Facts and Figures

[angieskidney]

Your saying that you get charged around the same amount in one year what kitkatz gets charged in one month?  Something sounds fishy here.  Who is closer to right?

Come on, I posted the actual "Medicare Summary Notice" and explained the difference between what is charged ("retail price") and what is paid by Medicare.  It can't be more straight forward than that.     

Zach, you are very ... damn I forget the word I was going to use for knowledgable .. anyway, for you it is simple and straight forward but for someone with no health issues as Sandman .. but dating a girl on dialysis who is in a country where everything is paid, you have to understand he might be confused and need clarifying.

[nextnoel]

I apologize ahead of time for the following question, but I'm panicking, and I need to know:  I'm still pre-dialysis, and I'm wondering if you know of anyone who decided against doing dialysis (and yes, I know the consequences) because of being unable to deal with the financial issues.  I am not a give-up type person, but I am having a lot of difficulty wrapping my mind around how I can actually deal with it all.  I am maxed out on what I can do energy-wise at work due to other health problems, so I know when I hit dialysis I almost certainly will not be able to work, so then I'll be on disability.  I mean, if I strip all the "extras" out of my life (except my 2 cats - I have to have them!), and just pay rent, phone, minimum groceries, I still don't see how I will be able to afford the medical things Medicare doesn't pay for.  I live in an urban area where rent is really high (I live in a small 1-bedroom in a hi-rise, at the cheapest end of the rent scale, and an efficiency there isn't much less; I can't move to a cheaper place because there aren't any around here).  To get cheaper rent, I would have to move way out of the area, and my only daughter lives near me now.  And by staying in an urban area, I will still be able to get to doctors, grocery stores, etc., on my own when I am worse.

So in reality, what actually happens to people in situations such as mine - do you just do without medicines and decline more quickly than you would with them, do you charge things as long as possible and then go bankrupt and THEN do without?  I don't know that living like that would be better than refusing treatment (I'm 61, which isn't particularly old, but come on, I've had a life).

Damn, I just reread this, and it sounds so petty, but I'm still going to post it, and expose myself to all of you as the coward I am.  I don't mind really difficult fights, I can handle having really troublesome times, and I still have a lot of gumption left, but I'm starting to think I just don't want to sign on for a long haul of unrelieved misery if that's all there'll be.  I picture the possibility of living with unrelieved suffering and super-sized stress, and the alternative doesn't seem so unappealing!

[BigSky]

Once again stauffenberg, you don't undertand.  The figures I posted are correct.  The larger amount is the monthly "retail price" which is rarely paid, but is charged in any case. The per treatment price (depending on medication) that Medicare approves (and pays 80%) is about $183, regardless of profit or non-profit facility.  This amount may vary a bit from State to State.

Yep.  I might add from what the head of our unit told me was Medicare also figures in age, weight, height among other things.

 
Using the deductible and coinsurance column, which is 20% of the approved amount by Medicare, it shows the price difference in approved amounts by Medicare for the same procedure when comparing it to what Zach posted of his statement.  (that is if I am doing this right)

This is what mine breaks down for 13 treatments.


Service                                Amount            Non Covered             Deductible &            You may
                                          Charged             Charges                  Coinsurance              be billed


Dialysis procedure(90999)        $6500                0.00                        385.40                   385.40


So if 385.40 is the 20% coinsurance I am liable for, the approved amount for this procedure by Medicare would be $1927.00 in my area.   

[Zach]

So if 385.40 is the 20% coinsurance I am liable for, the approved amount for this procedure by Medicare would be $1927.00 in my area.   

BigSky is right on the mark!

I picture the possibility of living with unrelieved suffering and super-sized stress, and the alternative doesn't seem so unappealing!

Nextnoel, don't be discouraged.  If you receive disability from Social Security, you should be able to qualify for your State's Medicaid, insurance for low-income (or no income) folks.  That in turn should pay for all medical bills, along with Medicare.  Once qualifying for Medicaid, you then could qualify for transportation for medical appointments, Section-8 housing vouchers, even perhaps food stamps.

Each State has different requirements and benefits.  Best to ask a social worker at your Nephrologist's office.

Just don't dispair!  I've been on hemodialysis for almost 25 years ... and I work full-time.

[nextnoel]

Thanks, Zach!  I'm breathing a bit easier now.  I'm not afraid of a rough road, I'm just scared of The Great Unknown!  Your reassurance helps a lot.

[AlasdairUK]

so I know when I hit dialysis I almost certainly will not be able to work, so then I'll be on disability. wn when I am worse.

After I started dialysis I felt better and with my EPO my HB levels are higher than before I started dialysis. I know it is the great unknown, but once you start dialysis you will not regret it. I work full time along with many others and dialysis just fits into your life.

[angela515]

So if 385.40 is the 20% coinsurance I am liable for, the approved amount for this procedure by Medicare would be $1927.00 in my area.   

BigSky is right on the mark!

I picture the possibility of living with unrelieved suffering and super-sized stress, and the alternative doesn't seem so unappealing!

Nextnoel, don't be discouraged.  If you receive disability from Social Security, you should be able to qualify for your State's Medicaid, insurance for low-income (or no income) folks.  That in turn should pay for all medical bills, along with Medicare.  Once qualifying for Medicaid, you then could qualify for transportation for medical appointments, Section-8 housing vouchers, even perhaps food stamps.

Each State has different requirements.  Best to ask a social worker at your Nephrologist's office.

Just don't dispair!  I've been on hemodialysis for almost 25 years ... and I work full-time.

Just a quick note on Medicaid. I get Social Security Disability (SSDI), and that is my only income. I do not work. I do not qualify for Medicaid or SSI beause my income is too great from SSDI. However, I don't get hardly anything on SSDI so I qualify for extra-help. Basically someone other tha me ispaying my Mdicare premiums, and I also have a Medicare Supplemental insurance and I have someone other than me paying my premiums on that also. So Medicare pays 80%, my supplemental insurance pays the oter 20% so I pay NOTHING. The point i'm trying to make here is if you can't get medicaid, there's lot's of other help out there, and your social worker can help you get it. Don't give up. 

[nextnoel]

Thanks, Angela.  I didn't realize there were so many possibilities for financial help out there.   I'm going to go back to not obsessing about it, and get information from the social worker when the time comes (well, long before that, actually).  At least now I know there's hope!  THANKS!

[sandman]

Your saying that you get charged around the same amount in one year what kitkatz gets charged in one month?  Something sounds fishy here.  Who is closer to right?

Come on, I posted the actual "Medicare Summary Notice" and explained the difference between what is charged ("retail price") and what is paid by Medicare.  It can't be more straight forward than that.     

I'm sorry Zach.  It's just that kitkatz had posted an amount that just sounded so unrealistic.  I mean really, how is ANYONE suppose to aford costs like that?  It just can't be done.

[jbeany]

kit was trying to figure her total retail cost for her treatment - not how much she has to pay herself, I think.  We're all pretty high maintenance around here.

[kitkatz]

I was not saying what I paid.  Hell, you guys think I am Rockerfeller around here? I am just a little school teacher on a school teacher's salary who happens to be VERY lucky to have insurance and Medicare to pay all of this stuff!  I was adding up total treatment costs. The only out of pocket expenses I have had in these eight years have been for medication copays, dr copays, and emergency room copays. Oh and the 200 dollars Medicare demands every three months.  They hit December pretty hard this year.
Thank the Lord and pass the ammunition I am well and able to work still!

[Fox_nc]

I'm sorry Zach.  It's just that kitkatz had posted an amount that just sounded so unrealistic.  I mean really, how is ANYONE suppose to aford costs like that?  It just can't be done.

No, it can't be done.  I think that's the sad, sad point of it all.  I just got approved for my Medicare and I'm happy to have it!

[Bajanne]

Here in the British Virgin Islands everything was totally free, because it was all done at the general hospital. Then the general hospital came under a statutory board.  The ruling was that once you had insurance, the insurance had to pay.  However, treatment will not be denied to anyone who doesn't have insurance.  The cost here per month is about $6000 (500 per session, including medication given).  We pay for Phoslo and any diabetes and hypertension medication that is prescribed.
In my home country, Barbados, we pay a health levy in our taxes and all treatment at the general hospital is free.  At private clinics, the cost is $300, $350 per session.
I am going home on holiday, and since I am not presently resident there, I have to go to a private clinic and pay up front, but the insurance company will reimburse.