So, how much does dialysis REALLY cost?

[noahvale]

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[Michael Murphy]

I think it's through the National Kidney Fund, when I started my insurance kept screwing up and leaving me large bills, before I figured out that they were not billing my secondary carrier which unfortunately is also my primary(my wife and I both have insurance) the Social worker offered to arrange for the NKF to pay my premiums.  It was not necessary since I have complete coverage but I have seen them do it for other patients to.

[noahvale]

^

[Michael Murphy]

Actually there is a NKF in the U.S.. I have several app from them they actually have a web site kidney.org. I was mistaken in remembering them as the organization that Fresinius offered to pay for my insurance. But the American Kindey Fund sounds a lot like the National Kidney Foundation. Since I use their apps a lot I just assumed they were the group that was mentioned. But the fact still remains the companies arrange to have the premiums paid. 

[Simon Dog]

Reimbursement is on average 10 times that of medicare.

I know private insurance pays better, but I find it hard to believe the average maintenance dialysis treatment is $2450 for private insurance.  I know mine coughed up $445 per treatment as a "paid in full" price.

[Bill Peckham]

All dialysis providers are a little different but looking at Davita's numbers is instructive and they are available online. The average revenue per treatment at DaVita is about $340 (Check out their 10K SEC filings (page 65 & 66)). If you take the total revenue from US dialysis operations and divide by all the US treatments Davita provides - Medicare, Medicaid, Private primary - you end up with $340.

So when you consider Medicare allows about $260 per treatment and 90% of Davita's patients are Medicare or Medicaid primary a little math can give you an idea how much the average private insurer is paying.

(.9 x 260) + (.1 x n) = 340 ... 234 + .1n = 340 ... .1n = 106 ... n = $1060

On average Davita is paid $1,060 per treatment by non Medicare/Medicaid payers. (note the $1,060 number is low because Davita does not receive the full Medicare allowed rate for people who have Medicaid primary or in many states Medicaid secondary to Medicare. But it does tell us the minimum rate Davita receives on average from private payers).

Of course averages are made of extremes. Some private payers are in network and have negotiated a rate that's lower, in the $500 range, while others don't have a negotiated rate and are charged magnitudes more. In general Davita is very good at determining what rate the market will bear and charging that rate. Other providers operate along the same lines.

[Alex C.]

"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."

Yeah, I'm gonna call "B.S." on that one. I can't imagine that Aetna, UHC, or ANYBODY else in the healthcare insurance business would accept for a second having to pay 10x what Medicare does. The idea is absolutely ludicrous. Even the $445 amount suggested sounds a bit high (if the $245 Medicare amount has any validity), unless it's an all-inclusive amount (dialysis, meds, doctor visit) vs. an ala-carte payment by Medicare.

[iolaire]

Yeah, I'm gonna call "B.S." on that one. I can't imagine that Aetna, UHC, or ANYBODY else in the healthcare insurance business would accept for a second having to pay 10x what Medicare does. The idea is absolutely ludicrous.

Read back in the thread a few of us have posted what insurance pays our dialysis centers.  For me its something very close to $1,550 per session, which includes all dialysis provided stuff like IV meds, but not lab work and doctors visits.  My insurance pays about $10 for the average lab test, but once and a while when I need travel labs they get billed in the $500 range.  The Dr's visits are in the rage on $250 for four visits per month.

It does seem ludicrous to me that my insurance pays roughly six times what Medicare does.  But someone is allowing that pricing, in fact this year they increased the payments by about $50 per session.

[Alex C.]

A lot of times, those statements that the insurance company sends you are designed more for misinformation. Maybe they were charged $1500/session, but what did they actually PAY? That, they don't tell you. It's become like pricing at furniture stores; the "list price" for a couch may be $1500, but today, it's on sale for $800. Tomorrow, maybe it will be $700.....

Also, due to the input of those in the "anti-socialized-medicine" political brigade, there has been a lot of misinformation posted online, so, unless somebody can provide actual documentation, you really can't trust anything you get online.

What I'd really like to know is this; how much do they pay in Canada for dialysis? Since under Canadian law, ONLY provincially-administered health insurance is permitted, therefore the price paid would be pretty close to the cost + reasonable profit. Does anybody  know what OHIP pays per in-center treatment?

[iolaire]

A lot of times, those statements that the insurance company sends you are designed more for misinformation. Maybe they were charged $1500/session, but what did they actually PAY? That, they don't tell you. It's become like pricing at furniture stores; the "list price" for a couch may be $1500, but today, it's on sale for $800. Tomorrow, maybe it will be $700.....

That's all disclosed.  I think its fair to assume that anyone else posting what insurance pays has read the claim details and know the difference between list price and what the plan pays. 

dialysis: DIALYSIS PROCEDURE
Bill received by Aetna on 08/31/2015  $5,885.00
Your Aetna Member Rate $1,535.00
Your Plan Pays $1,535.00

Doctor: ESRD SRV 4 VISITS P MO 20+
Bill received by Aetna on 07/06/2015 $400.20
Your Aetna Member Rate $258.17
Your Plan Pays $258.17

Lab: UV-ASSAY TRANSAMINASE (SGPT)
Bill received by Aetna on 07/02/2015 $71.63
Your Aetna Member Rate  $6.79 
Your Plan Pays  $6.79 

[iolaire]

What I'd really like to know is this; how much do they pay in Canada for dialysis? Since under Canadian law, ONLY provincially-administered health insurance is permitted, therefore the price paid would be pretty close to the cost + reasonable profit. Does anybody  know what OHIP pays per in-center treatment?

Here is my quote for one treatment in Montreal in October:
Below is for each treatment with needs patient before dialysis
Hospital component                       $ 915.96
Professional component              $   68.80 (Non-Quebec Res)
TOTAL:  $ 984.76 (Canadian dollars) roughly 735.98 US

[Zach]

Folks, listen to Bill Peckham.
He knows more about this issue than most of us.

Dialysis lawsuit reveals prices
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/law-suit-reveal.html

Lawsuit hints at in-network dialysis charges
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/lawsuit-hints-a.html

Here is more information (than you'll ever want to know) about what Medicare (U.S.) approves for hemodialysis (2014):
Remember, Medicare pays  80% of the approved amount.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/End-Stage_Renal_Disease_Prospective_Payment_System_ICN905143.pdf

Payment Rates for Adult Patients-2014

For calendar year (CY) 2014, the base rate for adult patients is $239.02, which is determined by:

Updating the CY 2013 ESRD PPS base rate of $240.36
by the ESRD bundled market basket minus a productivity adjustment
($240.36 x 1.028 = $247.09); and

Applying the 1.000454 wage index budget neutrality adjustment factor to the updated base rate of $247.09 and the home dialysis training add-on budget neutrality adjustment factor ($247.09 x 1.000454 x 0.999912 = $247.18), reduced by the portion of the drug utilization adjustment of $8.16 for CY 2014
($247.18 - $8.16 = $239.02). The drug utilization adjustment transition is discussed on page 5.

To determine the payment rate for an adult patient’s dialysis treatment, the following adjustments and applications are made to the base rate:
… Patient-level adjustments for case-mix;
… Facility-level adjustments;
… A training add-on (if applicable); and
… An outlier adjustment (discussed on page 4).

[Michael Murphy]

I know Aetna pats over 1500 for my treatment since when Fresinius screws up my bill I am sent the calculations to prove I owe money that was not paid by Aetna. In my case the Fresinius rep has screwed up and I just tell them to submit to my secondary carrier  which happens to be Aetna.  If you really want to freak find out what the rate is for the uninsured its over 3 times what Aetna pays.

[noahvale]

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[Bill Peckham]

(BTW, his home facility charges $5100 per treatment. Insurance approves $1375 and pays $1100 with his copay $275.)

Since I know this to be untrue, to me it makes all your other numbers equally suspect but arguing on the internet is a mug's game so I will leave it to each person to decide whether to either: credit an anonymous internet poster, writing under a nom de plume, asserting unsubstantiated numbers (numbers that don't even add up (178+45≠227)), or to credit official Medicare publications, court documents and SEC filings.

[noahvale]

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[Bill Peckham]

Yes, there is a $4.12 and $4.13 difference each month. 

You're saying your monthly charges equal $227? That's remarkable.


The assertion you made was that my dialysis unit charged  $5100 per treatment, that is what I know is false.


Other than that nothing you have written contradicts anything I posted, you live in a low wage area the national average medicare allowed rate is about $260 (when you include the net effect of comorbidity adjustments). Low wage areas are offset by high wage areas. Like I said averages are made of extremes.

[noahvale]

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[Bill Peckham]

Edit:  And I stand behind my assertion that you don't know every nuance about dialysis charges/payments.

I never made that claim. What I've done is supply primary sources with actual numbers. OP asked what Private insurers pay. Knowing Davita's average revenue per treatment given Medicare's average allowed payment per treatment and Davita's payer mix is as close as we can get to the answer when talking about "what insurers actually pay per dialysis treatment ... here in the U.S."

[OlManRivah]

Well here's another perspective,

I'm a Vet.  The Va picks up all but $15.00 a treatment.  Your humble Vet pays that.

[noahvale]

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[Simon Dog]

The assertion you made was that my dialysis unit charged  $5100 per treatment, that is what I know is false.

I don't know about his specific center, but when I was at a DaVita clinic near Seattle in late 2013, the asking price was $5050 per treatment.  Since it was an "out of area / no contract" treatment, my insurer (that was paying my local clinic $445 per treatment) paid the asking price of $10,100 for a grand total of two treatments.

[justagirl2325]

What I'd really like to know is this; how much do they pay in Canada for dialysis? Since under Canadian law, ONLY provincially-administered health insurance is permitted, therefore the price paid would be pretty close to the cost + reasonable profit. Does anybody  know what OHIP pays per in-center treatment?

I live in Ontario.  We don't have private clinics only hospitals for dialysis.  It would be next to impossible to know how much of our income income taxes flow to the hospital for dialysis.  I can tell you that in Ontario our top income tax bracket (for those making over $135,000 a year) is 49.53%.  And of the taxes collected, more than 50% is used for health care.

Interestingly enough, when we travel out of the country my husband pays for dialysis up front and then is allowed to submit the payment to OHIP for reimbursement.  They pay $210 per session.

[OlManRivah]

Well here's another perspective,

I'm a Vet.  The Va picks up all but $15.00 a treatment.  Your humble Vet pays that.

Thank you for serving our Country.  Vietnam Era?

[OlManRivah]

Well here's another perspective,

I'm a Vet.  The Va picks up all but $15.00 a treatment.  Your humble Vet pays that.

Thank you for serving our Country.  Vietnam Era?

Yeah it was . . .