I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: Alex C. on August 29, 2015, 12:10:27 PM
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It's nearly impossible to get a straight answer with the state of medical billing in this country is intentionally confusing (do they charge $321/session, or $800, or $21,000?), so I was wondering if anybody out there has any REAL information on just what insurers actually pay per dialysis treatment, either here in the U.S., or in other countries.
BTW, from what I can deduce, that mythical $21k price seems to be a way that dialysis centers keep too many people from visiting for short periods. If I visit another town, and they charge $21k, and somebody visits my center, where they charge $21k, then it evens out to zero. If, OTOH, NOBODY wants to use a certain center when visiting, they lose, and they need to make the place better (I guess...).
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I once read an article entitled "The Economics of Kidney Failure." It's a Canadian document but it has comparisons internationally. They put the cost at $60,000 per year per person on hemodialysis.
I don't know how to link it but you should be able to goole it.
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Some actual costs in the US:
- Medicare paid, in center, $245 per treatment
- Private insurance, in center, per treatment $445 (varies by insurance carrier)
- Vistor to Kent Dialysis, Kent WA; private insurance; paid $5050 per treatment. No, I did not miss a decimal.
- Rochester, NY visitor, a bit over $3000 per treatment (private insurance)
- Las Vegas; visitor; medicare - $245
My MD tells me he gets paid $8 per treatment to supervise and write orders for a transient medicare patient.
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According to NHS Blood and Transplant £246 or $ 325 depending on exchange rate per session. No idea what they charge visitors
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In the Netherlands a HD session varies from €201 to €3511 ($ 225 to $ 3925) according to VNV (the Dutch insurance organisation)
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I have Aetna as both my primary and secondary (my wife and I both have insurance) and they pay about 1500 dollars a session in New Jersey, Medicare pays just under 300 dollars a session. My understanding the Medicare rates are at break even or marginally profitable. The worst rates are the uninsured and using the 3 to 1 rule, the rates are usually 3 times the private insurers rates. This is so if the company is not paid they can get a tax write off for the larger amount and that means with a 33 percent tax rate they make what the private insurer pays.
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Aetna pays my local center $1,550 now up about $60 from last year. When I travel internationally and self pay is generally $250-$400 (I get reimbursed by Aetna). I expect the rate I pay when traveling still includes some markup.
Also that Aetna rate is all in, no charges for epo or other drugs, they do bill for the doctor and lab work.
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... To be quite honest, I could not make myself overly keen to find out the precise costs of these life-saving-dialysis-sessions...
... and I do hope no government official thinks about the nationwide costs of regular dialysis-sessions either,
just in case they might come up with a "revolutionary" idea of how to cut down the costs of quality-dialysis-time
in order to save the government more money ... :twocents;
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Medicare is my primary with employer insurance as secondary. I got a statement from my employer insurance co last week for the period 4/1 - 5/15. The bill was just over $73,000. After adjustments and Medicare payment my employer insurance paid $1800 (the 20% not paid by Medicare). The expected bill to me was $0.00.
When my employer insurance was primary they were paying $4,000 per treatment. The $73,000 billed for that 6 week period calculates to the $4,000 per treatment initially paid by the insurance co.
There are so many games being played in healthcare billing.
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Medicare is my primary with employer insurance as secondary. I got a statement from my employer insurance co last week for the period 4/1 - 5/15. The bill was just over $73,000. After adjustments and Medicare payment my employer insurance paid $1800 (the 20% not paid by Medicare). The expected bill to me was $0.00.
Do you have to pay your insurance deductible before they pay that 20%?
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just in case they might come up with a "revolutionary" idea of how to cut down the costs of quality-dialysis-time in order to save the government more money ... :twocents;
Why do you think 3 days/week instead of every other day is the prevailing standard?
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Hi iolaire,
I haven't yet but you never know when they will do something different. Medicare has been primary for 4 years after the switch at 30 months.
Last Nov I received a bill from F stating that I owed them $2600 for services in March and April that weren't paid by the insurance co. I checked my EOBs from the insurance co and everything submitted had been paid.
I called F and asked for an explanation of the charges and a detailed bill, lady said it was charges for deductibles as I was just getting into their system. I told her I had been in their system for 6 years and was a Medicare patient with secondary insurance. She said "Really"? I said " Yes, Really!!". She said OK, the bill was a mistake, please disregard. That's the only correspondence I've ever had with F's billing dept.
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just in case they might come up with a "revolutionary" idea of how to cut down the costs of quality-dialysis-time in order to save the government more money ... :twocents;
Why do you think 3 days/week instead of every other day is the prevailing standard?
Believe it or not I was told ... .they started with once a week and everyone died, they went to twice a week and everyone died, they went to three days a week and settled there.
Comforting science isn't it? :sarcasm; :waiting;
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At least once a quarter I get a call from Fresenius that I owe money I learned to ask did you send it to my secondary coverage. They reply you only have Aetna I used to get mad now I laugh and say yes that's the primary and that's the secondary I have Aetna and so does my wife. That person never calls back but within 3 months I will hear from them again.
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I'm very sorry for all you sweet people who live in countries where you have to pay so much towards your care, or have the bare minimum of that care, or have hassle about the paying of that care. I'm fortunate to live in one of the many countries which has a national health insurance. You still pay, there are still things to have a hassle with for sure, but the money bit is not one of them , yet.
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Yet the CEO's of these dialysis corporations makes Millions per year. So what does dialysis really cost? No one will ever know.
If you take the overhead of the building, supplies, water, and paying the staff then subtract 10 chairs with 3 shifts a day plus a Nocturnal shift 6.5 days a week.... Oh, I'd love to know the real bottom line.
There is no way a business could have to make it on x amount of money but only get 3% and survive. They are LYING! My EOB is up to $76k a month and they get 3k. No way could they be telling the truth.
Truth in Billing... That is what needs to be done in this country. :rant;
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Well, they wouldn't be dealing with Medicare if they lost money on each patient, so I think we can assume that at a rate of, say, $1000/week, they ARE making money. Maybe not a lot, but they wouldn't still be in business if they were losing money.
So, making that assumption, let's take my 36-chair dialysis center as an example. With 36 chairs, and usually at least 25 of them being used at any one time, assume that they take care of 75 patients each day, that would be 150 distinct patients each week, that would work out to $150,000 each week, and $7.8 million/year. Staff it with, say, 6 RN's, 8 LPN's, and 12 techs (assuming about $1.5 million pay), that would leave $6.3 million to pay for rent, heat, maintenance, and profit.
And, of course, anything ABOVE the Medicare rate is just extra money in their pockets. Sounds kinda cozy, doesn't it?
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Any one taking Medicare is at worse breaking even, the Medicare patients pay all the overhead costs, plus a small profit, the real money is made from private insurance during the 30 months before Medicare must be the primary. Some one once asked if Medicare is so underrated profitable why do hospitals and doctors advertise for Medicare patients. I live in New Jersey for now and the big rip off here was patient transportation. Billions each year were being spent on driving patients to and from dialysis. CMS (Center for Medicare and Medicaid Services) was forced to institute a policy that besides a doctors certification CMS needs to approve transportation requests. Now it's almost impossible to get transportation. However the companies have stopped paying patients to use their services.
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I have a secondary insurance. I have it in case of a hospital stay. 20% of a hospital stay could wipe a person out financially. So, dialysis benefits about $400 a month from my secondary. My doc charges $635 a month but gets from medicare $325 and another $30 from my insurance.
That is another cha ching!
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I'm assuming that an RN makes probably $50k/yr, an LPN about $40k, and a tech maybe $30k.
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I had experience with this first-hand when I was on in-center dialysis. I was still in the 30 month coordination period where my private insurance was paying out bundles of cash on a monthly basis for my care. I have very good reason to believe that this is why I was able to get a chair at the clinic and shift of my choice when I had to start dialysis.
After nine months of in-center treatments, I chose to start training for NxStage and also chose at the time to switch centers (and LDO's - Fresenius to DaVita). From my readings here and elsewhere, I knew my FA was going to get his :sir ken; chewed because he was "letting" a profitable patient walk out the door well before the end of the 30 month period. Inevitably, I got the chairside begging to stay and I had to give him the "it's not you, it's me" speech when it was them all the way since they did not provide NxStage training at the center and they wanted me to go to a center way out of my way for the training. No thank you, I will do what is best for me and my schedule, not worry about your precious profit.
Thankfully, the DaVita clinic I switched to was open referral so I didn't have to change nephrologists, as he was never the problem.
I will go further than most comments above and say if clinics only have patients with medicare/medicaid, then they would barely eke out a profit, if at all, given the current allowable charges that are reimbursed at 80% - even if every patient paid their 20% copays. Without the 20%, then clinics would definitely be in the red.
No, what makes corporate dialysis highly profitable is having as many patients as possible with private or employer based insurance that's primary for the first 30 months. Reimbursement is on average 10 times that of medicare.
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The need to have secondary insurance to cover the 20%that Medicare covers is the reason that Fresinius pays for the insurance for the patients who can't afford the insurance payments. Contrary to popular opinion this is a reasonable profit built into the Medicare rates. Again this is why hospitals and clinics advertise for Medicare patients. Even paying for the insurance there is a profit or it would be done less frequently.
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I thought that the LDOs made contributions to a charitable organization that pays for patient secondary insurance when necessary. I can't remember the name of the organization.
The need to have secondary insurance to cover the 20%that Medicare covers is the reason that Fresinius pays for the insurance for the patients who can't afford the insurance payments. Contrary to popular opinion this is a reasonable profit built into the Medicare rates. Again this is why hospitals and clinics advertise for Medicare patients. Even paying for the insurance there is a profit or it would be done less frequently.
Please give documentation showing Fresenius pays directly for patient insurance.
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I think it's through the National Kidney Fund, when I started my insurance kept screwing up and leaving me large bills, before I figured out that they were not billing my secondary carrier which unfortunately is also my primary(my wife and I both have insurance) the Social worker offered to arrange for the NKF to pay my premiums. It was not necessary since I have complete coverage but I have seen them do it for other patients to.
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^
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Actually there is a NKF in the U.S.. I have several app from them they actually have a web site kidney.org. I was mistaken in remembering them as the organization that Fresinius offered to pay for my insurance. But the American Kindey Fund sounds a lot like the National Kidney Foundation. Since I use their apps a lot I just assumed they were the group that was mentioned. But the fact still remains the companies arrange to have the premiums paid.
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Reimbursement is on average 10 times that of medicare.
I know private insurance pays better, but I find it hard to believe the average maintenance dialysis treatment is $2450 for private insurance. I know mine coughed up $445 per treatment as a "paid in full" price.
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All dialysis providers are a little different but looking at Davita's numbers is instructive and they are available online. The average revenue per treatment at DaVita is about $340 (Check out their 10K SEC filings (page 65 & 66 (http://yahoo.brand.edgar-online.com/displayfilinginfo.aspx?filingid=10519923&tabindex=2&type=html))). If you take the total revenue from US dialysis operations and divide by all the US treatments Davita provides - Medicare, Medicaid, Private primary - you end up with $340.
So when you consider Medicare allows about $260 per treatment and 90% of Davita's patients are Medicare or Medicaid primary a little math can give you an idea how much the average private insurer is paying.
(.9 x 260) + (.1 x n) = 340 ... 234 + .1n = 340 ... .1n = 106 ... n = $1060
On average Davita is paid $1,060 per treatment by non Medicare/Medicaid payers. (note the $1,060 number is low because Davita does not receive the full Medicare allowed rate for people who have Medicaid primary or in many states Medicaid secondary to Medicare. But it does tell us the minimum rate Davita receives on average from private payers).
Of course averages are made of extremes. Some private payers are in network and have negotiated a rate that's lower, in the $500 range, while others don't have a negotiated rate and are charged magnitudes more. In general Davita is very good at determining what rate the market will bear and charging that rate. Other providers operate along the same lines.
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"No, what makes corporate dialysis highly profitable is having as many patients as possible with private or employer based insurance that's primary for the first 30 months. Reimbursement is on average 10 times that of medicare."
Yeah, I'm gonna call "B.S." on that one. I can't imagine that Aetna, UHC, or ANYBODY else in the healthcare insurance business would accept for a second having to pay 10x what Medicare does. The idea is absolutely ludicrous. Even the $445 amount suggested sounds a bit high (if the $245 Medicare amount has any validity), unless it's an all-inclusive amount (dialysis, meds, doctor visit) vs. an ala-carte payment by Medicare.
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Yeah, I'm gonna call "B.S." on that one. I can't imagine that Aetna, UHC, or ANYBODY else in the healthcare insurance business would accept for a second having to pay 10x what Medicare does. The idea is absolutely ludicrous.
Read back in the thread a few of us have posted what insurance pays our dialysis centers. For me its something very close to $1,550 per session, which includes all dialysis provided stuff like IV meds, but not lab work and doctors visits. My insurance pays about $10 for the average lab test, but once and a while when I need travel labs they get billed in the $500 range. The Dr's visits are in the rage on $250 for four visits per month.
It does seem ludicrous to me that my insurance pays roughly six times what Medicare does. But someone is allowing that pricing, in fact this year they increased the payments by about $50 per session.
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A lot of times, those statements that the insurance company sends you are designed more for misinformation. Maybe they were charged $1500/session, but what did they actually PAY? That, they don't tell you. It's become like pricing at furniture stores; the "list price" for a couch may be $1500, but today, it's on sale for $800. Tomorrow, maybe it will be $700.....
Also, due to the input of those in the "anti-socialized-medicine" political brigade, there has been a lot of misinformation posted online, so, unless somebody can provide actual documentation, you really can't trust anything you get online.
What I'd really like to know is this; how much do they pay in Canada for dialysis? Since under Canadian law, ONLY provincially-administered health insurance is permitted, therefore the price paid would be pretty close to the cost + reasonable profit. Does anybody know what OHIP pays per in-center treatment?
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A lot of times, those statements that the insurance company sends you are designed more for misinformation. Maybe they were charged $1500/session, but what did they actually PAY? That, they don't tell you. It's become like pricing at furniture stores; the "list price" for a couch may be $1500, but today, it's on sale for $800. Tomorrow, maybe it will be $700.....
That's all disclosed. I think its fair to assume that anyone else posting what insurance pays has read the claim details and know the difference between list price and what the plan pays.
dialysis: DIALYSIS PROCEDURE
Bill received by Aetna on 08/31/2015 $5,885.00
Your Aetna Member Rate $1,535.00
Your Plan Pays $1,535.00
Doctor: ESRD SRV 4 VISITS P MO 20+
Bill received by Aetna on 07/06/2015 $400.20
Your Aetna Member Rate $258.17
Your Plan Pays $258.17
Lab: UV-ASSAY TRANSAMINASE (SGPT)
Bill received by Aetna on 07/02/2015 $71.63
Your Aetna Member Rate $6.79
Your Plan Pays $6.79
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What I'd really like to know is this; how much do they pay in Canada for dialysis? Since under Canadian law, ONLY provincially-administered health insurance is permitted, therefore the price paid would be pretty close to the cost + reasonable profit. Does anybody know what OHIP pays per in-center treatment?
Here is my quote for one treatment in Montreal in October:
Below is for each treatment with needs patient before dialysis
Hospital component $ 915.96
Professional component $ 68.80 (Non-Quebec Res)
TOTAL: $ 984.76 (Canadian dollars) roughly 735.98 US
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Folks, listen to Bill Peckham.
He knows more about this issue than most of us.
Dialysis lawsuit reveals prices
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/law-suit-reveal.html
Lawsuit hints at in-network dialysis charges
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/lawsuit-hints-a.html
Here is more information (than you'll ever want to know) about what Medicare (U.S.) approves for hemodialysis (2014):
Remember, Medicare pays 80% of the approved amount.
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/End-Stage_Renal_Disease_Prospective_Payment_System_ICN905143.pdf
Payment Rates for Adult Patients-2014
For calendar year (CY) 2014, the base rate for adult patients is $239.02, which is determined by:
Updating the CY 2013 ESRD PPS base rate of $240.36
by the ESRD bundled market basket minus a productivity adjustment
($240.36 x 1.028 = $247.09); and
Applying the 1.000454 wage index budget neutrality adjustment factor to the updated base rate of $247.09 and the home dialysis training add-on budget neutrality adjustment factor ($247.09 x 1.000454 x 0.999912 = $247.18), reduced by the portion of the drug utilization adjustment of $8.16 for CY 2014
($247.18 - $8.16 = $239.02). The drug utilization adjustment transition is discussed on page 5.
To determine the payment rate for an adult patient’s dialysis treatment, the following adjustments and applications are made to the base rate:
… Patient-level adjustments for case-mix;
… Facility-level adjustments;
… A training add-on (if applicable); and
… An outlier adjustment (discussed on page 4).
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I know Aetna pats over 1500 for my treatment since when Fresinius screws up my bill I am sent the calculations to prove I owe money that was not paid by Aetna. In my case the Fresinius rep has screwed up and I just tell them to submit to my secondary carrier which happens to be Aetna. If you really want to freak find out what the rate is for the uninsured its over 3 times what Aetna pays.
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(BTW, his home facility charges $5100 per treatment. Insurance approves $1375 and pays $1100 with his copay $275.)
Since I know this to be untrue, to me it makes all your other numbers equally suspect but arguing on the internet is a mug's game so I will leave it to each person to decide whether to either: credit an anonymous internet poster, writing under a nom de plume, asserting unsubstantiated numbers (numbers that don't even add up (178+45≠227)), or to credit official Medicare publications, court documents and SEC filings.
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Yes, there is a $4.12 and $4.13 difference each month.
You're saying your monthly charges equal $227? That's remarkable.
The assertion you made was that my dialysis unit charged $5100 per treatment, that is what I know is false.
Other than that nothing you have written contradicts anything I posted, you live in a low wage area the national average medicare allowed rate is about $260 (when you include the net effect of comorbidity adjustments). Low wage areas are offset by high wage areas. Like I said averages are made of extremes.
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Edit: And I stand behind my assertion that you don't know every nuance about dialysis charges/payments.
I never made that claim. What I've done is supply primary sources with actual numbers. OP asked what Private insurers pay. Knowing Davita's average revenue per treatment given Medicare's average allowed payment per treatment and Davita's payer mix is as close as we can get to the answer when talking about "what insurers actually pay per dialysis treatment ... here in the U.S."
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Well here's another perspective,
I'm a Vet. The Va picks up all but $15.00 a treatment. Your humble Vet pays that.
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The assertion you made was that my dialysis unit charged $5100 per treatment, that is what I know is false.
I don't know about his specific center, but when I was at a DaVita clinic near Seattle in late 2013, the asking price was $5050 per treatment. Since it was an "out of area / no contract" treatment, my insurer (that was paying my local clinic $445 per treatment) paid the asking price of $10,100 for a grand total of two treatments.
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What I'd really like to know is this; how much do they pay in Canada for dialysis? Since under Canadian law, ONLY provincially-administered health insurance is permitted, therefore the price paid would be pretty close to the cost + reasonable profit. Does anybody know what OHIP pays per in-center treatment?
I live in Ontario. We don't have private clinics only hospitals for dialysis. It would be next to impossible to know how much of our income income taxes flow to the hospital for dialysis. I can tell you that in Ontario our top income tax bracket (for those making over $135,000 a year) is 49.53%. And of the taxes collected, more than 50% is used for health care.
Interestingly enough, when we travel out of the country my husband pays for dialysis up front and then is allowed to submit the payment to OHIP for reimbursement. They pay $210 per session.
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Well here's another perspective,
I'm a Vet. The Va picks up all but $15.00 a treatment. Your humble Vet pays that.
Thank you for serving our Country. Vietnam Era?
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Well here's another perspective,
I'm a Vet. The Va picks up all but $15.00 a treatment. Your humble Vet pays that.
Thank you for serving our Country. Vietnam Era?
Yeah it was . . .
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It's funny....I started this post in order to hopefully get some answers. Instead, things just got even more confusing........