Insurance Nightmare

[Jannie]

I knew I had kidney failure years ago, but I declined slowly. In July they told me to get ready,it was time to start Dialysis. I picked hemo rather than PD and they told me, there;s a new dialysis center,, go there,  you'll love it. So I visited. It's near my home and they have parking. But my damned insurance company does not have a contract with them, they're not "in the network". So I dialyze where I can, at a local hospital. The nurses and techs are nice enough. But it's in the basement, it's dismal, and a REALLY HATE it there. When I call the other, nicer center, they say they're working on it, it will take a couple of months. So my plan is to keep going to the hospital, and wait for the new center to get a contract with my insurance. I know I can't afford the treatments myself, it's $600 a pop. That's $1800.00 a week. And I've got like zero in the bank and I'm living paycheck to paycheck. Should I try to appeal with the insurance company? Anybody?

[glitter]

what about medicare kicking in?

[KT0930]

glitter, medicare doesn't start paying anything until 3 months after you begin dialysis treatments, and if you have any other insurance, medicare is secondary to that. If her primary insurance doesn't pay anything, neither will medicare.

Jannie, as for whether you should appeal, I really don't know. I've tried arguing with them about things, and I never seem to get anywhere, and that was for a prescription, which was a heck of a lot cheaper than dialysis. If you have the time and the energy are the two things I would consider first, because it'll take a lot of both.

[Lulu]

Start doing the home training and your medicare kicks in the first month of the 1st day your train. If you do in-center then it takes 4 months.

[Katbyrd55]

Hi, I hate that you're having so much trouble.  Have you ever stopped to think that it may be the "nice" dialysis center that's the problem, not the insurance company?  From experience, I know that the dialysis centers will not take a patient until they have all the insurance information lined up, with a guarantee of payment of what they CHARGE, not what is conisdered "reasonable".  Especially DaVita, they are the worst.  Dialysis patient's should read the paperwork VERY CAREFULLY before signing anything.  Also, patients should make sure they enroll in Medicare immediately upon beginning dialysis (even though it is a 3 month waiting period).  Dialysis centers try to discourage patients from enrolling, telling them they don't need Medicare.  WRONG!!!!  I know this post hasn't helped your particular situation, for that I'm sorry.  Good luck to you. 
   

[KR Cincy]

I feel fortunate...my insurance company has been with me every step of the way through my surgeries and dialysis, providing me access to a nurse who would phone me every week or so to see what was up, did I need referrals to any other program, had I looked in to this medication, etc. Then they have a specialized renal program so I have a former dialysis nurse who visits me every couple of months to see how things are - she even came to my home because I'm her first home hemo cient.

My first day at the dialysis center-I'm a very happy DaVita patient-they handed me all the Medicare paperwork and said to get it signed pronto so I could go on it in exactly 3 months...which I did. Then, when I got my one and only center invoice, I filled out a form and they are in the process of waiving off that charge.

Don't be afraid to contact your insurance company to explain your situation and see what they can do, and definitely talk with the social worker or guest services director at the dialysis clinic and push them along as well. It's an old saying, but still true...the squeaky wheel gets the grease!

[Jannie]

The center I'm in has actually turned out better for me.  After 2 months, dialysis is actually becoming tolerable to me. I relax and watch TV and sleep while I'm there. I have a big fear of driving in bad weather, particularly ice and snow. Well, they are only 7 minutes away and they have an indoor parking garage, so I think I'll be staying there.  The other center is at least a 20 minute drive and they have outdoor parking. So I guess I jumped too soon. I tend to be impulsive. I didn't think this over seriously.