I looked more closely at my husbands monthly billing to Medicare. He does peritoneal dialysis. Medicare is being charged $1,527.00 a day for him to administer his own dialysis!
The bill was $49,813.00 for a month! Granted, a little over $3,000.00 was for drugs and testing, but geez! I pulled up Baxters cost of supplies, and there is no way we are spending this kind of money every day. It seems to me that WE should be paid for doctoring ourselves!
I was also told that the Baxter Pro machine costs a little less thatn $20,000.00 to buy, but it is rented out. Why? And we wonder why our health care is going bust.
I dont understand, can someone enlighten me? I am very, very upset about this. Although I do not pay for the service, it seems like a huge over bill, every month.
If you’re looking at your husband’s Medicare Summary Notice, be sure you’re looking at the Medicare approved amount. Your dialysis clinic probably billed Medicare at its commercial rate (the rate it bills to all insurances). As a primary payer Medicare has an allowed charge for dialysis, certain drugs, and dialysis-related labs. This amount is much lower for HD or PD than the amount he was billed. For PD, the amount is supposed to be about $700/week of which Medicare pays 80% as a primary payer.
I would ask the billing personnel for your dialysis provider to explain how they billed Medicare, i.e., what are the services that were billed and how much each of them were. It is a patient right to get this information. If they won’t tell you, they should tell your spouse.
Next I would call the insurance company that is paying the bills for dialysis providers in your area. There should be customer service number on the Medicare Summary Notice. I’d ask that person about the payment amounts. Prior to 2010, dialysis clinics were paid under the composite rate system. In 2010, most clinics chose to get a somewhat higher payment per treatment right away under the prospective payment system that required dialysis clinics to also provide some drugs and most labs for that payment. Some clinics chose to ease into the new payment system. In either case, I think $49K is much higher than what I’d expect Medicare to pay for a MONTH of PD.
Again, thank you for all your answers. I was finally able to talk to Medicare directly, and they informed me that the clinic was receiving approximately $92.00/day.
I felt much relieved. With all the horrors of medical rip offs, I just wanted to make sure everones “ducks” were in a row.
Hi, I just had to get on peritoneal dialysis this past feb. I have insurance but, medicare has now become my primary insurance. I just received my first billing statement for the month of June… granted I have never seen a bill or a statement from my other insurance. $403.66 every day and I do my own dialysis and do Not use a machine. I just gravity feed at night… This is reduclious what medicare is being charged. I called and said what is this for, they said they will get back with me. This is not right. This is whats wrong with this whole health care system and insurance company’s.
Dialysis facilities bill Medicare and insurance companies at their commercial rate. Medicare adjusts that rate by what it considers reasonable and customary. Medicare’s allowed rate will be less. Medicare pays 80% of its allowed charge after Medicare’s annual deductible is met. Your other insurance may pay all or part of the 20% coinsurance. Medicare’s allowed charge for a week of peritoneal dialysis (either CAPD or cycler) is the same as Medicare’s allowed charge for a week of hemodialysis. The formula to calculate the daily rate for PD is 3 times the hemodialysis rate divided by 7.