I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: Ohio Buckeye on April 15, 2008, 12:22:10 PM
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As some odyou may remember, back on Jan. 1st my new ins. policy took effect.
I had to change bcause the Anthem dropped the federal plan. Well the one I have
now has a $30 co-pay for each dialysis treatment. Since I do CCPD it is every night
which means a lot of $$$. i got my bill yesterday for $930 just for January. I told the SW I could not afford
that. She said not many could. She told me I could fill out a form for Davita requesting Davita
assistance. You list income and assets. Income is so small I don't worry aboutthat but assets
scare me. I have my house and am trying to hold onto it. Can they come after my house
or assets to get their money? It will be November before open insurance again and most likely
there will not be any improvements in what they offer. I don't want to become homeless.
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I'm not in the USA so sorry I can't answer that but I hope someone can set your mind at rest quickly. You really have had more than your fair share of troubles and I just wanted to offer my support and some hugs. :grouphug; :grouphug;
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Ohio Buckeye, why aren't you on Medicare? Every dialysis patient is eligible.
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I agree. You should have been on medicare immediately as soon as you started pd. What does your SW say about that? SHE should have told you, darn it!!!
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The SW told me that when you are on dialysis 30 months the medicare becomes the
primary insurer and the health ins. becomes the secondry insurer. I have 6 mos. to go
yet to have 30 months.
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Ohio Buckeye, what that means is your primary insurance is billed first and then Medicare is billed second, until your 30 months are up. Your unit is screwing you over and that just pisses me off. Actually, since you do home dialysis (doesn't matter what form), the medicare time is shortened by a bunch. I will find the web site and post it. You should not be paying out of pocket. They are just trying to milk what they can out of you and you'll never get the money back. Trust me. Let me go find this Web site. I'll be back.
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Ohio Buckeye, Here are some medicare sites: When I find the exact one I'll post it.
http://www.medicare.gov/
http://www.medicare.gov/MedicareEligibility/Home.asp?dest=NAV|Home|GeneralEnrollment#TabTop
http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=10050
http://www.medicare.gov/Publications/Search/Results.asp?PubID=10128&Type=PubID&Language=English
http://www.medicare.gov/Dialysis/Include/DataSection/Questions/SearchCriteria.asp?version=default&browser=IE%7C7%7CWinXP&language=English&defaultstatus=0&pagelist=Home
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I will check out those websites.
I'm really confused tho. When I talked to the SW today she told me that
Medicare does not pay co-pays.
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Thanks W&W.
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Ohio Buckeye scroll down to the red lettering. Print it out and take it to your social worker. Here is some more information:
http://www.medicare.gov/Basics/Kidneypatient.asp
Enrolling in Medicare - Kidney Dialysis or Kidney Transplant Patients
1. How Do I Sign up for Medicare Part A & B if I am a kidney dialysis or kidney transplant patient?
If you are eligible for Medicare because of End Stage Renal Disease (permanent kidney failure), you can enroll in Medicare Part A and Part B by calling or visiting your local Social Security Office or by calling Social Security at 1-800-772-1213. Enrolling in Medicare Part B is your choice. However, you will need both Medicare Part A and Medicare Part B in order for Medicare to cover certain dialysis and kidney transplant services.
2. I am over age 65 (or disabled). I have Medicare Part A but do not have Medicare Part B. Now that I have End Stage Renal Disease, can I sign up for Medicare Part B?
Yes. You can enroll in Medicare Part B without paying a higher premium rate if you enroll in Medicare based on End Stage Renal Disease. Call or visit your local Social Security Office or call Social Security at 1-800-772-1213 to make an appointment to enroll in Medicare based on End Stage Renal Disease.
3. I am over age 65 (or disabled). I am paying a higher Medicare Part B premium because I did not enroll in Medicare Part B when I was first eligible. Now that I have End Stage Renal Disease, do I need to continue to pay the higher Medicare Part B premium?
No. In order to stop paying the higher premium rate and begin paying the base premium rate, you must enroll in Medicare based on End Stage Renal Disease. Call or visit your local Social Security Office or call Social Security at 1-800-772-1213 to make an appointment to enroll in Medicare based on End Stage Renal Disease.
To learn more about who is eligible, what is covered, and how to apply, read the brochure: Medicare Coverage of Kidney Dialysis and Kidney Transplant Services
End-Stage Renal Disease
Permanent kidney failure [End-Stage Renal Disease (ESRD)] is a medical condition in which a person's kidneys cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis or a kidney transplant to maintain life. Beneficiaries may become entitled to Medicare based on ESRD. Benefits on the basis of ESRD are for all covered services not only those related to the kidney failure condition.
Specifics for Employers/Group Health Plans
Medicare is secondary to group health plans (GHPs) for individuals entitled to Medicare based on ESRD for a coordination period of 30 months regardless of the employee and employer status. The provisions for ESRD are applied without regard to the number of individuals employed and the employer coverage does not have to be based on current employment only. Medicare is secondary to GHP coverage from COBRA or a retirement plan. Medicare is secondary during the coordination period even if the employer policy or plan contains a provision stating that its benefits are secondary to Medicare.
The GHP may not differentiate in the benefits it provides to individuals who have ESRD. Specifically, GHPs are prohibited from terminating coverage, imposing benefit limitations, or charging higher premiums on the basis of the existence of the individual's ESRD.
When the beneficiary first enrolls in Medicare based on ESRD, Medicare coverage usually starts:
On the fourth month of dialysis when the beneficiary participates in dialysis treatment in a dialysis facility.
Medicare coverage can start as early as the first month of dialysis if:
o The beneficiary takes part in a home dialysis training program in a Medicare-approved training facility to learn how to do self-dialysis treatment at home;
o The beneficiary begins home dialysis training before the third month of dialysis; and,
o The beneficiary expects to finish home dialysis training and gives self-dialysis treatments.
For example: If the beneficiary starts home dialysis training in a Medicare approved facility, or if a course of home self-dialysis training is begun before the third month of dialysis, or if the beneficiary is expected to finish home dialysis training and perform self-dialysis on July 17th, the Medicare entitlement would be July 1st.
Medicare coverage can start the month the beneficiary is admitted to a Medicare-approved hospital for kidney transplant, or for health care services that are needed before the transplant if the transplant takes place in the same month or within the two following months.
For example: If the beneficiary has a kidney transplant on July 17th, the Medicare entitlement date would be July 1st.
For example: If on July 17th the beneficiary starts pre-surgical health care services that are needed prior to a kidney transplant and the transplant is performed on September 4th, the Medicare entitlement date would be July 1st, since the transplant was performed within two months of the pre-surgical services.
Medicare coverage can start two months before the month of the transplant if the transplant is delayed more than two months after the beneficiary is admitted to the hospital for that transplant or for health care service that are needed before the transplant.
For Example: The beneficiary was admitted to the hospital on May 25th for some tests that are needed before a kidney transplant. The transplant was to be on June 15th; however, the transplant was delayed until September 15th. Therefore, the beneficiary's Medicare coverage will start on July 1st, two months before the month of transplant.
When Medicare Coverage Ends
If the beneficiary has Medicare only because of ESRD, Medicare coverage will end:
o 12 months after the month the beneficiary stops dialysis treatments, or
o 36 months after the month the beneficiary had a successful kidney transplant.
o Note: There is a separate 30-month coordination period each time a beneficiary enrolls in Medicare based on ESRD. For example, if the beneficiary receives a kidney transplant that continues to work for 36 months, the beneficiary's Medicare coverage will end. If after 36 months, the beneficiary enrolls in Medicare again based on ESRD, there will be a new 30-month coordination period.
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CRAP,CRAP, CRAP I HATE THAT WHEN IT HAPPENS
get Medicare, after so long on dialysis my social worker did remind me to do that , now aneta is my second and medicare covers more and it is easier
you can not become homeless, it there a law to protect the disabled?
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Isn't this site wonderful? What great information! :clap;
Also, don't quote me on this, but I believe your home would be safe. I think it's your homestead and one vehicle. ??? Can someone verify this? I may be thinking of something else.
Good Luck
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Ohio Buckeye, I am so mad for you! Medicare starts covering the first month of home dialysis. I have been told this many times and it is written in all the Medicare sites. I don't know what your Social Worker is doing to you. You shouldn't be paying out of pocket for dialysis! Print out all the info that w&w posted and take it to the Social Worker and then ask to talk to the Director, your Doctor, Billing manager or any one that will listen. You don't need any more stress in your life. It is unforgiveable that you have been put in this situation. Can you tell I am furious? Having ESRD and a leg ambutated isn't enough? They have to put financial stress on top of that? I am so sorry. This just doesn't make any sense. :grouphug; :grouphug;
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It is confusing tho.
There is a mention of the 30 mo. time where medicare is secondary.
If they do not pay co-pays on Medicare wouldn't I still have the $30 a day to stress over?
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If you had Medicare seconday to your private insurance, Davita would have been writing off your co-pays the entire time. That is their policy.
Apply for Medicare immediately.
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Hi OB,
I forgot the second most important part of my post...please check your insurance card and go over your insurance documents regarding this co-pay. Is it listed as an office visit co-pay? Do you visit a clinic or office for your dialysis treatments? No you don't. These are not generally treatment co-pays but co-pays for office or clinic visits. This is a problem that we run into with claims for PD patients frequently. The most likely scenario is that you do not owe these co-pays at all as the insurance company has erroneously processed them as if you were receiving these treatments at a clinic. Davita should have followed through on this as far as billing and the claim being paid correctly prior to billing you. Please check this situation out to see if this is the case. Contact your insurance company yourself if you need to.
I am 99.9% sure you do not owe this $. Good luck.
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In Canada everyone gets a plastic identity card in the mail for free. Then you show that whenever you show up for any medical treatment, and it is completely free. Simpler, isn't it?
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OB, I am furious. I signed up for medicare when I started PD, and got it immediately, and retroactively.
YOU DO NOT OWE COPAYS ON TREATMENTS. FInal. THat is it. Oh, I am so mad. HOW DARE THEY.
Medicare has never required, other than the insurance premiums, any other payments.
SOMEONE is messing you over and I do not like it. oooooh. I am so mad.
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She told me I could fill out a form for Davita requesting Davita assistance. You list income and assets. Income is so small I don't worry aboutthat but assets
scare me. I have my house and am trying to hold onto it. Can they come after my house or assets to get their money? It will be November before open insurance again and most likely
there will not be any improvements in what they offer. I don't want to become homeless.
Ohio Buckeye, DO NOT, I repeat, DO NOT fill out any paperwork that requires you to list what you own or what you have in assets. Those things have nothing to do with your medical treatment of ESRD. Have you applied for Social Security benefits? If you haven't you need to ASAP. ESRD is an automatic and Medicare will start automatically at the same time and they will probably offer to back date it, if you pay the monthly amount. They cannot touch your home or your bank account, worst they can do is turn it over to a collection agency. If I can help in anyway, please let me know. It get so made at these clinics. All of them. It's all about how many dollars they can get out of a patient and it is just plain wrong. My blood pressure is now through the roof. Where's kitkatz's stick. :Kit n Stik; :Kit n Stik;
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off the topic
willie is the first dog who looks like a boy dog
and winnie is the beautiful, fluffy, silver dog who looks like a girl dog
right ???
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I just lost my BCBS, and Medicare became primary for me with just a phone call because I am on a home dialysis treatment. The 30 month doesn't apply once you start home d training. the only reason mine hasn't switched was because of having a good BC policy up until last month.
Besides, it your regular insurance won't cover co-pays, you should have been directed to get a Medigap policy. Mine is only $107 a month, and it covers the 20 percent that Medicare doesn't.