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| | |-+  Why is DaVita billing our insurer thousands for home hemo?
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Author Topic: Why is DaVita billing our insurer thousands for home hemo?  (Read 73 times)
NCspinner
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« on: January 09, 2019, 03:53:12 PM »

I have tried asking our nephrologist about this at the home hemo clinic and she just says "It's a numbers game." That's the same reply she gives when we ask about the astronomical fees our hospital tries to charge for fistula-grams. When we get a statement from our "Medicare Advantage Plan" insurer, it shows that DaVita has been billed several thousand dollars several times a week for my husband's dialysis ... which we are doing at home with myself as the unpaid provider.
The insurer dismisses these claims so the balance is "0" at the end of the pages of charges, but it is unsettling. If it's a numbers game, somehow the patients & caregivers are the pawns.  What's going on?
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PrimeTimer
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« Reply #1 on: January 09, 2019, 07:25:49 PM »

Why is DaVita billing your insurance thousands of dollars? Because they can.

While doing dialysis at home saves them money it still costs a lot. And until your husband reaches the 30-month mark and has to make Medicare his primary insurance and your other plan moves into secondary position, they will continue to bill for thousands of dollars. Meantime, if your hubby is getting insurance from an employer (either yours or his employer) I suggest reading up on "Self Insured vs Fully Insured" employer plans. As an employee your work will be closely scrutinized because the moment they can find a reason to fire you they will. They do not want to continue paying out high claims for dialysis and all things related, which is what happened to my own husband. Good luck to you. 
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Husband has ESRD with Type I Diabetes -Insulin Dependent.
I was his carepartner for home hemodialysis using Nxstage December 2013-July 2016.
He went back to doing in-center July 2016.
Michael Murphy
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« Reply #2 on: January 09, 2019, 11:21:02 PM »

For in center hemo $370 (Medicare), $1500 (Private Insurance}, and $4500 for no insurance.  The Medicare rate provides a modest profit margin for the service provider, the Private Insurance provides a obscene profit to the service provider, the no insurance rate assumes most people canít afford it so after bankruptcy for the patient the service provider gets a 4500 dollar tax deduction which should equate to a 1500 dollar reduction in the taxes the service provider pays or in reality a 1500 dollar profit.  The cost sheets you are looking at are designed by Medicare and all companies serving Medicare clients follow that format.
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Simon Dog
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« Reply #3 on: January 10, 2019, 05:15:40 AM »

My insurance (pre-medicare) paid the uninsured asking price ($5050 per treatment) at a DaVita clinic I used while traveling.

It's like cars and college educations - figure out the exact highest amount each customer is willing to pay and collect it.  In economic terms, it is called reducing consumer surplus.

As to employers - it depends on how their internal charging systems and accountability systems are set up.  When I was at a huge (50K person) company it was a non-issue, since department managers had budgetary accountability for the premium, not the self-insured claims.  Smaller employers have a greater danger because the hiring manager directly sees or pays the claims or increased premiums the next renewal cycle.   This almost happened to a friend whose wife had cancer, but he was the CEO so it was a non-issue for him.
« Last Edit: January 10, 2019, 05:17:59 AM by Simon Dog » Logged
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