Dialysis Center Paying for Supplemental Insurance

[KraigG]

At first I thought, "What a pleasant surprise!", then I realized it benefitted them more than me.

For years, I've had Medicare for my primary, and only, insurance. When the bills would come from the hospitals (and they came often) for the remaining 20%, they went into the circular file. I mean, come on, I live alone, on SSDI, and have no  other sources of income. I can't "work out a payment plan". With what? The money I use for medication? Maybe my food money?

So I was surprised to see the social worker come to my chair with an application for Blue Cross/Blue Shield insurance. They will pay the premium.

But if you figure Fresenius bills Medicare (for me) $30,000 per month, and they "only" get paid 80% of that, the insurance will pick up $6000 per month, with a premium of $300 per month, so it makes financial sense. It wasn't a loving gesture.

[fearless]

I had a supplemental insurance that was paid by the dialysis company too.  But after a couple years they decided they didn't want to pay the premiums anymore.  I guess it was cheaper to write off the 20% or something.  Who knows.  They get the money they want one way or another.  Just means i have no coverage if I need to use a clinic out of state.  So i don't go out of state. Thanks big multi-billion dollar dialysis company.  i haven't seen my family in years.

[KraigG]

Look for a Fresenius Medical Center near you, and one that has an aggressive manager. They did it for all the patients in my center that had no secondary insurance.

[fearless]

Thanks!

[unvaso]

It's actually American Kidney Fund (AKF) paying for your insurance premium.  The AKF HIPP program is in place to help pay premiums for people on dialysis who can't afford it, and they get the money from the program, actually, from insurance companies. (website: akfinc.org).The application process goes through the social worker at your facility, and the social worker at all facilities, including Fresenius, should be working to make sure you have as close to 100% coverage as you can get.  It's part of their job description, not because it benefits the facility to get that extra 20% (or, not JUST because), but because addressing financial stressors improves a patient's quality of life, which in turn improves a patient's treatment compliance, life expectancy, etc.   
I'm sure all this is covered elsewhere in this forum, but I just wanted to clarify some points because 1. It's actually kinda illegal for a dialysis facility to pay for your insurance premium, 2. I happen to be looking at an EOB that a patient just brought in, angry that we are billing Medicare 24615.20 a month- but if you get to the end you see Medicare paid 2524.73 for the month.  We can bill 10 gazillion dollars but Medicare will not pay us any more than 80% of the Medicare bundled rate, which in this patient's case is about 190.00 a treatment. The secondary insurance will never pay more than the 20% left over, and we can never bill for anything beyond the decided Medicare rate.  I'm a social worker, not a biller, so I can't explain all the finer details of the billing process- but I do know that with the new bundling system we lose money on many patients, and break even with most.
So, hopefully anyone reading this, stuck in a similar position, will ask to speak to the social worker at their facility if the available resources have not already been explained regarding assistance with insurance premiums, patient assistance programs for medications and nutritional supplements, etc!!  Seriously.  Most social workers (I won't say all, I haven't met them all...) are in this field because they truly want to help people and are happy to do so when asked.

[Bill Peckham]

It is nice when a long time lurker comes in from the cold, a renal sw no less. Glad you decided to post.


 80% of AKF funding, some 170 Million dollars comes from FMC and DaVita.

[fearless]

I received the supplemental insurance with premiums paid by AKF for a couple years.  It was discontinued several months ago, and I was told it was because Fresenius had chosen not to contribute some amount of funds to the AKF.   These relationships are confusing for me.  What stunk for me as a patient is that I didn't find out until after I'd started hemo that I would have to pay the 20% of treatment coverage for my therapy if I were to receive that therapy in another state.  I don't travel much, but I like to make a trip home to visit my elderly Mom once a year.  Now I can't do that because it would be too expensive.  I would have made one last trip while I was on PD if I had known, but I just got the info a bit to late to plan that.

PS - I absolutely LOVE my social worker!  And I can honestly say if if weren't for her I don't think I would have survived the last 8+ years on dialysis.

[CebuShan]

Hmm... I wonder if that is what happened to me? The former SW at my clinic had set it up where my medicare was being paid by a third party. Just the other day, I received a letter from medicare saying that my coverage has been dropped because of non-payment! Nobody said anything to me and now I can't afford to continue dialysis. I haven't been able to get ahold of the new SW (she's useless as far as I'm concerned) I was there when the clinic tried to get ahold of her and left my number but I have not heard anything. I already worry that BC/BS is going to find a way to drop me and now this! And don't tell me what the insurance company CAN'T do, because I know what they have done and are doing to me!

[fearless]

DON'T STOP your dialysis!  The finances will be worked out.  Even if you can't afford it, it will happen after the finances are worked out.  Every state has some contingency to help poor people cover the expense that Medicare does not.

[CebuShan]

DON'T STOP your dialysis!  The finances will be worked out.  Even if you can't afford it, it will happen after the finances are worked out.  Every state has some contingency to help poor people cover the expense that Medicare does not.

  That's so easy to say but I can't in good concience do that. It feels too much like stealing. I just hope SOMEONE bothers to contact me. I've called everyone that I can think of.

[fearless]

I'm serious.  When I was told I had to start dialysis I thought "Oh my God, this is the end.  I don't have the money."  But one by one each thing fell into place.  I started dialysis WAY before there was any money to pay for it.  It got worked out.  I am poor, but I have a place to live and food to eat, and I don't pay anything for my dialysis.  I've never thought of it as "stealing" because the company that provides my dialysis made over a billion dollars in profits last year, and some of that was from me being on dialysis.

You really must disconnect the money from the dialysis.  The actual figures are so ridiculous that no one could ever afford them anyway, whether they have insurance or not.  Focus on getting your health re-established and finding some joy and purpose in life.  The finances are there and they will work out just like they do for everyone else on dialysis.

cheers

[CebuShan]

I don't know. When I first started dialysis, I had only had 5 treatments and the financial person came to me while I was hooked up (in other words: captive!) and started telling me how much each treatment cost and wanting to know how I planned on paying for it! I got so upset, I had them take me off and I left. I didn't return until I was able to get some money from my church. I'm not looking forward to a repeat of that!

[fearless]

CebuShan,

Whatever I say now is just going to be a repeat of what I've already said.
You started your last post by saying "I don't know" and that is why I'm telling you: you will be able to finance your dialysis. 
If you choose not to continue dialysis, that's your choice, but I'm telling you: it's not because of money.  You just haven't learned yet what's involved in covering the cost.  If the "financial person" asks you how you're going to pay for dialysis, say: "I don't know - can  you help me?" 
good luck to you

[CebuShan]

The SW FINALLY called back today. Again I say she's useless. She asked me to fax her a copy of the letter I received with the promise that she would fax me a copy of a letter she claimed showed the bill has been paid. I kept up my end but have heard nothing back. I called this afternoon and was told she did, indeed, get my fax but left for the day. I an left to assume she lied and she has no such letter. BTW: the only reason she called was that I had called her boss yesterday.

[thegrammalady]

the 20% left over after medicare pays is $35 per treatment!!! i travel several times a year. akf pays my supplemental insurance premium. but iv'e only had that for the last year. i've never paid fresenius a dime and i've been on dialysis for the last 6 years. they've written everything off. there is a person in the billing office whose job it is to find supplemental insurance and funding for all patients! all clinics are not created equal and each area billing office functions differently too. the few times i've been contacted about paying it was phrased "are you in a position". and strangely that was just last year when i had insurance and the billing office couldn't seem to figure it out. go figure.