Can anyone do Nextage

[ESRD Survivor]

So I called our center that trains for nexstage, I was told that Medicare would not pay for more than 3 days unless I can prove I need more dialysis.  I am confused, I thought more dialysis was good for you.  I was told I could have a dialysis machine at home like in center and do 3 days, but I think we would have to do a lot more for water and such.  Really whats the difference, except I can do it on my own schedule.  Can't travel like I wanted to with a regular machine.  I have my heart on Nexstage.  A little depressed today.

[MooseMom]

Your nephrologist can write a letter outlining how you need more than just 3 days a week.  No, you're not confused; more dialysis IS good for you.   If your heart is set on NxStage, there is no reason you can't have it except for reasons your clinic is just making up to cover up their own insufficiency.  Don't back down.

[ESRD Survivor]

I just got a call from the center that trains for home hemo, I will not qualify because I am healthy. There are about 20 criteria on a list that you have to meet for Medicare to pay for home hemo. I do not meet any of them.  I was told that home hemo is the most expensive treatment.  I am very sad and depressed over this as I have a hard time emotionally being in center. 

[MooseMom]

I just got a call from the center that trains for home hemo, I will not qualify because I am healthy. There are about 20 criteria on a list that you have to meet for Medicare to pay for home hemo. I do not meet any of them.  I was told that home hemo is the most expensive treatment.  I am very sad and depressed over this as I have a hard time emotionally being in center. 

Right now this very instant, click on this link:

http://forums.homedialysis.org/forumdisplay.php/17-Beth-Witten-Social-Worker?s=03ce90f33626fbf013923a0dfad01205

This is a terrific website called "Home Dialysis Central", and there are professionals who will answer directly your questions about all manner of things; you'll see when you visit the site.  You can register for free (actually, I'm not sure you even have to register to ask a question), and Beth Witten is the licensed social worker who volunteers her time on that site.  Go there NOW and pose your question.  I'm going to be checking in on that forum to make sure you do it, or else I will do it for you.   

Let me explain something...clinical results show that standard inclinic HD are no more than "adequate".  It is the least optimal modality.  And this leads to more cardiovascular complications which lead to more hospitalization which lead to far greater costs to Medicare than NxStage could possibly approach.  For those who cannot do home hemo for whatever reason, they have to work harder to stay healthy, but to say that you are too "healthy" for NxStage is, frankly, and abomination.  And to fob you off with "it's too expensive" is very short sighted.  So you get yourself over to talk to Beth Witten, OK.  NOW!!  I'll be watching you!!!!!!!!!!!

PS..look at Bill Peckham's reply to a similar question

http://ihatedialysis.com/forum/index.php?topic=23741.0

[ESRD Survivor]

Thanks for the info MooseMom, it did help a little.  I put my paperwork into the committee, all they can say is no, but because of the Medicare bundling it changed it for going on home hemo.  It is just so discouraging.  I found out my antibodies are 93, so I see a future of hemo in center.  I have been on it a year and am so tired of it already.  I know it keeps me a live, but that doesn't mean I have to like it! lol

[MooseMom]

Thanks for the info MooseMom, it did help a little.  I put my paperwork into the committee, all they can say is no, but because of the Medicare bundling it changed it for going on home hemo.  It is just so discouraging.  I found out my antibodies are 93, so I see a future of hemo in center.  I have been on it a year and am so tired of it already.  I know it keeps me a live, but that doesn't mean I have to like it! lol

Just hang on tight.  I hope you don't mind, but I've asked Beth about this on your behalf, and let's just wait to see what she has to say.

Can you tell me more about this 20 criteria you are supposed to meet for Medicare to pay for home hemo on NxStage?

I find it hard to believe that Medicare patients aren't allowed to use NxStage like patients do who have private insurance.  There is something not right here.  I can see where maybe Medicare will pay for only three treatments per week with NxStage like they do with incenter HD, but for someone to tell you that you can't do it at all just seems unlikely.  But since I don't know for sure, I've asked Beth, and I'd bet some other IHDers will come on with some advice/answers.

Please don't give up yet.

[jbeany]

Huh, I was told the billing was the same for in-center or NxStage.

[MooseMom]

Huh, I was told the billing was the same for in-center or NxStage.

See?  ESRDsurvivor, I think someone's telling you porkies.

[ESRD Survivor]

Thanks, I don't mind out all you asking her.  I am anxious to find out.

The nurse rattled off a few of them, like pulmonary something, fluid overload and others I don't remember.  I do get fluid overload especially on the weekends, but it has to be well documented and I don't know if it has.  I get a little bit of puffy ankles, don't know if that counts.  I would be happy to drink more.  lol

Medicare is primary, Husbands insurance, United Health Care is second, so maybe they will pick up 2 or 3.  I will wait and see what you tell me
Beth says.  My stomach is in knots.

[silverhead]

Sure sounds like the Nurse is rattling off all the reasons you should be on NxStage, you sound like they are unable to remove enough fluid on a 3 day schedule, puffy ankles are a sure sign of too much fluid, that would also hold true for your lungs, which will lead to heart problems for certain. Anyway it sounds like they have not established your true dry weight.....

[MooseMom]

Sure sounds like the Nurse is rattling off all the reasons you should be on NxStage, you sound like they are unable to remove enough fluid on a 3 day schedule,

EXACTLY!

[MooseMom]

http://forums.homedialysis.org/showthread.php/2936-NxStage-and-Medicare?p=21266&posted=1#post21266

ESRDsurvivor, here is the link to my query on your behalf...check it out for replies.  I hope this will help.

[MooseMom]

FYI, Beth has replied, so follow the link above.  I really hope this helps.  Keep us posted, OK?

[ESRD Survivor]

Your a peach MooseMom.  Thank you for all your help.  You only need to have one of the twenty requirements.  I am hoping my dr can write a letter that will lead this committee to approve me for nxstage.  If I have to go to the committee or Medicare myself I will.  I don't know if all Fersinius has the same rules, but we don't have a large list of training places for nxstage.

[silverhead]

You are having to jump a little hurdle because of the Fresenius connection, goes against their bottom line to have you use a competitors machine.....

[cookie2008]

Sounds like ur unit wants to stay in control, keep fighting your health is worth it, Nxstage is worth it, good luck.

[ESRD Survivor]

Cookie, my unit is all for it, my doctors are all for it.  When I call the center that is to train me, that is where the nurse is telling me I won't be approved.

[MooseMom]

Cookie, my unit is all for it, my doctors are all for it.  When I call the center that is to train me, that is where the nurse is telling me I won't be approved.

Keep pushing.  Surely that isn't the only center that has a trainer.  If you have to travel further to get to a center that WILL train you, do it; training doesn't last forever, so the extra effort will be worth it.

Just because the nurse is telling you something doesn't mean it is correct.  See if you can get IN WRITING a copy of their policy outlining who IS approved, and get IN WRITING why you do not meet their silly criteria.  What they seem to be telling you essentially is that they don't bother training people who are on Medicare.  If your unit supports you and your doctors do, too, there is something amiss at the training center.  All of these people wouldn't be for you being on NxStage if they had evidence that proved it was unsuitable for you. 

[lmunchkin]

I have never heard of such a thing in my life!  When J was diagnosed he went to Fresenius clinic to train for PD (Now NxStage was not told to us at that time) we did it for 5 yrs, then In-Center where it did not suit either of us.  Neph told us about NxStage (We have M'Care Prim. & Cobra 2nd) but never was told about a 20 criteria that had to be met.
I mean what the heck does it matter, you need dialysis now, what does it matter if it is at the center or at home! I believe as the others, somebody is jerking you around. NxStage is an awesome way to dialysis.  I really believe it is the best Diallysis going! My husband is doing great with it, and I do believe that it is due to keeping him on longer but at a slower BFR.  I truly believe that these centers are rushing blood so fast in such a short time and hence, inadequate dialysis.
My husband would come out of those centers just totally wiped out!  I was lucky to get him in my vehicle without him falling!  I remember other patients coming out of the center just stumbling and I would help them to their sits. It was pitiful and heart-wrenching to witness! You could look in to their eyes & immediately could tell they were drained!  Literally, drained!  Since NxStage, not once has J. been wiped or drained, just simply feels better. Thank God for NxStage, cause In-Center was not doing it for him. On top of feeling better, he has not had to have as much medicine.  Some he has totally dropped because he is getting much better dialysis! NxStage has truly been a Godsend!

Na, someone is definately mistaken here! Call Medicare yourself or talk to a SWorker, anyone you can think of!  Write a letter, lodge a complaint! This is not right and "heads" would be spinning out of control, if it were me!

Hope you get to the bottom of this! Lord knows youve been through it!  You certainly don't deserve this abuse! Keep us informed!

lmunchkin     

[kimberlyn50]

HI, I don't know if this will hep, but here is a link to Medicare's site that will tell you what is covered and how.
http://www.medicare.gov/publications/pubs/pdf/10128.pdf

I do not see anything about '20 criterea' to be met.  There is a section on eligibility, which is quite short. 

I am Caregiver for my boyfriend with Nxtage at home, and I do know that Medicare pays 100%.  We dialysize 2 days on and one day off.....he was in-center 3 days a week when he was going there.

We recently received a statement in the mail spelling out Medicares costs for Nxstage at home.  It is far less than in-center treatment costs. by thousands....and is covered completely.

I'm not a doctor, but it is my understanding that if you are going in-center for dialysis 3 days a week, you will need it more at home, because Nxstage is not as aggressive as the in-center machines.

I would agree with others here that if you are not satisfied with the Center you are working with, find another one.  You can take charge of your treatment with the proper support.  Don't take no for an answer....research research research and keep asking questions, demand answers....this site is a wonderful place to vent, and seek  information and as many people that are here to listen, you will always find a way to relate, and will not feel alone.
I don't post on here much at all, but I do read alot, and have been so encouraged to keep on keepin on.
It's not an easy road we travel here...and some carry more than others, but we all can relate in one way or another.
Good luck ...never give up.....

[ESRD Survivor]

Thanks for the link Kim, now where did I ready that Medicare will only pay for 3 treatments a week.  It has a whole section on self training for home dialysis.

[*kana*]

I will be following this thread because I was also told by Fresenius that I couldnt do NxStage either because I was Medicare primary and Cigna secondary.  They told me I could do the Baby K only because Medicare would only pick up 3 days a week treatment.  Best of luck! 

Survivor, you wouldn't happen to be from Mi would you.  Sounds like we have the same Fresenius nurse telling us the same lie. 

[Meinuk]

I will be following this thread because I was also told by Fresenius that I couldnt do NxStage either because I was Medicare primary and Cigna secondary.  They told me I could do the Baby K only because Medicare would only pick up 3 days a week treatment.  Best of luck!

Kana, this is not true.  Medicare will pay for the additional treatments.  You should call you local ESRD Network and ask your Patient Services Coordinator about this.

http://www.esrdncc.org/

The wording you should use is:  "I am a medicare beneficiary, and I am being denied (my chosen) treatment because my clinic is not accepting payment from Medicare for my treatment.  I would like to lodge a complaint.  Please investigate this."

That should get the ball rolling. (pretty quickly.  If it doesn't, PM me.)