Paying for Dialysis

[coldhoist]

I am new to dialysis and I wonder how people are paying for their dialysis treatment. I have BCBC Medicare Advantage and Medicare.
In the last few months I have received bills from Fresenius for $400 and $895. Am I missing something here, I thought Medicare was supposed to kick in and cover something.
If I keep getting bills like this, I am going to be broke!
How does this work?  What am I supposed to be paying and what is Medicare supposed to pay?
Thanks







Sp mod Cas

[Rerun]

Talk to your Social Worker at the clinic.  You are covered. 

[Simon Dog]

It can sometimes be a hassle, since secondary insurance can fail to process a claim and FMC then bills you for the balance.  I just *finally* got my insurance to pay a claim for two traveling visits in January, 2016 that resulted in Fresenius hounding me for $123.   The final claim report from insurance shows 9 denials followed by an approval.

Medicare sets the rate (About $265 per treatment +/-), and pays 80%.   Medicare advantage should take care of the remaining 20%.







Sp mod Cas

[coldhoist]

I am looking at the bill and is it possible that Fresenius is charging the insurance $84k for January and $79k for April, that seems crazy. also, nowhere on the bill do I see anything about what Medicare paid, it shows $0 for Medicare payments. Is that right?







Sp mod Cas

[Simon Dog]

I am looking at the bill and is it possible that Fresenius is charging the insurance $84k for January and $79k for April, that seems crazy. also, nowhere on the bill do it see anything about what Medicare paid, it shows $0 for Medicare payments. Is that right?

$80Kish a month is the "asking price", but rarely paid.  When I was on private insurance, the negotiated rated was about $450 per treatment.   It's about $260 per treatment on Medicare.   The nephrologist bills separately (about $300 or so a month on Medicare).   When I was traveling though, my insurance paid $11K for two treatments in a DaVita clinic in the US.

The bill should show a Medicare payment.   Time to use your social worker.

[Michael Murphy]

In January last year I switched to Medicare as primary even though I let the clinic know it took over 6 months to fix the billing.  For years I had Aetna from my job and my wife had Aetna from her job.  At least once a quarter I received a bill leading to a call to Fresinius asking if they had billed Aetna. 

[Tío Riñon]

I am new to dialysis and I wonder how people are paying for their dialysis treatment. I have BCBC Medicare Advantage and Medicare.
In the last few months I have received bills from Fresenius for $400 and $895. Am I missing something here, I thought Medicare was supposed to kick in and cover something.
If I keep getting bills like this, I am going to be broke!
How does this work?  What am I supposed to be paying and what is Medicare supposed to pay?
Thanks

Sp mod Cas

I have Medicare as primary and BCBS as my secondary insurance.  Nevertheless, BCBS often processes my medical bills before Medicare has evaluated and paid their portion.  Hence, my claims are denied by BCBS pending the outcome of the Medicare portion.  This can take months and is sometimes confusing, but once Medicare sends me their statement, BCBS follows up with approval of their part.  You might be experiencing the same process.  In the end, I almost always never have to pay anything out-of-pocket.

Check with your clinic insurance contact and they can assist with or confirm the situation.

Good luck!

[Charlie B53]

Wife Retired effective April 1. She has had Medicare for years but working at the High School she had the School's Insurance as Primary. So Apr 1 Medicare was to become Primary, along with Part B, D and Medigap Part G.

NONE of her bills since have been paid as Medicare has some 'hold' still on file from a car accident.  Evidently Our Insurance Company notified Medicare a few years ago when she was involved in an auto accident.  The Insurance Company failed to notify Medicare once settlement had been made so Medicare 'assumes' every medical bill is related to treatment from that accident and refuses payment.

I've had to gather forms from the Attorney, get all signed and the Attorney is forwarding copies to Medicare to get this resolved so Medicare can stay paying recent bills.

What a P.I.T.A.

About the only Insurance that has paid is the Part D prescription plan, and there are a couple of meds we need to change as they are Tier 3 or 4 and have a much higher co-pay.

[Rerun]

Do not, I repeat Do not pay anything.  This will get straightened out.  If you pay them you may never see a refund.  I know it is hard because you are use to  "Paying your bills" but when you consider if they charge 80K per month and you paid it they would keep it.  Oh yeah, score and the CEO makes about 5 Million a year off Medicare.  It is a real trip.  And there are scads of threads on this site about the cost $$$$ of Dialysis.

The truth about Health Care in this Nation is it can NEVER be "fixed".  Because there is no Truth in billing.  A bag of saline is charged $1,000 at one place and $5 at another place and it cost ten cents to make.  It costs $15,000 for an ER visit at one hospital for a broken arm to set and at another place $400 to fix and set.  There is no Truth in billing.  How much does it cost vs. how much to we charge is way apart.

My Nephrologist charges $645 each month .... knowing she will get $300.  I asked her and she said "They told me to  pick a number"

   Just hang tough.

[coldhoist]

About five months ago, the social worker told me that I would be receiving a bill from Fresenius for about $900. she said if I could not pay all of it, just send them fifty or on hundred dollars, they will take anything. I sent them $200 and a month later I sent them another $200. I did'nt know.
So, I guess I can kiss that money goodbye. Live and learn.
I will talk to the social worker on Monday and she what she can do. I have a feeling I am going to have to sort this out myself. I do not know if I should trust the social worker.

[babycake]

i have been on dialysis  11years
and i have never seen any of my bills
so no i don't  pay
and if i had to
 that would be highly in possible
there  had been several illegal Mexican
at my center that have no insurance
and i had ask the Secretary one time
and she stated the company paid for there treatment







sp mod Cas

[nursey66]

My husband was on dialysis twice between kidney transplants, never got a bill. First time my work insurance was primarily, Medicare secondary, then after 2years they switched, the second time he was on dialysis I was retired and his part B payed all that original Medicare didn't cover. It sure can be confusing .

[smartcookie]

I have had patients who are fully insured, as you are, have a deductible that they have to pay.  But for your insurance, you should be fully covered and should never have to pay anything.  I would call "shenanigans" on them and ask your SW and your billing department what is going on. 

[coldhoist]

I talked to the SW and she was of no help. She was talking about Medicaid. applying for Medicaid and if I am denied help paying medical bills, then Fresenius would see what they can do. What?
She still could not tell me why there were no Medicare payments on my bill. I started dialysis in November 2016. Does it take medicare that long to kick in?
Fresenius is threatening to send my bill to a collection agency. Do you believe it. Is this how this is suppose to be done?

[coldhoist]

I have checked my BCBS Medicare Advantage account online and it show all of the bills from Fresenius paid in full and the amount that I may owe as $0.00.
Does that mean anything? I have never received a bill from BCBS.

[Charlie B53]

Pull up that web page again and print it.  Send a copy to Fresenuis and ask them what's going on.

[Shaks24]

I would do like Charlie B53 said. Print off your insurance summary and send copies to Fresenius billing and give a copy to the financial director of your clinic and tell them its their problem and you are disputing the bill. I bet they will write it off.

[Simon Dog]

I would do like Charlie B53 said. Print off your insurance summary and send copies to Fresenius billing and give a copy to the financial director of your clinic and tell them its their problem and you are disputing the bill. I bet they will write it off.

I have found that paperwork sent to Fresenius billing is ignored.   I went up the food chain and finally found a supervisor who was willing to call my insurance company.

Unlikely they will "write it off".  More likely, they will refer the debt to a collection agency that will make sure it goes on your credit report.

[Shaks24]

I had a dispute with Fresenius when I first started D and there was a billing discrepancy with my gap policy. I basically told the clinic social worker I did not plan to pay it and they wrote it off. If I recall it was about 1200 dollars. If the OP has paper work showing his insurance company paid them it will be hard for them to try to collect unless they can prove otherwise. I have heard of many circumstances where they write off a balance and many of them were even hardship cases.  I don't see how anyone can cope with the cost of dialysis without secondary insurance. Just the 20% that medicare does not cover approaches 1000 bucks a month depending on what modality you use. My gap policy premium continues to soar in cost. It started at 280 4 years ago and now is over 400. Got to have it though. I've got 7 years until I turn 65 where the penalty for being under 65 goes away. Who knows what insurance will be like by then.

[smartcookie]

At the top of Fresenius bills is a number you can call to talk with the billing department.  I would call them and ask if you qualify for an indigent waiver to pay for those bills.  An IW helps cover those who are underinsured.  To answer your question, Medicare takes three months to kick in and it is retroactive to when you applied.  It should take care of 80% and your other insurance the remaining 20%.

[iolaire]

I have BCBC Medicare Advantage and Medicare.

I think the BCBC Medicare Advantage and Medicare is its own specific set of rules but to help others with the same question I want to share my non BCBC Medicare Advantage insights.
1. Prior to having Medicare my insurance Aetna paid the bills and I got some co-pay bills from DaVita
2. During the coordination period after signing up for Medicare my primary insurance Aetna paid the bills but I have a co-pay of something like 20% up to about $1,700, DaVita never billed Medicare for co-payments, nor me.  I think this is because they got so much money from Aetna that they didn't want to bill Medicare for the co-payments because then Medicare would force them on the Medicare rate.
3. After Medicare became primary they now bill Medicare and then Aetna for the co-pay.  Again Aetna pays about 20% of that co-pay leaving the 20% to me which is billed. Because of that I've had small bills for the first six months of the year from DaVita, and will continue to until I've paid the Aetna in network copay cap of about $1,700.

so basically after Medicare became primary I've actually had to pay more co-pays despite having two insurances.

[coldhoist]

Well, I talked to the social worker. She told me to call Fresenius  and see what they could work out.
The rep at Fresenius told they could work out monthly payments for me. I told her that I was retired, living on a fixed income and could not afford to pay this $2500.00 bill.
She then told me I should talk to the financial coordinator at my facility and see they could do. I will do that soon.
I never knew dialysis would be this much trouble. I know my insurance says I am stuck with a 20% copayment, but I never thought that it would be so much. I thought at some point Medicare would kick in a pay something, but I have not seen Medicare do anything yet.
Can somebody recommend a medicare supplemental insurance that pays the 20% copay, 100%.
Dialysis is going to kill me financially. Help!!!!

[smartcookie]

Please talk to the financial coordinator.  Medicare should be paying, so it could be that your clinic doesn't have your Medicare listed correctly.  The only time my patients with two insurances get a bill is for the deductible, and it is never that much. 

[PrimeTimer]

Medicare is sloooow at paying. But they do pay. Took forever for hubby to even get signed up for Medicare. The financial coordinator at Fresenius kept having him sign the wrong forms and so Medicare just sat on them. Hubby basically ended up having to go to the Social Security office and taking care of it all himself, just between him and Medicare. Aetna paid their 20% once he showed them proof of having Medicare. They were kind of snotty about it, leaving a voicemail telling him that since he is a dialysis patient, they know he is eligible for Medicare and if not, they wanted a letter from Medicare stating why not. Face it, the insurance companies are not going to pay for anything unless they have to. But once hubby sent them proof, they were quick at paying. Which should have been Fresenius' clue that he has Medicare. But nooo...

We get harrasing calls from Fresenius every week....Hubby paid Medicare an extra $2,000 to back-date his coverage. Fresenius claims they haven't paid any of the back-dated amounts. Hubby could see that Medicare had cashed his check so again, he took matters into his own hands and called Medicare. Come to find out, yes, they received and cashed his check but didn't apply it to anything! So they took his money and didn't pay a dime to Fresenius. Wonderful! Wonder what they thought, that some good citizen out there just wanted to send them $2,000 to be nice? Hate to say it but there are some things in life that should not be left up to the govt to handle (Medicare is one of them). Talk about a FUBAR!

So...Medicare now says they will process hubbies $2,000 and send him a new card with the new date on it. That ought to satisfy Fresenius but in the meantime, they call us every freaking week. And every week we tell them the same story. Over and over and over. I'm surprised that Fresenius thinks they can afford to pay people to make these phonecalls or give someone the title "financial coordinator"....what do they coordinate? We had more help from a Social Worker than any of their financial coordinators but in the end, hubby had to take care of it himself and go one-on-one with Medicare. At this point, we don't care, Fresenius can keep calling all they want. Hubby isn't paying for 2 insurance policies for nothing. 

[solid98]

Medicare Advantage does not pay any extra beyond the 80% since it is not a medigap policy. You will still owe the 20% you would owe on straight Medicare. You do NOT have "Medicare Advantage and Medicare". Medicare Advantage is just a private insurer who manages your medicare benefits so they can limit your benefits and pocket the "savings" to the federal government.

You want to look for a Plan F Medicare Supplement policy. Check here https://www.medicare.gov/supplement-other-insurance/ and click on Find a Medigap Policy. Plan F is expensive but covers everything including all 100 days of Skilled Nursing and up to 365 days of hospital stay. For me, this is going to cost me about $170 a month when my COBRA runs out. My states insurance commissioners' website has a shoppers guide that explains all the differences between plans, lists insurance companies offering those plans and current premiums. Your state might do the same. Our Dept of Aging also offers a service called SHICK, Senior Health Insurance Counseling for Kansas. These are volunteers who are angels who help people wade thru Plan D prescription plans and show you the least expensive options based on your current prescriptions.

edit: Here is the link to Medicares page that compares Medigap policies. https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html