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Author Topic: Friend's Insurance is not paying for his Dialysis...  (Read 5091 times)
KarenInWA
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« on: January 27, 2010, 06:41:20 PM »
Hey Everyone,

One of my FB friends, a supervisor at my former job, has been on dialysis now for 2-3 years.  He has worked at my old company for over 10 years.  My old company, without naming any names, is a top U.S. wirless provider.  My friend just posted on his FB that his received a call from the kidney center, and they told him that his insurance, United Healthcare, is not covering the cost of his dialysis.  I believe he is in a non-profit center, since Davita is a recent player out here in the Seattle area, and I've never seen a Fresnius one.  He says in his post that he pays a lot for his insurance each month.  I will be sending him the link to this thread.  Anyone have any ideas?  I know I don't have a lot of information. 

Thank you in advance!

KarenInWA
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1996 - Diagnosed with Proteinuria
2000 - Started seeing nephrologist on regular basis
Mar 2010 - Started Aranesp shots - well into CKD4
Dec 1, 2010 - Transplant Eval Appt - Listed on Feb 10, 2012
Apr 18, 2011 - Had fistula placed at GFR 8
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Oct 2011  - My Wonderful Donor was approved for surgery!
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April 3, 2012 - Routine Post-Tx Biopsy (creatinine went up just a little, from 1.4 to 1.7)
April 7, 2012 - ER admit to hospital, emergency surgery to remove large hematoma caused by biopsy
April 8, 2012 - In hospital dialysis with 2 units of blood
Now: On the mend, getting better! New Goal: No more in-patient hospital stays! More travel and life adventures!
willowtreewren
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« Reply #1 on: January 27, 2010, 06:47:55 PM »
If he is on dialysis, he should be eligible for Medicare to pick up where his insurance lets off.  ???
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Chris
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« Reply #2 on: January 27, 2010, 06:57:41 PM »
Quote from: willowtreewren on January 27, 2010, 06:47:55 PM
If he is on dialysis, he should be eligible for Medicare to pick up where his insurance lets off.  ???
That was my first thought too, but also the doctor may need to get involved and explain to the dimwitt on the other end what dialysis if for and what no dialysis will do. , then ask for supervisor if they do not get anywhere.
 
Also get the social worker involved at his center if she/he isn't already, but should have been from the start.
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scooter26
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« Reply #3 on: January 27, 2010, 07:13:18 PM »
Your friend needs to try to find out exactly why his dialysis is not being covered.  Does his policy not cover dialysis?  Does he actually have a huge out of pocket or deductible to pay before the insurance will pay the claims?
Was there an authorization required that was not obtained?  Is his clinic not in his network if he needs to use only contracted facilities?   You get the drift, there could be many reasons why he was told by the facility he had no dialysis coverage.  He should contact UHC directly and get the answers himself and yes he should get the SW involved.
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chiefsfan301
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« Reply #4 on: January 28, 2010, 07:18:36 AM »
Clinic Social Worker ----->  Medicare
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Wallyz
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« Reply #5 on: January 28, 2010, 07:59:50 AM »
They will pay for it, he has to keep fighting.  United sometimes denies stuff out of habit, and then waits to see who will fight them.
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