Medicare Reimburse Less for NxStage or DaVita charge more?

[Black]

I spoke with the Facility Administrator at a DaVita clinic which has a NxStage training program.  We spoke for several minutes and then she transferred me to the Home Hemo Nurse for several minutes.  We're going to visit soon.  We'll have a conference with the Social Worker regarding Medicare/payment, etc.  Spend some time w/ the Home Hemo Nurse, watch part of patient training session, and she'll show us a new NxStage machine.

During the conversation with the Facility Administrator she said we would have to get a SAP (single payer agreement) signed because we don't have insurance.  She said that homedialysis costs more on the NxStage, and that they would apply the amount they are reimbursed for the "Baby K" toward the cost of the NxStage.   Anyone know what she was talking about?  What's an SAP    and are there different charges or Medicare reimbursements rate for different machines?

She did say they have no waiting list and they will need only one or two days notice that dialysis has been ordered and they'll have a NxStage ready for us.

BTW, Epoman, I told them about ihatediaysis.com, ilovenxstage.com and about you posting details of your daily training and they were very excited!

[Epoman]

I spoke with the Facility Administrator at a DaVita clinic which has a NxStage training program.  We spoke for several minutes and then she transferred me to the Home Hemo Nurse for several minutes.  We're going to visit soon.  We'll have a conference with the Social Worker regarding Medicare/payment, etc.  Spend some time w/ the Home Hemo Nurse, watch part of patient training session, and she'll show us a new NxStage machine.

During the conversation with the Facility Administrator she said we would have to get a SAP (single payer agreement) signed because we don't have insurance.  She said that homedialysis costs more on the NxStage, and that they would apply the amount they are reimbursed for the "Baby K" toward the cost of the NxStage.   Anyone know what she was talking about?  What's an SAP    and are there different charges or Medicare reimbursements rate for different machines?

She did say they have no waiting list and they will need only one or two days notice that dialysis has been ordered and they'll have a NxStage ready for us.

BTW, Epoman, I told them about ihatediaysis.com, ilovenxstage.com and about you posting details of your daily training and they were very excited!

I have never hear of a SAP, I have Medicare which covers 80% then I have my secondary which is Kaiser and they cover the remaining 20% I think they are talking about home dialysis costing more with the nxstage because it is done daily 5 to 6 times a week, where as conventional home dialysis is done only 3 times a week with a "Baby K" for example.

Thank you spreading the word about the two sites. 

[Rerun]

I have never hear of a SAP, I have Social security which covers 80% then I have my secondary which is Kaiser and they cover the remaining 20% I think they are talking about home dialysis costing more with the nxstage because it is done daily 5 to 6 times a week, where as conventional home dialysis is done only 3 times a week with a "Baby K" for example.

Thank you spreading the word about the two sites. 

I think you mean "Medicare" covers 80%. 

Black, you are trying to save them money.  Home dialysis is less expensive then in-center dialysis.  Sometimes the system is SCREWED up.

I have a friend with a mentally challenged adult child (age 31 now).  The STATE will pay for the kid to be in an apartment with someone with her at all times, but won't help my friend with money to hire a person to be there from 2 - 6 in the afternoons until she gets home from work.  The kid goes to a work program during the day but gets home around 2 in the afternoon.  Wouldn't it be cheaper for the STATE to help pay for an aid than to foot the whole bill for an apartment PLUS an aid?

You may find the same here.  Because you don't have insurance they may make you dialyze in-center EVEN though home dialysis is cheaper.
I hope not.  Keep us posted.




EDITED:  Fixed Quote - Goofynina

[goofynina]

retarded = mentally challenged, i think that sounds a little more decent,  just my opinion 

[Rerun]

Yeah, that's what she is all right.  Thanks!  I'll change it.   

[JerseyGirl]

I too am surprised they will let you do home dialysis at all without insurance.  Since when is Davita altruistic?  Are you not eligible for Medicare or Medicaid?

[Rerun]

Again, Medicare covers 20% (3 month waiting period, unless you have been on dialysis before) for 30 months.  Then Medicare covers 80% of dialysis and related medical costs.  I'm not sure of the rules with Medicaid or Medical (California). 

In other words......
Medicare is "secondary" if you have other insurance for 30 months.
Medicare is "Primary" if you have other insurance after the 30 months.

[JerseyGirl]

Rerun is correct.  You sure know insurance matters very well!

[Black]

Again, Medicare covers 20% (3 month waiting period, unless you have been on dialysis before) for 30 months.  Then Medicare covers 80% of dialysis and related medical costs.  I'm not sure of the rules with Medicaid or Medical (California). 

In other words......
Medicare is "secondary" if you have other insurance for 30 months.
Medicare is "Primary" if you have other insurance after the 30 months.

Since we don't have any insurance that is not a factor.  (Neither of us have been insurable for many years.) Both Social Workers told us that since he will begin training for home dialysis before the three month waiting period is over, Medicare will cover 80% from day 1.  The first Social Worker, at the other DaVita clinic, told us they would accept the accept whatever Medicare would pay as full payment and that at some point we will have to get Medigap insurance.  I guess we won't know until we talk with the Social Worker at this clinic.  It just keeps coming back to me that she said something about there being a difference in the cost of using a NxStage and the "Baby K", and the NxStage was more .  I wish I had been more focused and asked more questions about the cost.

Since I originated the call and never got put on hold, or told "They'll call you back.", I was trying to be considerate and not keep them on the phone too long, especially because we'll be seeing them in person soon.  They had a lot of questions about his condition, his latest labs, where would stay during training, etc., at the 30 minute mark I thanked them for their time and told them I'd let them know in a few days when we're coming.

I was hoping this subject of cost had come up with someone else on home dialysis; if not, I guess we'll find out when we visit.

[Roadrunner]

I may be wrong but I understood that DaVita gets paid for each patient from NxStage.  Something about rental costs.  It sounds like they are going to make less money on you then others.  It might be that they want more patients so the word spreads.
Roadrunner