so.
 Yes, Medicare will only cover 3 treatments per week, but, that is for any modality of hemodialysis ( in center or home ). To get around this, your, or any, nephrologist can write a justification for more dialysis and Medicare will pay for it. Many on Nxstage that are on 5 and 6 days a week get paid for all treatments.  If you would like more information, vist the nxstageusers website and there is a section called Medicare and You that may have some of the information you are looking for.

///M3R

[HubbysPartner]

Thanks, M3R, I will do that.

[Harvey Wells]

M3R is right, sometimes Medicare will pay for additional treatments WITH medical justification.  Unfortunately each area of the country is different and the state or area MAC's (Medicare Administive Contractor) approves or denies the necessity of additional treatments - there is no consistency.  Looking over my billings over the last year, they were all over the place - sometimes they did, sometimes they didn't.  Regardless there is no difference it what your obligation is as a Medicare beneficiary you are only obligated for your portion of what Medicare authorizes.  In my case that's picked up by my secondary private insurance, different states have different rules or procedures on the patient obligation after medicare pays based on their income and/or secondary payer.

Once you are on dialysis, Medicare automatically becomes primary after 30 months if you have employer or union group coverage, there are other types of insurance and programs to help pay some of the costs.  If you don't have employer or union group coverage or some type of private insurance, Medicare begins on your fourth month of treatment unless you choose home dialysis, either PD or Home Hemo, then they cover from day 1.

Bottom line is there should be no additional financial obligation incurred by choosing one dialysis treatment over another.  If anything, any home therapy should be less out of pocket if you're just begining dialysis.

Your center social worker should be able to explain all your options based on your situation.

http://www.medicare.gov/Publications/Pubs/pdf/10128.pdf

[Meinuk]

Thanks Harvey for the link.

I am a big fan of Home Dialysis Central for information. http://www.homedialysis.org/ they are professional, have a Social Worker posting & Dr. Agar (a leading Nephrologist from Australia), and are all around good people. 

Here is the link to their Medicare FAQ:

http://www.homedialysis.org/pros/medicarefaq/

[HubbysPartner]

Thanks everybody.  I knew there had to be a way to have the additional treatments paid for.  Otherwise, people wouldn't be able to afford treatment.