Medicare question

[Riverwhispering]

I've heard and read here in threads that medicare doesn't kick in for a few months after you start dialysis.   Does anyone know what will happen if you have no medical insurance and you don't have the money to cover your first three months of dialysis?  And you're not eligible for medicade because you get a Social Security check and own properties.  The social worker at the dialysis center wont' even talk with me about that stuff until I start on dialysis.   I was just wondering will they refuse to do dialysis if you don't have the income to pay for it?  Is that where we just give up and stress till it kills us or whatever? 

[Whamo]

Have you gotten an appointment with social security yet?  Go down and talk to the people there.  Eventually they will explain it all to you.  I was fortunate enough to be covered by health insurance.  If they hit you with big fees, try to negotiate the payment down.  This might work if you have cash on hand.  If not, you're going to feel the bite.

[Meinuk]

If you start self care training:  PD, Home Hemo or in center self care, your Medicare can start on day one of dialysis.

If you have not had health insurance for six months, you can apply to your state's pre-exisitng condition healthcare program. 
https://shiptalk.org/About/SHIProfileSearchForm.aspx?mf=Display

If you have too many assets to qualify for Medicaid, you can see if there is a spend down for your state's medicaid program.  Call your State SHIP (State Health Insurance program) and ask about your options.  sorry to add to your stress, but you need to mention to all that you speak to: Another problem that you are facing is how will you pay for your access: fistula, pd catheter or perm cath?

Speak very bluntly with your nephrologist about your concerns as well, they may know of some other options that are local to you.

If you are on SS for a disability, how close are you to qualifying for Medicare for your original disability?  Speak with them about that as well.

Also, if your potential center is a for profit center, they may participate in the AKF "Grant" Program, where the facility "Grants" the money for your insurance premium to the AKF and the AKF pays your insurance.  It is a shady system, but it works for many people.
http://www.kidneyfund.org/patient-grants/hipp/

[Riverwhispering]

Whamo I already get a social security check, started it when i turned 62 but I make too much from my SS check to be eligible for medicade.   

I'm kinda screwed because I own some rentals out here even though my income per month is a lot less then my existing bills which are mostly medical, house insurance, house payment, garbage, loans etc.  I am at the point that I have to not pay some bills so I can buy food for myself.   I can't get help from the state unless I sell the rentals and pay everything off and then I suppose I could get help from the state.  The thought of being on welfare because of this kidney disease is blowing my mind.

[Riverwhispering]

Meinuk Thanks for the info.   I know nothing about the pre-existing condition healthcare program and have not had health insurance for over 13 years.   I was told the social worker at the dialysis center will work with me to help me on this problem but she can't even talk with me about anything until I start dialysis.  I don't qualify for Medicaid because I make too much with my social security check.  I took a home equity loan to pay for my fistula surgery which ended up being two tries, second one worked and then he had to raise the vain so it was a total of three surgeries in about 3 months.  My Nephrologist has been great as far as not having me come to the appointments as scheduled if my labs showed nothing much changing.  That saves me $177 every 6 weeks when I don't have to go.

As far as the dialysis center goes.  I'm hoping if all goes well in my world that I can move to Calif before I start dialysis.  Sometime this summer I hope. 

[jeannea]

Definitely make an appt at your local SS office and get the details. Then if you still feel stuck between a rock and a hard place, consider writing your congressman. They were telling me that I had missed my sign up window for Medicare and I would have to wait 6 months or more so I wrote my congressman and got it in 2 weeks. Worth a shot. I hate the way this works. Sorry you're having problems.

[thegrammalady]

if you are under 65, once you start dialysis you are eligible for medicare. there is a 4 month waiting period from date of application. the dialysis center may  bill you $50,000 or so for the months you're not covered by medicare but don't worry they won't kick you out for not paying and will eventually write it off. they may not bill you at all. once you start ask to speak with the area finance person and they will help you get a supplemental policy to cover the 20% medicare doesn't pay, about $35 a treatment. they can even find help in paying for the policy. i get $331 a month to pay for mine. if you, for some reason can't get a supplemental  policy, the dialysis center can get a waiver and will write the 10% off. but they want you to have additional insurance so they will work very hard to get you some.  while they won't actually start working on things until you start i think it sucks that they won't give you any information.

[Meinuk]

the dialysis center may  bill you $50,000 or so for the months you're not covered by medicare but don't worry they won't kick you out for not paying and will eventually write it off.

Sadly Grammalady, in this economy you cannot count on anyone writing anything off.  As a matter of fact the one way that providers can gate keep is to not allow people to start dialysis at their facility because they don't have any (or the right) insurance.  It happens every day. 

Another things that is happening more and more is that people are being kicked out of their dialysis facilities for not paying their bills (even the 20% - there is no waiver given by medicare for any portion of the 20%).  Being kicked out of dialysis for non payment is called an involuntary discharge (IVD), and it is terrible.  Remember, most dialysis provided in the United States for at FORPROFIT centers.  How can they keep non paying people on the books and make their shareholders happy?  After all, Kent Theiry needs his Christmas bonus. http://ihatedialysis.com/forum/index.php?topic=21553.msg356501#msg356501

I think any time that you are faced with having to pay for healthcare or food, you should write to your congressperson. Jeannea, I have never heard of a congressional office lighting a fire under the application process before (that worked).  Thank you for sharing your positive results!

Here is a link to the conditions for an IVD, http://www.esrdnetwork8.org/dialysis-transplant-providers/quality-improvement/QI-assets/IVDpacket.pdf.

§ 494.180 Condition: Governance
(f) Standard: Involuntary Discharge and Transfer Policies and Procedures

The governing body must ensure that all staff follow the facility’s patient discharge and transfer policies and procedures. The medical director ensures that no patient is discharged or transferred from the facility unless:

(1) The patient or payer no longer reimburses the facility for the ordered services;

(2) The facility ceases to operate;

(3) The transfer is necessary for the patient’s welfare because the facility can no longer meet the patient’s documented medical needs; or

(4) The facility has reassessed the patient and determined that the patient’s behavior is disruptive and abusive to the extent that the delivery of care to the patient or the ability of the facility to operate effectively is seriously impaired, in which case the medical director ensures that the patient’s
interdisciplinary team:
(i) Documents the reassessments, ongoing problem(s), and efforts to resolve the problem(s),
and enters this documentation into the patient’s medical record;
(ii) Provides the patient and the local ESRD Network with a 30-day notice of the planned discharge;
(iii) Obtains a written physician’s order that must be signed by both the medical director and the patient’s attending physician concurring with the patient’s discharge or transfer from the facility;
(iv) Contacts another facility, attempts to place the patient there, and documents that effort; and
(v) Notifies the State survey agency of the involuntary transfer or discharge

(5) In the case of immediate severe threats to the health and safety of others, the facility may utilize an abbreviated involuntary discharge procedure.

[needlephobic]

Oh yeah Kent needs his Christmas money. I am in thee process of transferring out of the Davita center I am in. I refuse to sign there consent forms lucky for me I got to take it home and read it and was shocked at what I read. They want to be my beneficiary I think not. 

[Riverwhispering]

so you are saying if I can't pay my share of the bill they might kick me out of the center?  Do these people that get kicked out just give up and die?  It's dialysis or die from what I've been told unless you are blessed with a transplant.

I can't believe how freaking scary this is becoming. 

[Meinuk]

I'm sorry, but it is scary.  And it also depends on what clinic you are going to.  Will they work with you?  If the Social Worker won't work with you, try their business office.  When a person does not have a "Chronic" facility, they are beholden to Hospital Emergency rooms for their dialysis.  The thing with hospital emergency rooms is that they will only dialyize you if you are in distress. (elevated fluid or potassium)

Many hospitals have step down/chronic/satellite units, and when if you go into their system, often people are placed in their chronic facilities (no insurance gatekeeping - it is more cost effective NOT to dialyize someone in the emergency room)  Since many/most hospitals are not-for profit and federally funded, they can absorb a lot of the costs of dialysis for those patients who are uninsured. The same can be said for the non-profit facilities out there, but they are quickly being bought up by the Davita & Fresenius for profit dialysis corporations.

At this point, your State pre existing condition Insurance pool until you qualify for Medicare may be your best bet.  Or if you can find a center that has self care training for in center dialysis (Medicare will then be retroactive to day 1 of training). I don't know where you live, but it is worth investigating what options are out there for you.  www.Medicare.gov/dialysis has a dialysis facility compare that can help you find facilities and you can check out their track records by looking at their report cards or look them up in the Propublica database (a link is in my signature line).

If your bills are already extraordinary ( and by the sounds of your fistula access surgeries, they are) re-visit your state medicaid, and ask what their monthly spend down would be for coverage.  Having to start dialysis is a catastrophic health event, and our country's safety net should be in place for such an event.

The social worker at your future clinic is not working with you because you are not their patient yet. If you strike out with their billing department I still suggest having a blunt "this is how it is" talk with your nephrologist. You are not the only person who is facing this hardship, and your nephrologist should know of alternatives for you.

I am very sorry that this is causing you so much stress, and I truly hope that you find a solution that won't bankrupt you.

[kporter85db]

If you start self care training:  PD, Home Hemo or in center self care, your Medicare can start on day one of dialysis.

If you start training for home hemo or PD, your medicare will start on day one. This is your answer.