Question about paying for dialysis...

[tiredandthirsty]

Hello all,

this is a very personal question for everyone and i completely understand if you would rather not answer.  but since i am on the verge of dialysis (for those who have read my intro), i want to run some numbers and get some ideas on how i can pay for it.  i currently have insurance through my company (still working full time somehow even though i cannot walk around too much, fatigue, muscle wasting, general tiredness etc).  i am trying to figure out how much i will have to pay out of pocket for each session.  and how everyone on here is managing that aspect of this massive trouble called CKD. 

would anyone be kind enough to share?

[cattlekid]

I have never had an issue paying for dialysis.  Like you, I work full time and carry my own insurance (Blue Cross Blue Shield).  When I started dialysis last year, I had already met my OOP maximum for the year so I never had to pay any co-payment for my dialysis sessions.

This year, I put the amount of my OOP maximum into my FSA account.  I still haven't had to touch it because I have not gotten any bills from my provider - I believe that they write off anything that they don't get from the insurance company above and beyond the amount Medicare would pay.  I have to verify this though - I don't want any surprise bills coming out in the next few months.

[Willis]

In the U.S. anyone on dialysis is eligible for Medicare if you've paid FICA for 40 quarters or more. (There may be eligibility differences for younger people so you will have to check with Medicare directly.) Of course, Medicare charges premiums just like an insurance company and if you get a Part C Supplemental policy or Part D drug policy then those will cost too. But they will pay for dialysis and any surgery such as for an AV fistula or a catheter. Depending on your current insurance situation you may not need that and perhaps could drop it. I'm not sure about that one because I did not have insurance before going on dialysis with Medicare. But I'm pretty sure that even if you can't drop your insurance, after 3 years Medicare will pick it up and your insurance company will no longer have to pay.

I think when Medicare starts paying depends on whether you go in-center or do home dialysis. There is a certain number of weeks/months you must be on dialysis before they pay, but I think once they start paying that the payments are retroactive to when you started dialysis. So if for the type of dialysis you are doing requires a 3 month wait, you would have to work out some payment arrangement with your provider until Medicare kicks in.

In my case, I decided to do home PD and one of the reasons I decided to do that modality is because I had no insurance and Medicare kicked in the same month you start home PD. One thing to know about Medicare is that they only reckon their dates on the first day of the month. So no matter when you start D, even if it's July 31st for example, as far as Medicare is concerned you started July 1st. So I planned carefully to have my catheter surgery right after the first of the month, then within 10 days I started my PD training, then after 1 week I started actual PD still in the current month. So as far as Medicare was concerned, I was on Medicare as of the 1st and they paid for everything in that month and beyond (less premiums and deductibles of course).

I'm no expert on Medicare...I learned most of this right here on IHD and if I hadn't read it here I can damn sure guarantee that no one in the medical community would have told me!

One other thing that has tripped people up...depending on individual circumstances, time of the month, etc., you may not get your initial Medicare invoice for 2 or even 3 cycles. But when you do get the invoice, Medicare will want it all in one payment even if that means paying 3 quarters worth at one time. In my case, the billing amounts were all twice what I expected and when following up with Medicare they told me that I was being charged for 2 quarters. It went back to the normal premium after that, but if your budget is low, then that's something to be prepared for.


 

[tiredandthirsty]

I have never had an issue paying for dialysis.  Like you, I work full time and carry my own insurance (Blue Cross Blue Shield).  When I started dialysis last year, I had already met my OOP maximum for the year so I never had to pay any co-payment for my dialysis sessions.

This year, I put the amount of my OOP maximum into my FSA account.  I still haven't had to touch it because I have not gotten any bills from my provider - I believe that they write off anything that they don't get from the insurance company above and beyond the amount Medicare would pay.  I have to verify this though - I don't want any surprise bills coming out in the next few months.

i have united healthcare.  and i have been paying quite a few bills this year yet somehow the yearly maximum is barely moving!  i wonder how they calculate that stuff.  i have an yearly maximum of 2000 before all of it is covered.  i mean i have gotten 3 paracentesis treatments this year in addition to all kinds of blood work and doctor appointments.  and the yearly max is moving at worms pace.  so that's why i am assuming i am going to have to pay some from pocket for each session.  for example, i get an epo shot once every two weeks and i have to pay 110 out of pocket for it.  each time.  i am totally clueless on how this insurance works.  it did pay for the transplant work up though.  that was a giant relief.  thank God for that.

[tiredandthirsty]

Willis:  wow, thanks a lot for this response. i will have to do a proper search on this website to get all this information.  i don't even know if i am eligible for medicare!  very convoluted process this is.  thanks a lot for this elaborate response.  much appreciated.

[cattlekid]

Well, most healthy people don't really worry about the OOP maximums - I know I never did until ESRD hit.

Assuming you have a similar plan as I do, here's the way it works.  I have a $250 deductible, then 80% coinsurance until the OOP maximum of $2000 is met. 

So, my first couple of Dr. appointments were paid out of my pocket until I hit the $250 deductible.  After that, I have to pay 20% of everything else until the total of the payments hits $2000.  So on a regular pre-ESRD year, I might never hit the OOP maximum.  But last year, I had a kidney biopsy on January 7th and that took my OOP maximum out right away and I didn't pay anything else out of pocket for the rest of the year. 

This year has been weird - the insurance company paid the dialysis provider and then I got an EOB listing my 20% share.  But it is my understanding that the dialysis provider writes off anything above what Medicare would pay - so even though I "owe" 20%, I'm not getting billed for it.  But it has gone against my OOP maximum anyhow.

When you start dialysis, your provider should have a social worker or insurance specialist who will help you make sense out of this whole mess.

i have united healthcare.  and i have been paying quite a few bills this year yet somehow the yearly maximum is barely moving!  i wonder how they calculate that stuff.  i have an yearly maximum of 2000 before all of it is covered.  i mean i have gotten 3 paracentesis treatments this year in addition to all kinds of blood work and doctor appointments.  and the yearly max is moving at worms pace.  so that's why i am assuming i am going to have to pay some from pocket for each session.  for example, i get an epo shot once every two weeks and i have to pay 110 out of pocket for it.  each time.  i am totally clueless on how this insurance works.  it did pay for the transplant work up though.  that was a giant relief.  thank God for that.

[tiredandthirsty]

i might have to talk to my transplant insurance contact.  maybe she might have an idea.

my insurance works 90/10.  and i don't have a deductible.  so basically, i believe, i pay 10 percent of the cost and insurance pays 90.  each paracentesis procedure, i have noticed, the hospital charges 2000 to the insurance company and obviously insurance company pays a negotiated rate to them.  which has been different all three times!  one would assume there would be some sort of consistency.  but all three times the negotiated rate was different. no wonder these guys are super profitable.  i might have to buy some insurance company stocks. 

[sullidog]

My employers insurance paid primary every month until this year, medicare is now primary and my employer picks up the tab for bills medicare doesn't cover fully. I have an MRA account and all but 10.00 is spent on perscriptions because I only have my employer for drug coverage, I could get some more funds in my account but, however they told me I no longer qualify for the coaching/wellness programs they offer to get funds because since I follow a doctor, they don't want to override his advice.

[tiredandthirsty]

sullidog:  so you applied for medicare even though you had your own insurance? if you are qualified for medicare, do your benefits with your own insurance change/decline? i mean if you qualify for medicare, will your own insurance cover less than it did before?

i have a HSA account with more amount than the yearly maximum for my insurance, but it seems as if the HSA account is depleting at a faster rate than the yearly maximum is getting accumulated. i might run out of HSA funds earlier than i will meet my yearly maximum, i am almost certain.  the way it is currently going.

[Animal]

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[GraphicBass]

Medicare becomes primary and your plan becomes secondary for three years. Then your plan will be primary for , I think three years- then it goes back to medicare with your being secondary forever.

Hmm, that's the opposite of how it worked for me when I was on dialysis.

My private insurer paid 80%, including treatments, labs and EPO. Medicare, which I was encouraged to sign up for despite private coverage (which turned out to be an OK deal), paid  he remaining 20%. Nephrologist visits were covered 100% with no co-pay.

My biggest surprise was the Medicare premium, which was about $155/mo, paid quarterly. Doesn't seem like much until it's added to my $1,200/mo private insurance premium.

Being chronically ill sure is expensive!

Good luck.

gary

[big777bill]

"Being chronically ill sure is expensive!"



   Amen to that!!!

[Rerun]

OMG!  There are SO many mistakes above!  PLEASE  just go to www.medicare.gov  and look it up for yourself.  There is a section for starting dialysis.  http://www.medicare.gov/site-search/search-results.html?q=Starting%20Dialysis

Just know.... I never pay a bill.  Medicare is primary for me and blue cross is secondary.  Medicare covers End Stage Renal Disease.  It is in there definition since 1974.   Don't get the Medicare drug plan.  Your insurance will cover your drugs and you already pay your premium for that.

And we ask why Medicare is going broke?   

It is true that Medicare starts paying right away if you choose "home dialysis".  So even if you don't want to be on home dialysis take the training and try it for a day or two.  You can always say it didn't work out for you.  It will save you thousands of dollars.

[Cordelia]

I feel for you.    I'm very thankful I don't pay for dialysis--I live in Ontario, Canada where we have insurance that pays for what is deemed as "medically necessary"

And one day, when I will have my transplant, I won't have to pay for that surgery, either.