Medicare and pre-emptive tx

[MooseMom]

I'm just curious...

I know there are IHDers who are hoping to get a pre-emptive tx since they have a live donor, and I'm just wondering how Medicare and/or private insurance works.  I know that if you have private insurance via your employer and you start dialysis, your ins covers your dialysis expenses for the first 30 months, after which Medicare kicks in and becomes the primary payor with your private insurance being secondary.

Does it work the same with pre-emptive tx?  Or do you become eligible for Medicare on, say, the day of your tx?

[smcd23]

You become eligible for ESRD Medicare starting with the tx. But if you are out on SSDI based on disability and have been on it for 2 years, you'd be Medicare eligible.

I know when we did the preemptive tx, SO's private insurance covered all the workup for me and him like it was a normal everyday medical procedure... Up to the point where they wanted to do the tx. Then they denied it until they had a letter of medical necessity. But that didn't take very long to resolve, and they paid for it.

And qualifying on the first day of the transplant starts the Medicare 30 month coordination of benefits with private insurance, if you have any. So Tony had his tx 9/08 and his insurance was primary payor up until 3/11, which they didn't like very much, but it is the law

[MooseMom]

Oh, thanks so much for that!  But reading your signature leads me to another question that's rather unrelated, I'm afraid.

After your SO had the kidney removed, he didn't have to start dialysis right away?  I've always wondered about what happens if you have a pre-emptive tx and it doesn't work...what happens next?  Do your native kidneys just keep doing their thing until they peter out completely?  That's what it sounds like happened to your SO.  Is that right?

[smcd23]

Correct - he still urinated (which is why they didn't realize the kidney wasn't working for so long - he was making urine still from his kidneys) and still had some kidney function. He didn't start dialysis until 8 months later when he was throwing up every day, extremely fatigued and downright miserable. His nephrologist said most people would have started within a month or so of the tx, but he was stubborn and pushed through until he just couldn't anymore.

[MooseMom]

smcd, thanks for your reply.  Wow...8 months!  That must have been a difficult time for both of you.   

[smcd23]

It wasnt that bad because he was in denial and good at hiding how sick he was. But during the last month or so when he had to face the truth it got hard, and I was pregnant and hormonal so that made it 10x harder and more emotional. It's definitely been a roller coaster!