DiVita Submitted Charges "OVER" the Top!!

[Rerun]

I just got my EOB (Explanation of Benefits) from my secoondary insurance BlueX Federal.

My Submitted charges for January Dialysis (DaVita) is a whopping $64,738.50 .... yes that is for January.  Plus what they actually get paid is a thousand more than usual.  So they actually get $3,224.34 for January which is more than usual. 

I don't want to see them go out of business for FRAUD because that would affect me and alot of other people in about 8 days.  But, come on!  Just tell the truth.  I do NOT cost $64,738.50 to keep ALIVE!

I went 24 times in January.    All it says is  Medical Equip/supply $16 (I get that one)
Diagnostic Lab Test $532.08
Diagnostic Lab Test  $71.91
Diagnostic Lab Test $133.11
Then 48 charges for Prescription Drugs  and then 14 charges for Medical care.  So I got no Medical care the other 10 times and all those Rx drugs?  And if the prices were the same I would understand but they just go up and up as the month goes on.  AND I bring my own Lidocaine.

I'm so mad.






EDITED:  Thread moved to proper section:  "Medicare/Insurance" - jbeany, Moderator  (I'm in an OCD mood today, Rerun, and am shuffling thing around!)

[cattlekid]

You want to see something that will make your head spin?  I am on freaking HOME HEMO, where I do ALL the work.  My billed charges from DaVita PER TREATMENT are:

$3314.00 - dialysis
$72.80 - med/surgical supplies
$108.80 - drugs

So let's see.  I use two 4x4s, four 2x2s, some tape, four gloves, six syringes, two chux pads, two alcohol wipes and two betadine wipes per treatment.  One liter of saline, and one garbage bag.

Then there is the NxStage cartridge, and the PureFlow diasylate.  One bag of dialsylate lasts two treatments.

Drugs?  $108.80 for 5000 units of heparin.

Then we have the real insult to injury.  On the days when I give myself my 25,000 units of EPO, my unit bills another $4970 for the EPO. 

Of course, 75% of that is whacked off the top and DaVita only receives 25%. 

I'm in the wrong freaking business.   

[Rerun]

I have started questioning at the local level.  I've got one rung higher but I'm going all the way until they can tell me what the charges are for.

For one thing, no business can take a $60K loss per person on dialysis and survive. 

Time Magizine dated March 4, 2013 has a special report.  Read it if you get a chance.  It is on outrageous Medical costs that have to be paid "up front" now for some treatments for cancer. 

[Speedy1wrc]

I was shocked when my Home Hemp nurse told me also that it was in the area of $3000 for each treatment. As mentioned above I use pretty much the same consummable supplies. I have talked to people who have seen internal bills for dialysate and it is only around $1200 per month, so indeeed what the heck costs so much?

I have experienced something like this before with an eye Dr. His bill was around $1000 for a procedure and my insurance was only going to pay him around $400. I was speaking with an insurance representative a the time and she told me it is very common. The Dr bills high and gets paid less than what he is owed. He then can takre a loss and writes it off on his taxes. So even though they take in a ton of money and would then have to pay a ton in taxes, they offset all that income with losses and to the IRS it shows that they didn't make squat.

I'm not sure how that can work for a corporation though since they need to show a decent profit to the shareholders. I am sure though that they have accountants smart enough to make anything look good. Of course DaVita wouldn't do anything sketchy or anything even slightly shady. Oh wait, they already have and got caught doing it.

The going rate for a quantity of 10/10,00 unit vials of Epogen is around. $1400 retail. Doing the math then 25,00 units would be 25% of that which is $350. So for 25,00 units at over $4000 there's something fishy going on. I would have to imagine in quantity and wholesale it's got to be much cheaper even still.

Why do so many businesses feel that to make money they gave to cheat? Why not make the best product you can and let great sales keep you in business?

[Rerun]

I agree Speedy!

I have gone to see my Social Worker who could not answer my questions so gave me a phone number to talk to Barbara and She could not answer my questions so sent me off to Mimi and she sent me to Tami but the call didn't go through and just hung up on me.  I then got Margaret and she gave me Michale's extension. 

And the music on hold  is a cross between scary and nerve wracking!  But, I complimented them on it and told them it was lovely and I could sit and listen to it all day.   

I will start with Michael tomorrow as they are already closed for today.

Did anyone read the Time article yet.  The Bitter Pill. 

Again, I don't want them shut down because we would all die.  Hell of a place to be isn't it. 
What if we really were expected to pay $65K a month.  I could go 3 times then not.  And they still make money.  But, it is off Mediare and Sick people.  That is just wrong.

[looneytunes]

Oh RR...this is my soap box too!  In 2010, we dubbed hubby "the million dollar man" since the BILLED medical charges were 1.2 million dolllars (USD).  Medicare and private supplement insurance actually paid just over 200k of the billed amounts.  AND WE OWED NOTHING!  I agree with you....this is outrageous! 

[jeannea]

I don't think this is just a dialysis thing. You see it in everything from hospital stays down to a visit with your primary care doc. The docs charge a large amount hoping to get a livable amount out of the insurance company. It's a broken system where no one knows what things really cost or how to be honest about it. I wish we could have an honest charge paid straight out by the insurance.

[Jean]

Speaking of hospital bills...... In Nov. I had a 7 day stay in the hospital. Got the bill the other day, a mere, $ 62000.00. The one for the Rx was $8000.00 !!!!!! Now, I dont spend anywhere near $8000.00 in a year for all my RX's and the only thing they gave me that was different was saline solution, which probably costs $2.00 and 2 days of the super calorie liquid feeding, and massive anticiotics as well. The topper comes when you realize that Medicare and my medigap insurance paid all but $350.00 of this entire bill!!!!! Two CT scans cost over $9000.00. I would think by now that those damned machines would be paid for.

[Simon Dog]

I was on PD until recently (haven't see a hemo EOB) yet with Fresenius, still in the 30 month private insurance window.   Fresenius billed a fixed $1600.00 per day for PD, but gladly accepted the $138.95 my insurance company paid.

[Rerun]

Broken system is right.  Our country is just as corrupt as any country that we send humanitarian aid to.

Our country just knows how to keep us from rioting (all of us at once)  Just keep us fed, and warm with a cell phone and transportation.  We keep calm.  Oh, and some sort of health care.

I just think if we all came down to the truth.  A "non-profit" company could keep 10% profit and give the rest to charity.  So the CEO would make 1 million instead of 30.  But, greed is a mighty force.

[Jean]

Rerun, I think you have it down pat!!!

[Rerun]

DaVita won't talk to me.  They say my balance is zero so I need to talk to my insurance as to why submitted charges are $65K for January.  That is BS.  They charge it, and Medicare pays their portion and then My insurance pays the rest.  I want to know what cost $65K a month.  I have a meeting with the clinic director, manager, social worker and dietitian today and I'm taking my EOB and have them try and explain it.

What was a surprise to me is that one of the prompts on the DaVita phone is Patients that want to pay by credit card push #2..... What are patients paying for?

My friend who is with the competition that starts with a "F" got a bill for January due April 4 for $1,400.  For what?  She has Medicare and insurance..... can't they accept that? Are we now going to be expected to pay something that we know the prices are fictitious anyway?  I want TRUTH in billing.

How many of you are paying out of pocket monthly to have dialysis?

[cattlekid]

I have a $2000 out of pocket maximum for my employer group health insurance.  Because I am still working, my employer insurance is primary.  Because I am an idiot, I didn't realize that you actually had to call Medicare and explain to them that you have employer insurance so that the Coordination of Benefits can happen.  So for the first two weeks of January, I got dinged by DaVita for the $2000 out of pocket.  I actually haven't seen a medical bill of any type since then. 

I throw DaVita fifty or a hundred bucks whenever I'm feeling flush.  I really just want them to write it off because they get THOUSANDS of dollars from my insurance company every month.  But I'm not in the mood to fight it, and my SW said as long as I send them SOMETHING every month, they won't get too wound up.

[Rerun]

I really think I'm banging my head against the wall.   

They are never going to tell me why they charge so outrageously.  They may even deny me services if I don't "shut up".  It is a sad situation.  I should have the guts to say "I quit" because I don't want treatment from the Mafia. 

[rocker]

Of course they won't tell you why they charge what they charge.  They don't know.  No one does. Medical providers have a price list called the "chargemaster". The prices on the chargemaster are hundreds to thousands of times (yes, really) what you would pay for the items anywhere else.  The chargemaster prices are entirely fictional, there's no formula for them, someone updates them every so often, but there's no rhyme or reason to it.  Providers defend this practice by saying "No one actually pays those prices."

Insurers pay a fraction of those prices, typically 20-30%, which is still a huge markup.  Medicare pays far less than that - and providers still take Medicare.

But that's what they charge uninsured people. Another little-known item that the Time article brought to light - the hospitals don't consider the bill to be "what you owe", even if you're uninsured. There's an entire industry of "hospital bill negotiators", whose job is to challenge bill items and get the hospital to accept thousands of dollars less.

Consider this.  The majority of dialysis patients have Medicare as primary payer.  Medicare pays a little over a hundred dollars per treatment. The two major dialysis companies make about four BILLION dollars in profit per year, combined.

All that money is going straight to the people on top.

[Angiepkd]

I received my first EOB for my NxStage training last week.  DaVita billed my insurance company $5400.00 per day (times 5). Wow!! They wrote off $4600 and billed me $820. Per day?!  One of the nurses at my center showed me an article stating that centers lose about $10 per treatment when Medicare is primary.  That small amount and much of the "profit" is made up through patients with private insurance.  Most centers try to recruit patients with private insurance so they can keep running in the black and have ratio's they are supposed to try and meet.  How sad.  I have never asked for assistance with anything my entire life, but these charges would make it impossible for me to survive without my insurance.  What a terrible thing for people to live with, on top of ESRD and dialysis! 

[rocker]

Sorry, but I don't believe for a second that these companies are losing $10 on every Medicare treatment, "article" or no.  I've done a fair amount of research in this area.

[Speedy1wrc]

I don't believe they are losing money either. I have talked to a center nurse and from what I have been told, even with write-off's, they make a ton. I got an insight into what their costs are and it's a lot less than what we are being charged.

[amanda100wilson]

I don't believe that the costs charged are the actual cost.  investigations of costing in ER depts. reveal that, they charge stupid amounts even for a hot blanket.  these practices must go on in all hospitals, and at all levels.  the real cost probably lies somewhere between what is billed and what the insurance companies will pay.  If you think of it, the US has the most expensive healthcare system in the World.  I wonder why?

[Angiepkd]

http://www.dopps.org/doppscd/DoppsCD2012/pdf/Hirth-ISHCOF-US-2007.pdf  This is the article. Not sure if it is legit, but it looks real to me.

[lmunchkin]

My bills run all different amounts each month.  One month it 30k nex its 80K.  And like Cattlekid, Im doing all the work!  Not complaining cause it keeps my man alive, but the cost is astronomical.  It not just Davita, it is all of them including Fres.M.C.

I think this country is so far in debt that the only way out is a Big Depression like in the 1930's & 40's.  My parents grew up in that time.  There will be alot of people in trouble if it were to happen, including us!  People on the left & right do not care for us. They haven't for years now.  They get our money and live very extravagant lives.  It should come as no surprise, its been going on since the 60's.

If people do not stop depending on government for all their needs & turn back to God, there is no way this country will come back from despair!  Just my 2 cents!

I tend to look for the good in all, and damn this government that have profited off the backs of good descent people in this country.  Shame on them all!!!!!!  God will judge this Nation and all the others.  I fear Him, and him only!

God Bless,
lmunchkin   

P.S. Not much any of us can do about it, It is what it is!  We must keep our heads & hearts "UPWARD"!

[Simon Dog]

Just saw my HD bill from F - asking price per treatment over $3000; private insurance paid a bit over $300.    I wonder if the asking price is targeting visiting arabs - even Dialysis @ sea does not charge that much.

[BlueKat]

Sorry, but I don't believe for a second that these companies are losing $10 on every Medicare treatment, "article" or no.  I've done a fair amount of research in this area.

Hospital owned dialysis units do loose money on dialysis medicare treatments. The reimbursed amount from Medicare does not cover the cost of the tx. Hospitals made up this money with charges on expensives medications, such as epo. Medicare reimbursed the full price of the meds. The cost of the meds was higher than the tx. Along came bundling. Medicare gave a minor raise in their reimbursed amount, but in return required all dialysis technicians to be certified, & the whole cost of the tx. is rolled into one bill. The dialysis units will no longer get to charge medicare separately for the tx. & the medications. Hospitals kept their dialysis units even if they were loosing money, because the average dialysis pt. has 3 hospital admissions per year. The hospitals are reimbused much better for a hospital admission. Keeping dialysis pts. tied to a particular hospital, helps keep the hospital census up.
The bundling is changeing all this. Hospitals are selling their dialysis units to companies such as Davita & Fresenius. If your unit was sold to a large dialysis company, you will notice changes in how they do things. All of the changes have to do with cost. "bean counters" The large dialysis companies bill private insurance companies for as much as they possibly can. The difference between what a private insurance is billed & what medicare reimburses is insane. $1000's of dollars.
There are new problems rising. Medications & dialysis supplies shortages. There are currently medications used with dialysis pts. that are in severe shortage & can't be purchased. One brand of dialyzer is in shortage. Companies have to change to a different brand. These new problems may not go away. Why are there shortages of medical supplies in the USA? Several antibiotics can't be found. Shortages on some cancer medications. The list is getting longer every week.

[Rerun]

Okay, BlueKat, lets start pricing things.  You tell me how much it "really" costs for a bag of lines and a bag of saline, the real cost of 1 dializer and 2 gauze 2x2's and one roll of paper tape and 1 use of a machine.....  Let's put down the real costs so we are not just saying hospitals "lose" money on dialysis.   And if you were on life-saving dialysis wouldn't you want a "CERTIFIED" technician working on you?  Mary Mother OF JESUS!

The ...reason... Medicare had to start bundling is because they were being cheated by clinics and hospitals using too much EPO and Iron etc...just to make a gigantic profit.  Oh, now treatments are bundled, all of a sudden our HCT doesn't need to be 13... it can be 11. 

I want an itemized list where I can see a bag of saline costs 88 cents instead of $30 and the RN is making $20 an hour instead of $200 an hour and just line by line seeing what things really cost.

Is that too much to ask?

Why should a non-profit (doing God's work) make a profit?  As long as everything comes out even.  Not a profit.     

[jeannea]

Rerun, that's a really tough analysis. I'd like to see it too. But you can't just count gauze, saline, etc. You need the cost of labor, including benefits, for the tech who works on you, the nurse manager who is there, and the asst who is there doing the stocking of the supplies and stuff. Maybe even the janitor. Then you need overhead such as the cost of electricity and water. You might even need to average the cost of room maintenance such as paint, light bulbs, etc. There's so much other cost that has to be paid for besides your personal supplies.

I agree with the non-profit part. If you say you're non-profit then act like it. The hospitals I use are for profit. My dialysis center is for profit for the benefit of the doctors who run it.

I don't know if it's possible to find out who is losing or making money per treatment. Esp with hospitals. Their accounting must be insane.