Transportation to Dialysis

[meadowlandsnj]

Does anyone take transportation to dialysis?  I mean like the ambulette services that Medicare pays for.  How do you check the safety record of a company?  How much do they make (charge to Medicare) for each trip?  Any info you can give me is appreciated. 

 

Thanks
Donna

[jbeany]

Medicare only pays for emergency transport - which is defined as a situation where transport in any other vehicle would be a risk to your life.  I've looked into local services that offer transport for the disabled or elderly, but they are all state run programs, not federal, or non profit church groups.  (None of them run a transport schedule that would work with regular dialysis times anyhow.)

[Epoman]

Look around, some of the smaller independent centers (privately owned) offer transport as an incentive. The "Indie" I went to offered free shuttle to and from, I used it sometimes. It is usually like a van pool however so you may have to drop others off as well. It may take you a while to get home, but you will eventually.

- Epoman

[Dr. Evil]

   WHOA!!!!!!!!

A dialysis center that accepts medicare CANNOT provide transportation to the center.  That is illegal and is called FRAUD and INDUCEMENT.  You cannot pay someone in goods or services to come to your center, so that you then bill medicare for another service.  This is like paying someone $10 so you can turn around and bill medicare $140.  THIS IS VERY ILLEGAL and they will not be able to get away with this for long.  Sometimes the OIG (Office of Inspector General) takes some time to get to the smaller players, but they will. 

It would be nice if some "safe harbor" can be set up to allow some kind of transportation arrangememt.  However, like any new benefit, i can just imagine the abuse that will happen.  How much should medicare pay for transportation....why should it pay for some, not others....should it pay for transporting people past the closest unit just because the patient wants to go someplace else....etc...etc..etc...

[Epoman]

  WHOA!!!!!!!!

A dialysis center that accepts medicare CANNOT provide transportation to the center.  That is illegal and is called FRAUD and INDUCEMENT.  You cannot pay someone in goods or services to come to your center, so that you then bill medicare for another service.  This is like paying someone $10 so you can turn around and bill medicare $140.  THIS IS VERY ILLEGAL and they will not be able to get away with this for long.  Sometimes the OIG (Office of Inspector General) takes some time to get to the smaller players, but they will. 

It would be nice if some "safe harbor" can be set up to allow some kind of transportation arrangememt.  However, like any new benefit, i can just imagine the abuse that will happen.  How much should medicare pay for transportation....why should it pay for some, not others....should it pay for transporting people past the closest unit just because the patient wants to go someplace else....etc...etc..etc...

Isn't it the same thing Dr. Evil, if Davita doesn't accept the required co-pays? I know that "Some" Davita's do not accept the dialysis co-pays as an incentive to attract patients. The co-pays I am talking about are the $5 to $20+ co-pays that some insurance companies require. Or is it OK for the dialysis company to waive those co-pays?

But yeah the "Indie" I went to accepted Medicare and provided transportation to all patients who requested it. By the way please post more often, I was hoping you would reply in my "A-Fib" thread.

- Epoman

[Sara]

  WHOA!!!!!!!!

A dialysis center that accepts medicare CANNOT provide transportation to the center.  That is illegal and is called FRAUD and INDUCEMENT.  You cannot pay someone in goods or services to come to your center, so that you then bill medicare for another service.  This is like paying someone $10 so you can turn around and bill medicare $140.  THIS IS VERY ILLEGAL and they will not be able to get away with this for long.  Sometimes the OIG (Office of Inspector General) takes some time to get to the smaller players, but they will. 

It would be nice if some "safe harbor" can be set up to allow some kind of transportation arrangememt.  However, like any new benefit, i can just imagine the abuse that will happen.  How much should medicare pay for transportation....why should it pay for some, not others....should it pay for transporting people past the closest unit just because the patient wants to go someplace else....etc...etc..etc...

Welcome back Dr. Evil!  I was wondering where you'd run off to. 

[Joe Paul]

  WHOA!!!!!!!!

A dialysis center that accepts medicare CANNOT provide transportation to the center.  That is illegal and is called FRAUD and INDUCEMENT.  You cannot pay someone in goods or services to come to your center, so that you then bill medicare for another service.  This is like paying someone $10 so you can turn around and bill medicare $140.  THIS IS VERY ILLEGAL and they will not be able to get away with this for long.  Sometimes the OIG (Office of Inspector General) takes some time to get to the smaller players, but they will. 

It would be nice if some "safe harbor" can be set up to allow some kind of transportation arrangememt.  However, like any new benefit, i can just imagine the abuse that will happen.  How much should medicare pay for transportation....why should it pay for some, not others....should it pay for transporting people past the closest unit just because the patient wants to go someplace else....etc...etc..etc...

Definition DOCTOR?

[Dr. Evil]

  WHOA!!!!!!!!

A dialysis center that accepts medicare CANNOT provide transportation to the center.  That is illegal and is called FRAUD and INDUCEMENT.  You cannot pay someone in goods or services to come to your center, so that you then bill medicare for another service.  This is like paying someone $10 so you can turn around and bill medicare $140.  THIS IS VERY ILLEGAL and they will not be able to get away with this for long.  Sometimes the OIG (Office of Inspector General) takes some time to get to the smaller players, but they will. 

It would be nice if some "safe harbor" can be set up to allow some kind of transportation arrangememt.  However, like any new benefit, i can just imagine the abuse that will happen.  How much should medicare pay for transportation....why should it pay for some, not others....should it pay for transporting people past the closest unit just because the patient wants to go someplace else....etc...etc..etc...

Definition DOCTOR?

Doctor as in M.D.    ...Board Certified in Internal Medicine and Nephrology.

[Dr. Evil]

  WHOA!!!!!!!!

A dialysis center that accepts medicare CANNOT provide transportation to the center.  That is illegal and is called FRAUD and INDUCEMENT.  You cannot pay someone in goods or services to come to your center, so that you then bill medicare for another service.  This is like paying someone $10 so you can turn around and bill medicare $140.  THIS IS VERY ILLEGAL and they will not be able to get away with this for long.  Sometimes the OIG (Office of Inspector General) takes some time to get to the smaller players, but they will. 

It would be nice if some "safe harbor" can be set up to allow some kind of transportation arrangement.  However, like any new benefit, i can just imagine the abuse that will happen.  How much should medicare pay for transportation....why should it pay for some, not others....should it pay for transporting people past the closest unit just because the patient wants to go someplace else....etc...etc..etc...

Isn't it the same thing Dr. Evil, if Davita doesn't accept the required co-pays? I know that "Some" Davita's do not accept the dialysis co-pays as an incentive to attract patients. The co-pays I am talking about are the $5 to $20+ co-pays that some insurance companies require. Or is it OK for the dialysis company to waive those co-pays?

But yeah the "Indie" I went to accepted Medicare and provided transportation to all patients who requested it. By the way please post more often, I was hoping you would reply in my "A-Fib" thread.

- Epoman

The "Indie" clinic can get away with it for a while, but they will get in trouble at some point.

I reviewed the AFIB thread.  As always, I cannot give you direct medical advice as I do not know all the details about your case.  However, the two biggest concerns are 1) Stroke risk and 2) Heart rate control.  I would like to see a holter monitor on you to see if you are going in and out of Afib without you knowing it.  Afib is the most common arrhythmia.  It usually from some underlying heart condition.  In your case, you probably have some Left Ventricular Hypertrophy from HTN and longstanding renal disease.  All you can do there is control BP as best you can.  Back to the Afib....the biggest concern is stoke risk.  The blood can pool in the atrium with Afib, form a clot, and then the clot can go to the brain...this is a stroke.   This is bad.  So, this has been extensively studied.  Anyone in Afib should strongly consider going on anticoagulation with coumadin (Asprin doesn't give much stroke protection...coumadin does.).  This is also true for paroxysmal Afib.  So I would go back to the cardiologist and have that person explain to you why you shouldn't be on coumadin.  Sometimes people are too high risk for bleeding, but those are usually very old or debilitated people that have a high fall risk that outweighs the stroke protection.  The fact that you are running a web site means your brain is working too good and you should do all you can to protect it from strokes.  So I am surprised you are not on coumadin.

[Dr. Evil]

  WHOA!!!!!!!!

A dialysis center that accepts medicare CANNOT provide transportation to the center.  That is illegal and is called FRAUD and INDUCEMENT.  You cannot pay someone in goods or services to come to your center, so that you then bill medicare for another service.  This is like paying someone $10 so you can turn around and bill medicare $140.  THIS IS VERY ILLEGAL and they will not be able to get away with this for long.  Sometimes the OIG (Office of Inspector General) takes some time to get to the smaller players, but they will. 

It would be nice if some "safe harbor" can be set up to allow some kind of transportation arrangement.  However, like any new benefit, i can just imagine the abuse that will happen.  How much should medicare pay for transportation....why should it pay for some, not others....should it pay for transporting people past the closest unit just because the patient wants to go someplace else....etc...etc..etc...

Isn't it the same thing Dr. Evil, if Davita doesn't accept the required co-pays? I know that "Some" Davita's do not accept the dialysis co-pays as an incentive to attract patients. The co-pays I am talking about are the $5 to $20+ co-pays that some insurance companies require. Or is it OK for the dialysis company to waive those co-pays?

But yeah the "Indie" I went to accepted Medicare and provided transportation to all patients who requested it. By the way please post more often, I was hoping you would reply in my "A-Fib" thread.

- Epoman

Yes-  the DaVita clinic needs to bill you for the Co-Pays.  Medicare just requires a reasonable attempt to collect the co-pay.  If DaVita sends you a bill, that is probably good enough.  They don't have to rigorously pursue you (ie- bill collection agency, etc.).  So if you don't pay the co-pay, they can choose to not go after you.  However, this cannot be a 'written' policy, since that is illegal for the same reasons.

[Epoman]

  WHOA!!!!!!!!

A dialysis center that accepts medicare CANNOT provide transportation to the center.  That is illegal and is called FRAUD and INDUCEMENT.  You cannot pay someone in goods or services to come to your center, so that you then bill medicare for another service.  This is like paying someone $10 so you can turn around and bill medicare $140.  THIS IS VERY ILLEGAL and they will not be able to get away with this for long.  Sometimes the OIG (Office of Inspector General) takes some time to get to the smaller players, but they will. 

It would be nice if some "safe harbor" can be set up to allow some kind of transportation arrangement.  However, like any new benefit, i can just imagine the abuse that will happen.  How much should medicare pay for transportation....why should it pay for some, not others....should it pay for transporting people past the closest unit just because the patient wants to go someplace else....etc...etc..etc...

Isn't it the same thing Dr. Evil, if Davita doesn't accept the required co-pays? I know that "Some" Davita's do not accept the dialysis co-pays as an incentive to attract patients. The co-pays I am talking about are the $5 to $20+ co-pays that some insurance companies require. Or is it OK for the dialysis company to waive those co-pays?

But yeah the "Indie" I went to accepted Medicare and provided transportation to all patients who requested it. By the way please post more often, I was hoping you would reply in my "A-Fib" thread.

- Epoman

The "Indie" clinic can get away with it for a while, but they will get in trouble at some point.

I reviewed the AFIB thread.  As always, I cannot give you direct medical advice as I do not know all the details about your case.  However, the two biggest concerns are 1) Stroke risk and 2) Heart rate control.  I would like to see a holter monitor on you to see if you are going in and out of Afib without you knowing it.  Afib is the most common arrhythmia.  It usually from some underlying heart condition.  In your case, you probably have some Left Ventricular Hypertrophy from HTN and longstanding renal disease.  All you can do there is control BP as best you can.  Back to the Afib....the biggest concern is stoke risk.  The blood can pool in the atrium with Afib, form a clot, and then the clot can go to the brain...this is a stroke.   This is bad.  So, this has been extensively studied.  Anyone in Afib should strongly consider going on anticoagulation with coumadin (Asprin doesn't give much stroke protection...coumadin does.).  This is also true for paroxysmal Afib.  So I would go back to the cardiologist and have that person explain to you why you shouldn't be on coumadin.  Sometimes people are too high risk for bleeding, but those are usually very old or debilitated people that have a high fall risk that outweighs the stroke protection.  The fact that you are running a web site means your brain is working too good and you should do all you can to protect it from strokes.  So I am surprised you are not on coumadin.

I hate to HIJACK this thread but.....

Thank you for your reply doc, let me ask you this. My heart rate has been fine even when I was in A-fib it was about 90, I am taking Atenolol and my heart rate gets to 50-70 when it gets to the 50 range I don't feel my best but it is livable. I have a BP monitor that tells me when my heart is beating irregular. I have not been in A-Fib as far as I know for 10 days and my BP has been around 110/80 give or take 10 points either direction on both the top and the bottom number, and my rate has been as I said 50-60. I get really worried when my rate hits the low 50's I had an Echo done, and they said I have some calcification, and my ventricles are a little stiff, but other than that my output is very good, they mentioned 50 is the normal range for output and mine is 65. They said my heart does not look that bad. My question is should I be on coumadin if my pulse rate is low? Also Doc could this be related to Thyroid issues? As you may know I had my Thyroid and Para-thyroids removed. And it has been a battle to with my body ever since. I am really worried about taking the Atenolol because my pulse rates are getting to low. But I am taking the Atenolol in the hopes to keep me out of A-Fib and keep the pulse rate down. I am on 25mg once a day, which is a low dose.

- Epoman

[Dr. Evil]

Well, without a holter monitor, you really can't be sure that you are not in Afib.  You can have an almost regular rhythm with well controled HR, but only the EKG/Holter monitor can tell for sure.

Atenolol does have some anti-arrhythmic properties, but not much.  It is mainly lowering the heart rate.  But beta blockers have other side effects.  Perhaps a calcium channel blocker may be better for you (diltiazem)? 

So, the coumadin question depends on what your heart is actually doing...thus the holter monitor.  The 'stiff heart' as you described sounds like the LVH I was talking about.  The pulse rate doesn't matter in terms of stroke risk of Afib...if your atria are fibrillating, then you need coumadin.  Heart rate doesn't matter.

Yes- Thyroid (hyperthyroid) can cause Afib.  But a TSH test should settle that question really eaisly. (Blood test).
I don't know of any parathyroid issue that causes Afib.

[Epoman]

Well, without a holter monitor, you really can't be sure that you are not in Afib.  You can have an almost regular rhythm with well controled HR, but only the EKG/Holter monitor can tell for sure.

Atenolol does have some anti-arrhythmic properties, but not much.  It is mainly lowering the heart rate.  But beta blockers have other side effects.  Perhaps a calcium channel blocker may be better for you (diltiazem)? 

So, the coumadin question depends on what your heart is actually doing...thus the holter monitor.  The 'stiff heart' as you described sounds like the LVH I was talking about.  The pulse rate doesn't matter in terms of stroke risk of Afib...if your atria are fibrillating, then you need coumadin.  Heart rate doesn't matter.

Yes- Thyroid (hyperthyroid) can cause Afib.  But a TSH test should settle that question really eaisly. (Blood test).
I don't know of any parathyroid issue that causes Afib.

Thanks Doc, are you concerned at all that my rate gets to 50? I heard that under 60 is bad. I will tell my Cardiologist I want a holter monitor. I was told that the holter monitor is only activated when it picks up a irregular hearbeat, such as A-Fib, in fact I was told I woud have to hit "start" when I feel the symptoms or am I thinking of a different device. You mentioned "diltiazem" while the doc prescribed "Sotalol" to replace my Atenolol are you familar with that med?

- Epoman

[Dr. Evil]

You had an event monitor.....this is, like you said, you have to hit the button.  I think a holter would make more sense, as it records continuously....although you only wear it for a day or two at a time.

Sotolol is a combination beta blocker and antiarrhytmic drug.  It is not a good drug to use for ESRD pts as it is rapidly cleared by dialysis and so the drug will be cleared from your system with each dialysis treatment.  This is not good for a drug that needs steady blood levels to keep the heart "happy".

I would kindly remind your cardiologist about this, or notify your nephrologist so he/she can talk to the cards person.

HR of 50 by itself is not too bad, as long as you feel OK.