Shocked to see my first Dialysis Bill

[WJ2013]

Started dialysis in an out-of-network dialysis center and shocked to the first bill sent to my EGHP and settled by my EGHP.
(day 1) Epoetin Alfa 100U - Billed $2500, member rate $2500   
(Day 1) HD cost billed $2700, member rate $1600.
there are some other charges too, just for one day, I am speechless.

[Angiepkd]

My bill was 5400 per day while doing my training for NxStage home hemo.  Most of it was written off due to a maximum charge agreement with my insurance.  Still a scary amount of money!  I am waiting for my Medicare to be approved.  Once it goes through, it will supposedly cover what my insurance doesn't.  I am hoping this is true, as I have a high deductible, too.  With everything else going on, I try not to think about the money!

[WJ2013]

My bill was 5400 per day while doing my training for NxStage home hemo.  Most of it was written off due to a maximum charge agreement with my insurance.  Still a scary amount of money!  I am waiting for my Medicare to be approved.  Once it goes through, it will supposedly cover what my insurance doesn't.  I am hoping this is true, as I have a high deductible, too.  With everything else going on, I try not to think about the money!

Thanks.
i will have to get used to these high bills

[Zach]

Started dialysis in an out-of-network dialysis center and shocked to the first bill sent to my EGHP and settled by my EGHP.
(day 1) Epoetin Alfa 100U - Billed $2520, member rate $2520   
(Day 1) HD cost billed $2700, member rate $1600.
there are some other charges too, just for one day, I am speechless.

i have high out of pocket because this center is out of network but they said i most probably will be eligible for their waiver program.
note: i am not on medicare yet, planning to enroll.

The wholesale cost of EPO is about $12.00 per 1,000 units --that's what most hemodialysis centers pay.

[galvo]

Bloody hell!

My costs, here in Australia, are: In-centre HD $0
                                            and EPO       $5.90.

Good luck!

[Bill Peckham]

Started dialysis in an out-of-network dialysis center and shocked to the first bill sent to my EGHP and settled by my EGHP.
(day 1) Epoetin Alfa 100U - Billed $2520, member rate $2520   
(Day 1) HD cost billed $2700, member rate $1600.
there are some other charges too, just for one day, I am speechless.

i have high out of pocket because this center is out of network but they said i most probably will be eligible for their waiver program.
note: i am not on medicare yet, planning to enroll.

The wholesale cost of EPO is about $12.00 per 1,000 units --that's what most hemodialysis centers pay.

 

It's even less than that, I doubt DaVita pays in the double digits.

You can look at DaVita's financial statements, in the past they have published the average reimbursement per treatment, or you can get a rough idea from top line numbers, last I looked it was about $345 per treatment. That's for everything, EPO, Iron, the treatment itself. So clearly the cost of providing one dialysis treatment - soup to nuts is around $330 dollars, at least for DaVita which is run as aggressively as a dialysis unit can be run so you can assume other providers make less and the treatments cost more but say $330+ per treatment is in the ballpark of what it costs to provide dialysis per treatment.

Medicare's allowed rate is about $250 per treatment, on average, including full case mix and geographic adjustments. Well if 75% of your patients are generating $250 per treatment and 10 to 15% even less (Medicaid) then clearly for the business to continue the 10 to 15% private payer is going to pay more, but how much more is an open question - in network, out of network? Lower cost competition or no competition? What can they get away with? The system is designed for private payers to pay a premium, but now it is being exploited, with very little push back. The situation could change but really it doesn't look like it. Believe it or not, in the public record there is a report of people being charged in excess of $9,000 per treatment, you're actually getting off easy WJ.

[Sydnee]

FMC here in town is the only dialysis unit within an hour and a half drive from our home but the insurance considers them out of network. From day one they bill the insurance $5000 a treatment but the insurance only pays $550.  I was really nervous the end of last year because the bill with FMC was so high but the last bill for the year was $0.

We only found out about a month ago that FMC has not billed medicare at all ( this year or last) and they don't plan to unless blue cross blue shield doesn't pay any longer.

Oh and our insurance isn't very good.

[geoffcamp]

I'm amazed every time I look at my statements. For me my monthly dialysis bill to Medicare is $60,000 plus!!  It's mind blowing. My rough figures put the approximate total for the last 10 years at $7.2 MILLION!!!!!!  Wow that is incredible. I have to say my out of pocket expenses have been minimal but still it seems like everything possible should be explored for transplantation. It sure seems like this would be financially a better solution and get me back to being a more productive person in society. I am extremely thankful for the Medicare ESRD program, it has literally been a life saver!! 

[Angiepkd]

I'm amazed every time I look at my statements. For me my monthly dialysis bill to Medicare is $60,000 plus!!  It's mind blowing. My rough figures put the approximate total for the last 10 years at $7.2 MILLION!!!!!!  Wow that is incredible. I have to say my out of pocket expenses have been minimal but still it seems like everything possible should be explored for transplantation. It sure seems like this would be financially a better solution and get me back to being a more productive person in society. I am extremely thankful for the Medicare ESRD program, it has literally been a life saver!!

I agree with you, Geoff!  When everything else they do is financially motivated, why wouldn't they be doing everything in their power to help with transplant options.  Just doesn't make sense to me.  I am thankful for the Medicare ESRD program, too.  But I would be happy to be less of a financial burden on society and get back to being a "normal" person (whatever that is)!

[jeannea]

The frustrating part for me is that Medicare ends 3 years after transplant. Most people with a transplant, even including the drugs, cost a lot less than dialysis. A number of people stop taking transplant drugs after 3 years because of cost. The government won't help them. But if the transplant then fails and they go back on dialysis, everything is ok and paid for. I know there are people advocating for change but so far no go.