Why does my dialysis clinic want me to keep COBRA and not switch to Medigap?

[msf21]

I recently was approved for SSDI and Medicare A and B. While I was waiting for approval I enrolled in COBRA to cover dialysis costs. Now that I am approved I was thinking about dropping Cobra and switching to medigap through humana. I found a plan that covers prescriptions and anything left over from medicare and the premiums are free. When I told the insurance liaison for Davita that I wanted to switch she told me no and keep the COBRA. I would be paying almost $500/mo with cobra and medicare B combined. If I switch to medicare with medigap I would only pay $104.90. I was told not to worry about that because American Kidney Fund pays my premiums so I don't pay out of pocket anyways. While that is technically true, it still doesn't make since. It seems like this is purely for the benefit of Davita. To the point, Davita gets paid less money by medicare vs private insurance. It effects their bottom line. If the combined coverage of medicare and medical leaves me no out of pocket shouldn't I take the cheaper option out of principal? Should I do whats good for me or whats good for Davita? There seems to be a problem mentality in this country that there is such a thing as free money. The money from the American Kidney isn't unlimited and comes from somewhere (taxes and donations, I assume) so its not really free.

http://money.cnn.com/2014/04/21/news/economy/medicare-doctors/

[chuckdims]

My COBRA plan pays Fresenius over $800,000 a year.  Medicare wouldn't come close to that.  That's why.

[chuckdims]

Oh, and the AKF "pays" my COBRA premium.

I use quotes because Fresenius makes a donation to AKF . . . in my name . . . for the exact amount of my premium.

[cattlekid]

I understand that there is a need to help those who need assistance with paying for insurance so they can obtain needed medical care.

However, it has always seemed fishy to me that Davita/Fresenius donate to AKF, then AKF covers the premiums so that the company can recoup more dollars overall than they paid out in the donation. 

To me, it then seems like the patient is just a necessary evil in the money-making scheme.    

[Simon Dog]

My COBRA plan pays Fresenius over $800,000 a year.  Medicare wouldn't come close to that.  That's why.

I think you meant over $80,000.

My private insurance pays $445 per dialysis treatment ($69,420 assuming 3tx for 52 wks - not sure how may they bill for on NxStage).  The Medicare rate is about $245 ($38,220 with the same assumptions).   My insurance company paid over $10,000 for two "out of area" treatments at a DaVita clinic when I was traveling (no, that is not a type - over $5K per treatment).

However, it has always seemed fishy to me that Davita/Fresenius donate to AKF, then AKF covers the premiums so that the company can recoup more dollars overall than they paid out in the donation.

It's called good business.

[chuckdims]

No, I meant $800,000.  Eight hundred thousand. 

Fresenius charges about $24,000 a week, but Aetna pays less, about $15,000 a week, or $2,500 per treatment.

[msf21]

To me, it then seems like the patient is just a necessary evil in the money-making scheme.   

Its very much a scheme. The longer I am on dialysis, the more I am aware of this fact. The patients well-being is an afterthought. I understand the need to get paid for your services, but $2500 per treatment? It all seems like they are exploiting our bad situation.

[cattlekid]

I just tried to check the Blue Cross/Blue Shield website, but they have purged all of my old claims from when I was on dialysis.  As I recall, it was about $15,000 per week as well that was paid to Davita when I was doing NxStage 5x per week.

[msf21]

hey chuck, I noticed your from KCMO. I live in mission, KS. How long have you been on dialysis? I started 5/15/13. I also noticed you have FSGS, same here.  Welcome to IHD!

[Michael Murphy]

Not counting extras such as iron and epo shots Aetna pays my clinic 1500 a session for my dialysis, 3*52*1500 = 234,000 a year plus extras.  Aenta does not pay the full freight since they have negotiated a lower than full price rate.  Where I go medicare pays 273  3*52*273 = 42,588. So in my case if Fresenius paid 1000 per month for my insurance the net gain would be 180000 a year additional income.  So at no additional cost to the patient more then recovers the cost of the insurance.  Plus the patient gains by getting better coverage for the rest of their medical needs.  Every one wins but the insurance company.

[Simon Dog]

I just tried to check the Blue Cross/Blue Shield website, but they have purged all of my old claims from when I was on dialysis.  As I recall, it was about $15,000 per week as well that was paid to Davita when I was doing NxStage 5x per week.

$15,000 per week seems awfully high for the "paid in full BCBS negotiated price", but does sound like a typical "asking price".

[Simon Dog]

No, I meant $800,000.  Eight hundred thousand. 

Fresenius charges about $24,000 a week, but Aetna pays less, about $15,000 a week, or $2,500 per treatment.

Wow.

[cattlekid]

We just use BCBS for claims management, I don't actually have a BCBS policy, our company self-insures.  Now that I think about it, the actual payment amount was probably a bit less, but not by much.  I knew that was why my old in-center clinic administrator threw a hissy fit when I left to go do NxStage.  He didn't give a rat's patoot about me as a person, but I knew he would have a lot of answering to do about why he let me walk out of a clinic that was lucky to get Medicaid rates for most of their patients.

I just tried to check the Blue Cross/Blue Shield website, but they have purged all of my old claims from when I was on dialysis.  As I recall, it was about $15,000 per week as well that was paid to Davita when I was doing NxStage 5x per week.

$15,000 per week seems awfully high for the "paid in full BCBS negotiated price", but does sound like a typical "asking price".

[Michael Murphy]

The other strange fact about medical billing the uninsured rate is about 3 times cost at a minimum so if they are not paid the tax deduction will cover the costs.  So of a procedure really costs 5000 add 1000 profit times 3 and a bill for 18000 is sent out. As long as they make a minimal effort to collect (send to collection agency)  They get a 18000 dollar deduction, about 6000 off of taxes. Hey that's what they wanted to make after all.  Mean while the poor patient is being hounded by a collection agency for money the medical provider has wrote off and does not really expect to be paid.  If the collection agency is successful they get to keep most of the money they get.  Great system except for the uninsured.

[chuckdims]

Not counting extras such as iron and epo shots Aetna pays my clinic 1500 a session for my dialysis, 3*52*1500 = 234,000 a year plus extras.  Aenta does not pay the full freight since they have negotiated a lower than full price rate.  Where I go medicare pays 273  3*52*273 = 42,588. So in my case if Fresenius paid 1000 per month for my insurance the net gain would be 180000 a year additional income.  So at no additional cost to the patient more then recovers the cost of the insurance.  Plus the patient gains by getting better coverage for the rest of their medical needs.  Every one wins but the insurance company.

My clinic manager told me that on many of the Medicare-only patients they break even or lose money, so I know they want to make money where they can.  I don't blame them.  The profit incentive is a great reason for them to take as good care of me as they can.  Plus, I know that when my COBRA runs out in late 2016, unless my wife works full time by then and I have another private insurance, I will likely be one of the patients that they only break even on.

So I don't mind them paying it, I get it.  Plus, it gives me way better coverage than if I had Medicare only.  I'm lucky in that I had a pretty crappy job in the scheme of things but the insurance they offered was phenomenal.

[chuckdims]

hey chuck, I noticed your from KCMO. I live in mission, KS. How long have you been on dialysis? I started 5/15/13. I also noticed you have FSGS, same here.  Welcome to IHD!

Msf21 - Mission, KS -- home of Oklahoma Joe's BBQ!  I guess now Kansas City Joe's BBQ, but I refuse to embrace the new name.  I have been on dialysis since 09/26/2013.  My nephrologist is Dr. Winklhofer through KUMED.  My clinic is the Fesenius on Parallel Pkwy in KCKS.  What about you?  Send me a DM if you would rather.

[iolaire]

Not counting extras such as iron and epo shots Aetna pays my clinic 1500 a session for my dialysis, 3*52*1500 = 234,000 a year plus extras.  Aenta does not pay the full freight since they have negotiated a lower than full price rate.  Where I go medicare pays 273  3*52*273 = 42,588. So in my case if Fresenius paid 1000 per month for my insurance the net gain would be 180000 a year additional income.  So at no additional cost to the patient more then recovers the cost of the insurance.  Plus the patient gains by getting better coverage for the rest of their medical needs.  Every one wins but the insurance company.

Interesting Aetna pays my DaVita just under $1500 in center, but that's all in (including the injectionables) except for billing for some of the DaVita lab work but that only adds up to maybe $200/month.

The whole billing of insurance versus Medicare is stressful.  On one had I feel like my insurance is getting taken for a ride, but on the other hand I'm subsidizing other people - so my insurance is benefiting the community...  On the flip side my company is probably self insured so I'm showing up on the bottom-line in some fashion.

I think you need to do what is best for you.  The clinic is a business and they have lots of people to help you, but you have to look out after your best interest.  Make sure you look into the out of pocket costs for Medicare/Medi-gap coverage.  At least with my Aetna once I pay my co-pay I'm 100% covered, will Medicare be similar and will you stop paying after say $3000?

Also a question, say I get a transplant, and loose that transplant, does the 3-years for Medicare to take over reset or is it continued based on my time in dialysis pre transplant.

[Shaks24]

I have original medicare with  medigap F. I have zero out of pockets expenses other than the  premiums. Because I am under 65, the medigap F is costly though.