How do you afford dialysis???

[donnia]

I hope this is the right place for this.

I just got off the phone with my insurance, they told me my co-pay is $30 per visit....thats almost $400 per month!  Medicare wont kick in for 3 months after I start dialysis... I know medicare will be my secondary for the first 30 months... do they help pay anything while they are the secondary???  Gosh, I am really freaked out on how I am going to pay for this!!!

[thegrammalady]

when medicare kicks in it will pay 80%. we all probably started dialysis before medicare, unless we were already over 65. i didn't have any additional insurance, the center wrote off the first 3 months. Yours will probably accept the insurance you have, check with your center's social worker.

[Ginger]

The bills I received from my insurance company showed a co-pay but the dialysis unit never billed for it. They just took what they were paid. Now I am on medicare as my 30months is up.

[donnia]

How much do you have to pay now that Medicare is your primary?

[Bill Peckham]

I hope this is the right place for this.

I just got off the phone with my insurance, they told me my co-pay is $30 per visit....thats almost $400 per month!  Medicare wont kick in for 3 months after I start dialysis... I know medicare will be my secondary for the first 30 months... do they help pay anything while they are the secondary???  Gosh, I am really freaked out on how I am going to pay for this!!!

One way people have minimized the copay is having the unit Bill monthly. The initial 3 month period before qualifying is waived if you start home dialysis training.

Are you getting any financial counseling from the unit?

[donnia]

Not yet, I guess I need to contact them.... I just had my AV fistula done last week, so it will be a few months before I can start dialysis... but, I am trying to be prepared for everything.

So I should go to the unit and ask them for financial counseling?  Okay.  Thanks!!

[Hawkeye]

It would be in your best interest to get all the info you can now so your not surprised and overwhelmed when you do start.

[thegrammalady]

donnia, once medicare kicks in since you have a second insurance you shouldn't be billed anything. medicare will pay 80% and your private insurance will pick up the rest. the only time i have to pay anything is when i travel. i have medicare and Medicaid and the medicaid only pays within colorado. when i visit my family in oregon the hospital bills me for the 20% medicare doesn't pay which is only around $110 for a two-three week visit.

[stauffenberg]

I find it cruel to the point of lunacy that the richest country in the world imposes these bureaucratic complications and financial cruelties on people who already have to summon all their available resources of courage and fortitude to deal with their catastrophic medical problem.  In Canada, in contrast, money and medicine have nothing to do with each other, for anyone, anywhere.  When you need medical care, you just present the identity card you get free from the government for being a citizen or permanent resident, and that entitles you to everything you need.  There are no cash registers, billing units, greedy doctors, cruel hospitals, elaborate bureaucracies, people going into bankruptcy from medical expenses, people putting off medical visits they can't afford until their condition becomes untreatable, no private insurance vultures living off the misery of others, nothing -- just a single plastic card and everyone's happy.

[Zach]

  ... just a single plastic card and everyone's happy.

Really? Give me a break!

[angela515]

When I lost my HMO and only had Medicare, I went into debt. I couldn't afford the co-pays and such of dialysis or doctor visits so the bill just sat there, un-paid, and now they all sit on my credit report. Some were written off, others weren't.

[jbeany]

-- just a single plastic card and everyone's happy.

Then why do so many rich Canadians end up down here getting medical treatment? Couldn't have anything to do with the fact that the waiting time for many cruical treatments is so long that they are afraid they will die before they make it to the top of the list?

 http://www.heartland.org/Article.cfm?artId=18276

Our system may have a lot of hurdles, but we don't wait for 17 weeks after a referral!

[goofynina]

What has hurt us the most is my lost income, since i cant work anymore we are really feeling it.  Granted i do get a small amount from the government but that is what i used to make in a week.   I do however thank God for my hubby's insurance and Medicare, without it i am sure i wouldnt be here now.   There would be no way we would be able to pay for dialysis even if it was 20%.  just my   

[Sluff]

What has hurt us the most is my lost income, since i cant work anymore we are really feeling it.  Granted i do get a small amount from the government but that is what i used to make in a week.   I do however thank God for my hubby's insurance and Medicare, without it i am sure i wouldn't be here now.   There would be no way we would be able to pay for dialysis even if it was 20%.  just my   

That is more than your  It is a reality. I don't know what my future holds but I do know without my wife's insurance I'd be sunk.

[del]

We are in Canada so the medical treatment is free?? Not totally. You still have to pay for travel to get these treatments.  My insurance covers $600 per year for travel.  Big deal!!  When you have over an hours drive 3 times a week that covers expenses for about 1 month. I can claim the rest on income tax but still don't get back all we pay. Last year we spend over 4000 dollars just on gas - tht doesn't count the wear and tear on the car.  Thank God we are doing home hemo now. Our car is four years old and has 165,000km on it.  There is a long waiting period for referrals that's why you see people going out of the country.  It is ridiculous to have to wait over a year to se a dermatologist or any other specialist.

[Sluff]

We are in Canada so the medical treatment is free?? Not totally. You still have to pay for travel to get these treatments.  My insurance covers $600 per year for travel.  Big deal!!  When you have over an hours drive 3 times a week that covers expenses for about 1 month. I can claim the rest on income tax but still don't get back all we pay. Last year we spend over 4000 dollars just on gas - tht doesn't count the wear and tear on the car.  Thank God we are doing home hemo now. Our car is four years old and has 165,000km on it.  There is a long waiting period for referrals that's why you see people going out of the country.  It is ridiculous to have to wait over a year to se a dermatologist or any other specialist.

That is the draw back on the kind of healthcare Canada has, people I think are abusing the system.

[thegrammalady]

i guess i live in a good state, i'm on disability and get medicaid. yes i have a very limited income, less than half of what i used to make, but i worked for almost 40 years, i fell that i have earned what i get.

[kelliOR]

At the time I went on dialysis, I was well insured by both my employer and my husbands.  I thought this was great and I would have no worries.  However, for the first three months,  Fresenius billed my insurance anywhere from $7300 - $9400  every 2 WEEKS for dialysis treatment (NOT including medication) !!!!!! 

On top of that, I had to meet annual deductibles and still pay 20-30% before reaching out of pocket maximums totaling $6000.   I would have been better off not working. 

People with insurance get totally screwed as well. 

[brenda]

Not quite sure where you got your info from Stauffenberg. As a Canadian myself, I happen to know that I have to pay for that little card, and it isn't cheap. If you go to the doctor or emerg and you don't have one of those little cards you paid for, the bill will come in the mail. And yes, we do go to the states for some treatments, providing we have financial means to do it. Wait times here are ridiculous. We pay premiums just like the rest of you. On top of that I have to pay for a "special" Blue Cross because I am a dialysis patient so I can get some medications covered that a regular insurance company won't cover. That covers 80%. Need to by $2500 worth of Eprex every three month's? Then you better have another insurance company to cover the other 20%. Which I also have to pay for.

[Zach]

Not quite sure where you got your info from Stauffenberg. As a Canadian myself, I happen to know that I have to pay for that little card, and it isn't cheap. If you go to the doctor or emerg and you don't have one of those little cards you paid for, the bill will come in the mail. And yes, we do go to the states for some treatments, providing we have financial means to do it. Wait times here are ridiculous. We pay premiums just like the rest of you. On top of that I have to pay for a "special" Blue Cross because I am a dialysis patient so I can get some medications covered that a regular insurance company won't cover. That covers 80%. Need to by $2500 worth of Eprex every three month's? Then you better have another insurance company to cover the other 20%. Which I also have to pay for.

Thank you Brenda and everyone else for setting the record straight.
 

[stauffenberg]

Brenda, I don't know where you live, but where I live in Canada, in Ontario, all I had to do to get my healthcard was fill out a form and wait for it to arrive in the mail.  There were no fees attached.  The Canadian healthcare system varies slightly among the provinces, within the limits set by the federal government, which does require that "all medically necessary services be free."  When you say you pay for your healthcard, perhaps you mean through taxation.  But the progressive taxation system pays for healthcare according to how rich the person is and thus how easily and painlessly he can afford to pay, rather than to how sick the person is -- as a private healthcare system does -- which does not take into account ability to pay.  So under a socialist healthcare system dialysis is paid for by rich people having to settle for a 30-room mansion rather than a 34-room mansion, while under a non-socialist system, it is paid for by renal patients having to go into bankruptcy at the very moment they are in the fight of their lives against a deadly disease.  You pick which system is more moral.

During the 9 years I spent on dialysis in Ontario I never paid anything for any special Blue Cross insurance such as you describe, and never even heard of it until now, and I never paid a cent for EPO.  All medications administered in the hospital or in a dialysis clinic are absolutely free.  It is only medications you take at home that are not covered -- though when England introduced its system of socialized medicine in 1948, even home medications were free.  When I lives in England in the 1970s and 1980s, there was a standard price for all my prescriptions, which was 50 pence (then equal to $1.00 Canadian), regardless of how much the pills actually cost.  For drugs I had to buy for chronic conditions, there was no charge at all.

Even now that I am off dialysis and living with a transplant, I do not pay a penny for my EPO (in the form of Aranesp), which the provincial government provides for free.

[meadowlandsnj]

-- just a single plastic card and everyone's happy.

Then why do so many rich Canadians end up down here getting medical treatment? Couldn't have anything to do with the fact that the waiting time for many cruical treatments is so long that they are afraid they will die before they make it to the top of the list?

 http://www.heartland.org/Article.cfm?artId=18276

Our system may have a lot of hurdles, but we don't wait for 17 weeks after a referral!

With it's faults and abuse I think the US has a great system.  It's not perfect but I am very grateful for the help I'm getting from the government.  I rarely see a bill.  No system can be perfect but I thank the USA for my care.  Of course I paid into it since I was 16 by working.

Donna   

[Bill Peckham]

Well said by the angry Bear  http://www.angrybear.blogspot.com/

Sure, the argument goes, the US health care system has some shortcomings - but at least it doesn't involve long waiting lists for elective procedures, as is the case with countries that have primarily government-run health care.

It turns out that this is largely a myth.

Let me leave aside the point that waiting lists exist in abundance in the US for elective procedures - it's just that when people are waiting in the US, they are waiting for a miraculous windfall of money to be able to afford the procedure, rather than waiting a few months until their number is called. No, right now I want to focus on the myth that government-financed health care necessarily entails waiting lists for elective procedures.

The data shows that many countries with "nationalized" health care systems have little or no waits for elective medical procedures. A 2003 OECD working paper entitled "Explaining Waiting Times Variations for Elective Surgery across OECD Countries" by Luigi Siciliani and Jeremy Hurst provides some survey evidence of actual waiting times in various OECD countries. The results of that survey are presented below. (here is the link to a gianormous PDF file http://www.oecd.org/dataoecd/31/10/17256025.pdf )



Note: figures for Canada and U.K. reflect median waiting times.

In all of the countries surveyed above (except the US), the government is responsible for the vast majority of health care spending. (See AB's post from yesterday for specific data on that.) Yet many of them have no waits for common elective procedures. Clearly government financing of health care does not, in and of itself, cause waiting lists for medical procedures. If a country has waiting lists for elective health care, that is due to some specific design flaws in its health care system, not because it is financed by the government.

The rest of the paper mentioned above goes on to take a look at the factors that lead to waiting lists. The authors run some econometric tests that conclude that long waits for elective surgeries tend to happen when 1) countries don't have enough acute care hospital beds (France and Germany have plenty, the UK doesn't); 2) countries have older populations (older populations create more demand for elective procedures); and 3) countries pay specialists a salary rather than according to a fee-for-service formula.

One last point of interest: what do consumers in other countries have to go through in order to receive these elective procedures? The following table shows out-of-pocket costs for elective procedures, and who makes the decision about whether an individual should receive the service.



In countries with government-financed health care, the decisions are made by doctors - often by the specialists themselves - and out-of-pocket expenses to individuals are negligible. Compare this to the case of the US, which is somewhat different in both dimensions. What would an American expect to pay out-of-pocket for elective hip replacement, and how many hoops would they expect to have to jump through to get approval from their HMO?

So the next time you hear that the US health care system is better than those of other countries because Americans don't have to wait for their health care, recognize this argument for the myth that it is.

[Sluff]

Not quite sure where you got your info from Stauffenberg. As a Canadian myself, I happen to know that I have to pay for that little card, and it isn't cheap. If you go to the doctor or emerg and you don't have one of those little cards you paid for, the bill will come in the mail. And yes, we do go to the states for some treatments, providing we have financial means to do it. Wait times here are ridiculous. We pay premiums just like the rest of you. On top of that I have to pay for a "special" Blue Cross because I am a dialysis patient so I can get some medications covered that a regular insurance company won't cover. That covers 80%. Need to by $2500 worth of Eprex every three month's? Then you better have another insurance company to cover the other 20%. Which I also have to pay for.

I stand corrected also, I wasn't aware of the premium associated with the card.

[brenda]

Well aren't you Ontarians lucky. Free, free free. Guess I live in the wrong province. Not likely. Maybe you should educate our Alberta Government. Or maybe I'll just call the premier myself on one of my several mansion phones. Just for you Stauffenberg I read my paystub again today, $62.00 off each and every month for Alberta Health Care. Oh, and here's my Blue Cross bill, $41.00 per month, paid in full. Oh, and here's a bill for Phoslo $151.18 that nobody will pay for except my pocket. I have worked and worked hard everyday for all 13 years of my dialysis life. Not every dialysis patient in Canada goes bankrupt.