So, how much does dialysis REALLY cost?

[Alex C.]

It's nearly impossible to get a straight answer with the state of medical billing in this country is intentionally confusing (do they charge $321/session, or $800, or $21,000?), so I was wondering if anybody out there has any REAL information on just what insurers actually pay per dialysis treatment, either here in the U.S., or in other countries.

BTW, from what I can deduce, that mythical $21k price seems to be a way that dialysis centers keep too many people from visiting for short periods. If I visit another town, and they charge $21k, and somebody visits my center, where they charge $21k, then it evens out to zero. If, OTOH, NOBODY wants to use a certain center when visiting, they lose, and they need to make the place better (I guess...).

[justagirl2325]

I once read an article entitled "The Economics of Kidney Failure."  It's a Canadian document but it has comparisons internationally.  They put the cost at $60,000 per year per person on hemodialysis.

I don't know how to link it but you should be able to goole it.

[Simon Dog]

Some actual costs in the US:

- Medicare paid, in center, $245 per treatment

- Private insurance, in center, per treatment $445 (varies by insurance carrier)

- Vistor to Kent Dialysis, Kent WA; private insurance; paid $5050 per treatment.  No, I did not miss a decimal.

- Rochester, NY visitor, a bit over $3000 per treatment (private insurance)

- Las Vegas; visitor; medicare - $245

My MD tells me he gets paid $8 per treatment to supervise and write orders for a transient medicare patient.

[cassandra]

According to NHS Blood and Transplant £246 or $ 325 depending on exchange rate per session. No idea what they charge visitors

[cassandra]

In the Netherlands a HD session varies from €201 to €3511 ($ 225 to $ 3925) according to VNV (the Dutch insurance organisation)

[Michael Murphy]

I have Aetna as both my primary and secondary (my wife and I both have insurance) and they pay about 1500 dollars a session in New Jersey, Medicare pays just under 300 dollars a session. My understanding the Medicare rates are at break even or marginally profitable.  The worst rates are the uninsured and using the 3 to 1 rule, the rates are usually 3 times the private insurers rates.  This is so if the company is not paid they can get a tax write off for the larger amount and that means with a 33 percent tax rate they make what the private insurer pays.

[iolaire]

Aetna pays my local center $1,550 now up about $60 from last year. When I travel internationally and self pay is generally $250-$400 (I get reimbursed by Aetna).  I expect the rate I pay when traveling still includes some markup.

Also that Aetna rate is all in, no charges for epo or other drugs, they do bill for the doctor and lab work.

[kristina]

... To be quite honest, I could not make myself overly keen to find out the precise costs of these life-saving-dialysis-sessions...
... and I do hope no government official thinks about the nationwide costs of regular dialysis-sessions either,
just in case they might come up with a "revolutionary" idea of how to cut down the costs of quality-dialysis-time
in order to save the government more money ... 

[Cowdog]

Medicare is my primary with employer insurance as secondary. I got a statement from my employer insurance co last week for the period 4/1 - 5/15. The bill was just over $73,000. After adjustments and Medicare payment my employer insurance paid $1800 (the 20% not paid by Medicare). The expected bill to me was $0.00.
When my employer insurance was primary they were paying $4,000 per treatment. The $73,000 billed for that 6 week period calculates to the $4,000 per treatment initially paid by the insurance co.
There are so many games being played in healthcare billing.

[iolaire]

Medicare is my primary with employer insurance as secondary. I got a statement from my employer insurance co last week for the period 4/1 - 5/15. The bill was just over $73,000. After adjustments and Medicare payment my employer insurance paid $1800 (the 20% not paid by Medicare). The expected bill to me was $0.00.

Do you have to pay your insurance deductible before they pay that 20%?

[Simon Dog]

just in case they might come up with a "revolutionary" idea of how to cut down the costs of quality-dialysis-time in order to save the government more money ... 

Why do you think 3 days/week instead of every other day is the prevailing standard?

[Cowdog]

Hi iolaire,
I haven't yet but you never know when they will do something different. Medicare has been primary for 4 years after the switch at 30 months.
Last Nov I received a bill from F stating that I owed them $2600 for services in March and April that weren't paid by the insurance co. I checked my EOBs from the insurance co and everything submitted had been paid.
I called F and asked for an explanation of the charges and a detailed bill, lady said it was charges for deductibles as I was just getting into their system. I told her I had been in their system for 6 years and was a Medicare patient with secondary insurance. She said "Really"? I said " Yes, Really!!". She said OK, the bill was a mistake, please disregard. That's the only correspondence I've ever had with F's billing dept.

[Vt Big Rig]

just in case they might come up with a "revolutionary" idea of how to cut down the costs of quality-dialysis-time in order to save the government more money ... 

Why do you think 3 days/week instead of every other day is the prevailing standard?

Believe it or not I was told ... .they started with once a week and everyone died, they went to twice a week and everyone died, they went to three days a week and settled there.

Comforting science isn't it? 

[Michael Murphy]

At least once a quarter I get a call from Fresenius that I owe money I learned to ask did you send it to my secondary coverage. They reply you only have Aetna I used to get mad now I laugh and say yes that's the primary and that's the secondary I have Aetna and so does my wife. That person never calls back but within 3 months I will hear from them again.

[cassandra]

I'm very sorry for all you sweet people who live in countries where you have to pay so much towards your care, or have the bare minimum of that care, or have hassle about the paying of that care. I'm fortunate to live in one of the many countries which has a national health insurance. You still pay, there are still things to have a hassle with for sure, but the money bit is not one of them , yet.

[Rerun]

Yet the CEO's of these dialysis corporations makes Millions per year.  So what does dialysis really cost? No one will ever know.

If you take the overhead of the building, supplies, water, and paying the staff then subtract 10 chairs with 3 shifts a day plus a Nocturnal shift 6.5 days a week....  Oh, I'd love to know the real bottom line. 

There is no way a business could have to make it on x amount of money but only get 3% and survive.  They are LYING!  My EOB is up to $76k a month and they get 3k.  No way could they be telling the truth.

Truth in Billing... That is what needs to be done in this country.   

[Alex C.]

Well, they wouldn't be dealing with Medicare if they lost money on each patient, so I think we can assume that at a rate of, say, $1000/week, they ARE making money. Maybe not a lot, but they wouldn't still be in business if they were losing money.

So, making that assumption, let's take my 36-chair dialysis center as an example. With 36 chairs, and usually at least 25 of them being used at any one time, assume that they take care of 75 patients each day, that would be 150 distinct patients each week, that would work out to $150,000 each week, and $7.8 million/year. Staff it with, say, 6 RN's, 8 LPN's, and 12 techs (assuming about $1.5 million pay), that would leave $6.3 million to pay for rent, heat, maintenance, and profit.

And, of course, anything ABOVE the Medicare rate is just extra money in their pockets. Sounds kinda cozy, doesn't it?

[Michael Murphy]

Any one taking Medicare is at worse breaking even, the Medicare patients pay all the overhead costs, plus a small profit, the real money is made from private insurance during the 30 months before Medicare must be the primary.  Some one once asked if Medicare is so underrated profitable why do hospitals and doctors advertise for Medicare patients.  I live in New Jersey for now and the big rip off here was patient transportation. Billions each year were being spent on driving patients to and from dialysis.  CMS (Center for Medicare and Medicaid Services) was forced to institute a policy that besides a doctors certification CMS needs to approve transportation requests.  Now it's almost impossible to get transportation.  However the companies have stopped paying patients to use their services.

[Rerun]

I have a secondary insurance.  I have it in case of a hospital stay.  20% of a hospital stay could wipe a person out financially.  So, dialysis benefits about $400 a month from my secondary.  My doc charges $635 a month but gets from medicare $325 and another $30 from my insurance.
That is another cha ching! 

[noahvale]

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[Alex C.]

I'm assuming that an RN makes probably $50k/yr, an LPN about $40k, and a tech maybe $30k.

[cattlekid]

I had experience with this first-hand when I was on in-center dialysis.  I was still in the 30 month coordination period where my private insurance was paying out bundles of cash on a monthly basis for my care.  I have very good reason to believe that this is why I was able to get a chair at the clinic and shift of my choice when I had to start dialysis. 

After nine months of in-center treatments, I chose to start training for NxStage and also chose at the time to switch centers (and LDO's - Fresenius to DaVita).  From my readings here and elsewhere, I knew my FA was going to get his  chewed because he was "letting" a profitable patient walk out the door well before the end of the 30 month period.  Inevitably, I got the chairside begging to stay and I had to give him the "it's not you, it's me" speech when it was them all the way since they did not provide NxStage training at the center and they wanted me to go to a center way out of my way for the training.  No thank you, I will do what is best for me and my schedule, not worry about your precious profit. 

Thankfully, the DaVita clinic I switched to was open referral so I didn't have to change nephrologists, as he was never the problem. 

I will go further than most comments above and say if clinics only have patients with medicare/medicaid, then they would barely eke out a profit, if at all, given the current allowable charges that are reimbursed at 80% - even if every patient paid their 20% copays.  Without the 20%, then clinics would definitely be in the red.

No, what makes corporate dialysis highly profitable is having as many patients as possible with private or employer based insurance that's primary for the first 30 months. Reimbursement is on average 10 times that of medicare.

[Michael Murphy]

The need to have secondary insurance to cover the 20%that Medicare covers is the reason that Fresinius pays for the insurance for the patients who can't afford the insurance payments.  Contrary to popular opinion this is a reasonable profit built into the Medicare rates.  Again this is why hospitals and clinics advertise for Medicare patients.  Even paying for the insurance there is a profit or it would be done less frequently.

[noahvale]

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[cattlekid]

I thought that the LDOs made contributions to a charitable organization that pays for patient secondary insurance when necessary.  I can't remember the name of the organization.

The need to have secondary insurance to cover the 20%that Medicare covers is the reason that Fresinius pays for the insurance for the patients who can't afford the insurance payments.  Contrary to popular opinion this is a reasonable profit built into the Medicare rates.  Again this is why hospitals and clinics advertise for Medicare patients.  Even paying for the insurance there is a profit or it would be done less frequently.

Please give documentation showing Fresenius pays directly for patient insurance.