If you’re in the first couple years of dialysis and your medical expenses are covered by private insurance, you need to know this: You are the Golden Ticket to a dialysis center!
After 33 months on dialysis, you automatically convert to Medicare. But, before that, your bills are paid by the private insurance and the amount paid by Medicare is WAY less than what private insurance pays. Today most private insurance only pays 80 percent of the bill. But that 80 percent is FAR more than Medicare pays. That makes you a very desirable patient to a typical center. Let’s face it, the profit motive is strong in any for-profit dialysis center and getting the most “private pay” patients is a desired goal. It’s not that Medicare pays so little. They pay a good amount but the private insurance companies pay a lot more. Simple math. The more private pay customers, the more revenue. The more revenue, the more profit.
I didn’t know this when I was in the first year of dialysis. I figured insurance was taking care of it all. I didn’t realize they were only paying 80 percent and the “Center from Hell” wasn’t telling me. They were letting it accumulate. So, after about a year, I was presented with a bill for several thousand dollars.
It was interesting how they did this. Someone I’d never seen before came up while I was in treatment and introduced herself as the Office Manager. She explained that I was responsible for the co-pay and deductible for that last year. She showed me the statement and the balance due. Then she asked me to pay it. I was in shock. It’s enough that I was in treatment at that moment, and it rarely went easily and well, but now I have to absorb this shocker and dialysis at the same time.
My first response was, “I’ll have to stop dialysis because I can’t afford to pay that!”, I said. “Oh no,” she replied, “We’ll just put you on a payment plan. How much can you afford to pay per month?” I thought it over for a minute and gave her a number, “Okay, I’ll draw up the paperwork and you can sign it and just pay off the balance monthly.” She didn’t bother to inform me that the balance would continue to increase every month as I paid less than the billed amount. It was like paying the minimum payment on an a credit card but that all seemed simple enough at that moment.
A week later she brought me an agreement and I signed it and started paying monthly. That lasted for several months until I did some research and thinking about reimbursement by private pay. Not only was the center getting THOUSANDS of dollars from my insurance company at 80 percent of the amount billed, but that 80 percent was far more than they were getting for the same procedure from Medicare. In my case, they wanted their cake and eat it too. I was doing without some things so I could pay this additional amount because they couldn’t be content to get what they were getting. That didn’t seem right.
So, I stopped paying. They would send me a bill every few months and the balance kept going higher and higher. I ignored it. If they couldn’t be satisfied with the huge amount they were getting, too bad. When I finally changed centers, the balance due was over five thousand dollars. I wrote them a letter and let them know I was not going to pay and that it was only due to their Social Worker’s incompetence that I owed anything at all. I never heard from them again.
Here’s what I didn’t know at the time and the inept Social Worker never told me. When I first started dialysis, she came to me with a paper that said something about “waiving” my rights to Medicare. I had no clue what she was talking about but I signed it. In that first couple weeks of dialysis, I signed lots of papers. Almost every day, someone had something for me to read and sign. I was in a fog and, as they babbled on, I nodded my head, and signed their papers. Later, I found that she was getting me to sign a statement that I wouldn’t have Medicare pay the co-pay and deductible — the 20 percent not paid by my insurance — so she wouldn’t have to fill out the paperwork to get me on the program! Lazy, dumbass that she is. I could have paid about $100 a month for the Medicare supplemental insurance and they would have paid everything my private insurance didn’t pay. Further, If I couldn’t afford that, there were state and private agencies that would pay it for me! She said NOT A WORD about any of that. I don’t know if it’s because she didn’t know or didn’t care or was too incompetent to fill out the required forms.
Here’s how an effective, knowledgeable Social Worker handles all that. When I changed centers at about 27 months of dialysis, the first question she asked was, did I have Medicare Supplemental? No? No problem, I’ll sign you up. Can you afford it? No? I’ll get you the forms to apply for payment assistance. You just sign them. I’ll take care of the rest. So, now my co-pay and deductible are paid and the center gets the full amount; eighty percent of their billing from private insurance, twenty percent from Medicare and I don’t get a bill for anything. How difficult was that? My only regret was that the old center got paid huge amounts by my insurance for over two years and the new center would only get it for a few months before the Medicare takes over from private pay.
So, if you’re still under private insurance, you’re the Golden Ticket to a dialysis center. You are subsiding several other patients by your presence. The center’s business office knows you and loves you. Take full and complete advantage of this. Shop around for a center that will fully appreciate having you as a customer! (If you’re in any condition to do so, of course.) I know being in the first year of dialysis is tough and there is a lot to deal with but, as a private pay patient, you should be sitting in the front of the plane…. the first class section… not in coach. If I knew then what I know now, I wouldn’t have put up with what I did. Instead I put up with a facility that had poor care and an even worse environment.
You can read about my adventure in Part One of The Center from Hell and Part Two of The Center from Hell
P.S. I will continue this topic with some interesting facts about how different centers can be in both care and features. You don’t have to put up with a center that is deficient in anything, especially if you are a private pay patient!
I hope this was helpful. Feel free to comment.
© 2012 DevonTexas
Hoo boy, I could have written most of this post. I’ve been on dialysis for 18 months now and am still on private pay insurance. I feel like an ass doing it, but I admit that I have thrown my “weight” around the dialysis centers near me because I know the difference between what they are getting from my insurance company vs. what they would get from a Medicare patient. When I started in-center, I got the center I wanted and the time slot I wanted with no issue. When the FA started making noise about my catheter, I told him to buzz off and that if he kept bugging me about it (I had live donors being tested and wanted to avoid a disfiguring fistula at all costs) that I would take my $4500 per week reimbursement and walk out the door. I currently have a bill from DaVita for the beginning of the year before my OOP maximum kicked in and I certainly don’t plan on paying it. I need to get on the stick and call the Financial office and tell them that they need to write it off, and remind them that if I was a Medicare patient, they’d be getting about 80% less and they need to be happy with what they got.
My biggest worry is that I will start getting substandard care when Medicare becomes primary. Have you found that to be the case?
Good move. I love it when patients seize the opportunities available to them. We have so few. We’re usually just passengers on the boat and we just do what’s ordered. But we should keep in mind we’re customers, too. Let us know how it goes for you.
About the difference between the level of care of Private Pay versus Medicare patients, I don’t think there in a difference. Staff don’t know who are and are not, only the business office would know that and as far as I know they don’t distinguish. That might explain why they feel compelled to send a bill for the difference and, unless you respond as you plan to, they are doing according to procedure. As a private pay, you are the icing on the Center’s cake since the amount billed and paid is so much more than Medicare. You are wise to use that to your advantage.
Well I have been on dialysis for 18 months and got a call Friday that my private insurance has been cancelled because the social worker didn’t mail my premiums from the national kidney foundation in on time! What am I supposed to do now? Was on the active transplant list with an approved cross doner. Only the good lord knows now I suppose. Thank you davita.
Contact your center’s administrator. The charge nurse should be able to hive you his/her contact information.