Transient billing - yikes

[Simon Dog]

I had two transient treatments at a DaVita clinic (great service once I corrected a few errors).     When I was in-center, my private insurance was paying about $445 per treatment, and I understand Medicare pays about $245.  (typo corrected)

I just saw the statement from my insurer for these two transient 4 hour sessions.   The amount paid (not asked, actually paid) was over $4500.00 per treatment!!!

The next time I am thinking of traveling, I will either take the NxStage (I was not on it at the time of these treatments) or call my insurance company and ask if they would like to pay me not to go.

[Zach]

You are correct, Medicare's approved charge for a single hemodialysis treatment is about $235.00 (depending on region and a few other variables) of which 80% is paid by them.

Of course with your employer insurance being primary payor, anything goes.

How much do you think they will pay you not to go next time?

 

[Bungarian]

235.00 seems too cheap

[iolaire]

I had two transient treatments at a DaVita clinic (great service once I corrected a few errors).     When I was in-center, my private insurance was paying about $445 per treatment, and I understand Medicare pays about $245.  (typo corrected)

I just saw the statement from my insurer for these two transient 4 hour sessions.   The amount paid (not asked, actually paid) was over $4500.00 per treatment!!!

The next time I am thinking of traveling, I will either take the NxStage (I was not on it at the time of these treatments) or call my insurance company and ask if they would like to pay me not to go.

Davita bills Aetna $4,500 and Aetna pays a negotiated rate of around $1,400 at my clinic. Even that is hard to believe given the Medicade rate!  I called Aenta to see if that rate was correct and they didn't seem to know much other than its a contact rate.

[iolaire]

You are correct, Medicare's approved charge for a single hemodialysis treatment is about $235.00 (depending on region and a few other variables) of which 80% is paid by them.

Does that rate include everything, lines, filters, epogen, helprin, etc?

[Zach]

Yes, the bundle includes most everything for an individual treatment:  the dialyzer, lines, epo, iron, vit. D, heparin, syringes, etc. (see attached list).
I only wish that it also included Jack on the Rocks!

 

Edit:  I believe the Medicare bundle rate received a cut of 2% this year due to the sequester.

More than you ever want to know about the Medicare bundle:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/End-Stage_Renal_Disease_Prospective_Payment_System_ICN905143.pdf

[iolaire]

Yes, the bundle includes most everything for an individual treatment:  the dialyzer, lines, epo, iron, vit. D, heparin, syringes, etc. (see attached list).

Thanks, $4,500 seems excessive as does $1,400 if Medicare gets the same thing for much less.  I'm sure the Medicare rate is based off of some sort of calculation that is razor thin margins, but still somewhat based on reality.

[Simon Dog]

Yes, the bundle includes most everything for an individual treatment:  the dialyzer, lines, epo, iron, vit. D, heparin, syringes, etc. (see attached list).

Thanks, $4,500 seems excessive as does $1,400 if Medicare gets the same thing for much less.  I'm sure the Medicare rate is based off of some sort of calculation that is razor thin margins, but still somewhat based on reality.

There is an incremental margin, and a fully burdened margin.  The former is the profit based on the incremental cost of providing a treatment - but does not cover overhead, executive salaries and bonuses, etc.   It is possible that medicare rate treatments produce an incremental profit but not a fully burdened profit (which works as long as they can hose private insurance to cover the overhead).

[cattlekid]

The one thing I found about constantly being on private insurance primary while I was on dialysis is boy could I throw my weight around at the dialysis center.  I have read that there are specific meetings (at least with DaVita) with the Facility Administrators where the higher ups make sure that the FA's know who the patients are who are on private insurance and make sure that the FA's are doing what is necessary to keep the private pay patients around. 

I know that there was a lot of hand wringing when I left my Fresenius center to go to a DaVita center to get NxStage, but not enough for them to start a home hemo program with NxStage at my local center. 

[Rerun]

Zack:  I get Jack on the Rocks while on dialysis.... You must not have private insurance....    

We need to take into account the TAX SAVINGS for always showing a LOSS.  Cheaters!