January 28, 2008
Bill would limit changes affecting dialysis coverageBy Daniel Lee
daniel.lee@indystar.com
The Indiana House this week is expected to consider a bill that would restrict changes health insurance companies can make in coverage and payment rates for dialysis treatment.
The bill, authored by Rep. Craig R. Fry, D-Mishawaka, would require health insurers to follow certain guidelines in how they reimburse outpatient centers for dialysis, a life-preserving treatment for people with serious kidney disease.
Backers of the measure, House Bill 1323, say it is needed to stop insurance companies from forcing already sick dialysis patients to leave dialysis centers where they have been receiving care to drive longer distances to centers within their insurance network.
"Dialysis providers have experienced significant unilateral reduction in both in-network and out-of-network rates in Indiana," according to Brandon Edwards, a spokesman for dialysis companies FMC, National Renal Alliance and DaVita, all members of Kidney Care Council.
WellPoint's Anthem Blue Cross and Blue Shield, the state's largest commercial health insurer, said it is still reviewing the bill.
"But we're concerned that it contains several legislative mandates that would only serve to increase the cost of health care for Indiana employers and residents," Anthem spokesman Tony Felts said in an e-mail.
Dialysis is required for those with end-stage kidney failure to survive. Patients typically get three treatments a week that last about four hours each. About 6,400 people in Indiana require dialysis, according to Kidney Care Council, a Washington, D.C.-based trade association of renal-care companies that is supporting the bill.
The Kidney Care Council says that insurers are cutting reimbursement even though they have to cover dialysis only for a limited time. After the first 30 months, Medicare takes over, the group said.
Indiana is not the only state where out-of-network rates for dialysis care have become an issue.
National Renal Alliance, a Tennessee-based dialysis company, filed a lawsuit this month against WellPoint's Blue Cross Blue Shield of Georgia that said the insurer made "unprecedented" cuts in reimbursement to 12 percent of usual charges in violation of law protecting dialysis patients and providers.
WellPoint said the suit is without merit.
"We are committed to keeping health care costs affordable while promoting high quality care for our members and their families," WellPoint spokesman Jim Kappel said in an e-mail. He said National Renal provides services to about 20 Blue Cross Blue Shield of Georgia members.
"Their current benefits and access to NRA clinics will not change because of this lawsuit, absent NRA's refusal to accept them as patients."
Call Star reporter Daniel Lee at (317) 444-6311.
http://www.indystar.com/apps/pbcs.dll/article?AID=/20080128/LOCAL190106/801280382
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