I am shocked at what they are charging our Insurance company

[vcarmody]

I was floored when I seen that our center is charging my husbands insurance company $720.00 a treatment.  When he was in center it was only $360.00 a treatment 3x's a week.  Now that we are home with NxStage they are charging $4320.00 a week and 440.00 once a week for his Epo shot, that is not including charges for his Neph and lab work.  His insurance company pays 100% of the charges so they are dishing out more then $5,000.00 a week just for ME to do my husbands treatments, and to top it off they made me buy my own chair and blood pressure machine.  I questioned the charges and they kinda got huffy about it, said that that's what Blue Cross Blue Shield told them they can charge.  When we seen how much they were charging we decided that we wanted to cut down to 5 treatments a week in the hopes to save the insurance company some money, but they gave him a hard time and told him he signed a contact stating he would do 6 treatments a week and if it was to much he was gonna have to go back in center.  He don't want to go back in center, but we are concerned that his insurance company will find a way to cancel him because of his medical bills (he averages about 50,000 a month or more with his on going foot issue).  I know people will say they can't cancel him, but my husband went out on disability from his company in April 2009, his company closed up 5 months later in Sept 09 and luckily he is still collecting disability from them and still has his medical insurance.   Does anyone else know what there center charges them a treatment?  Does $720.00 seem a little steep for one treatment?

[MooseMom]

So much for being able to make your own personal medical decisions.  Someone is making a lot of money out of your husband's illness.  And your post illustrates the fallacy behind having employers pay for workers' medical insurance.  I don't understand why we tolerate this system.  I always thought that America was supposed to be pro-business, but burdening companies with this black-holish expense is crippling to business, and in this economy, companies are trying to trim their costs, so I am not surprised that you are worried about your situation.

I don't have any answers for you, only righteous indignation!!!!

[RichardMEL]

In a way it doesn't surprise me. In Australia the govt spends around $83,000/year on hemo dialysis/patient. That includes epo, iron etc. I've seen somewhere the actual cost to the govt per epo shot, and it's absolutely in the hundreds of dollars. I'm so glad to pay my taxes in this country that provide all of that for very little out of pocket.

 

[lola]

Davita LOVED Otto's private ins, charged them 60,000 a MONTH. What a F#$%^&* joke................

[silverhead]

Davita has been moving into our area the past couple of years, and they will welcome you with open arms if you have private insurance, if you are on Medicare only they suddenly have no room for you.......

[Zach]

Private insurance policies do pay more for dialysis treatment than Medicare, sometimes a lot more.

That being said, what the dialysis center charges and what an insurance policy pays can be very different, depending on their negotiated rate.  Medicare pays 80% --but only on the Medicare rate.  My center charges Medicare $1,000 per treatment, but Medicare's rate is around $140.00 per treatment (not including drugs).

On my "Explanation of Benefits" form, Medicare was charged $16,240.06 for one month of dialysis including drugs and supplies.  But near the end of the statement in the "Notes" section, it reads the amount Medicare paid the provider for this claim is $2,059.15

Always look for "we paid ..." to know for sure the final amount.

[rocker]

So much for being able to make your own personal medical decisions.  Someone is making a lot of money out of your husband's illness.

I wonder who!  In 2004, the CEO of United Healthcare was paid $125 million.  $125,000,000.00.  Over a TENTH OF A BILLION DOLLARS.  For one year.

Someone broke that down into his hourly rate.  $65,100.00/hr.

I wonder what the CEO of DaVita makes.  Probably a salary that's simply ludicrous, instead of completely surreal.

There are a lot of ways for insurance and medical companies to become more efficient that don't involve endangering your health, as someone else suggested.

And your post illustrates the fallacy behind having employers pay for workers' medical insurance.  I don't understand why we tolerate this system.  I always thought that America was supposed to be pro-business, but burdening companies with this black-holish expense is crippling to business, and in this economy, companies are trying to trim their costs, so I am not surprised that you are worried about your situation.

You don't seem to be aware that no company in the US is forced to provide insurance to employees.  Those that do so, do so at their own discretion.  And given that few states have must-sell or must-carry laws, in some states it is nearly impossible for a small business to buy a policy for one or two employees.  And of course, no small policy will take you if you have a pre-existing condition....like, say, kidney disease.

And businesses don't pay taxes on the money they spend on health insurance - but you do.

I don't have any answers for you, only righteous indignation!!!!

Righteous indignation is fine - just direct it where it is deserved.

[rocker]

Ok, I got interested and looked it up.

http://www.forbes.com/lists/2006/12/IPFN.html

A relative pauper, at  compensation of $27,880,000.00 last year.

Wonder how many treatments that would pay for.

[MooseMom]

rocker, I am indeed very cognizant of the fact that employers are not forced to carry their workers' insurance, which illustrates my point that this hodgepodge of benefit allocation is daft.  I don't understand why businesses have to be in the business (lol!) of providing insurance in the first place.  It's a holdover from earlier days when there were ceilings on wages, and providing medical insurance was a perk and nothing more.  But now that medical insurance is essential, well, that changes the dynamic entirely.  It narrows the opportunities for small businesses to employ good people, and it hampers choice of employment for workers.  How many people are trapped in jobs they don't like because they can't afford to risk their family's insurance coverage by making a move that could be a better career choice?  This country is supposed to be about freedom, but our current medical insurance system traps us all.

It's goverment by corporation.  We've long ceased to be a democracy. Money rules.  If you have it, you have power.  If you have it, you get elected.

[johnwoon]

RAI was charging me around $32,000.00 per month for in-center dialysis and when I started Home hemo on the Nxstage machine with a pureflow they billed my insurance company around $35,000.00 per month.  This was for a average of 5-6 treatment per week, I am on 3 days and then 1 day off.  I think they billed my insurance company that much to cover all the people on dialysis that do not have insurance.

[vcarmody]

Zach my husbands insurance pays 100% of what ever they bill. For example they billed his insurance company $14,098.00 for June 7th to June 30th, this was for 13 NxStage treatments, 2 in center so he could get his 2 iron infusion and 4 epo shots.  His insurance paid all $14,098.00, they have always paid 100% of what ever is billed.  Now his Neph charged 500.00 for his one monthly visit, but they only pay him $249.00 which is considered payment in full because he offers a discount rate to Blue Cross Blue Shield.  I think even when my husbands Medicare kicks in in 2012 and becomes primary they will still get the full amount because they will bill what ever Medicare don't pay to his BC/BS.  Just seems like an outrageous amount of money to me.   

[rocker]

rocker, I am indeed very cognizant of the fact that employers are not forced to carry their workers' insurance, which illustrates my point that this hodgepodge of benefit allocation is daft.

Then I misinterpreted what you were saying.  And I couldn't agree more.

  I don't understand why businesses have to be in the business (lol!) of providing insurance in the first place.  It's a holdover from earlier days when there were ceilings on wages, and providing medical insurance was a perk and nothing more.  But now that medical insurance is essential, well, that changes the dynamic entirely.  It narrows the opportunities for small businesses to employ good people, and it hampers choice of employment for workers.  How many people are trapped in jobs they don't like because they can't afford to risk their family's insurance coverage by making a move that could be a better career choice?  This country is supposed to be about freedom, but our current medical insurance system traps us all.

It's goverment by corporation.  We've long ceased to be a democracy. Money rules.  If you have it, you have power.  If you have it, you get elected.

I agree - and with so many people getting filthy rich off denying care in the current system, there's little incentive for those at the top to change it.

 - rocker

[Zach]

Here's and old lawsuit about the topic:

Thursday, January 17, 2008
National Renal Alliance sues Blue Cross Blue Shield of Georgia
ATLANTA BUSINESS CHRONICLE - BY Urvaksh Karkaria STAFF WRITER
http://sanantonio.bizjournals.com/atlanta/stories/2008/01/14/daily30.html

Bill also wrote about this on his blog, "Dialysis from the Sharp End of the Needle" (DSEN):
Dialysis lawsuit reveals prices
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/law-suit-reveal.html

Bill makes this recent request on his blog:

" ... I think it would be a good project for DSEN to have dialyzors send in their Explanation of Benefits. You'd strip off, black out, redact any personal info e.g. name, SS #, but leave the amount charged, the amount paid, and service location.

I'd then republish the info - if a couple hundred dialyzors participated it would be a pretty interesting data base."

Let's help Bill get this data base started!

[RainingRoses]

Not unusual for me to see a $35,000 per month charge for home dialysis with PD.

[Bill Peckham]

I've heard about $10,000 + a treatment being paid - over a million a year.

It would cause a few waves if we did put together a data base. What people are being charged/what the companies are being paid, is suppose to be secrete information.

[okarol]

It's like play money, what is charged and what is paid - it's a joke.

[Bill Peckham]

Of course the problem with the data base would be that vcarmody's provider would realize they could charge 10 times more than their already inflated prices.  I think a lot of providers - those charging just $700/treatment - would realize they're leaving money on the table.

[Zach]

Of course the problem with the data base would be that vcarmody's provider would realize they could charge 10 times more than their already inflated prices.  I think a lot of providers - those charging just $700/treatment - would realize they're leaving money on the table.

But perhaps the insurance companies might decide to reimburse say at Medicare plus 20% or Medicare plus 10%, and save themselves a ton of money.