Will Medicare pay for more than 3 treatments per week? Such as 5 to 6 treatments per week on Next Stage?
Yes, but your nephrologist has to justify the extra treatments…Many people are on 5 and 6 days per week and the centers are being reimbursed. Im sure Beth will be more specific, but yes, they will pay for more than 3 treatments.
///MM
Employer health plans typically pay for the number of treatments a patient does. Medicare routinely pays for 3 hemodialysis treatments a week. There are different insurance companies that pay Medicare claims in differnet areas of the U.S. I’ve heard of some that pay for 5 or 6 treatments with medical justification and others that won’t pay for more than 3, even with medical justification. Some clinics accept what Medicare and insurance pay as payment in full. Others may charge you for extra treatments when Medicare doesn’t pay for all of the ones you do. There is a special form called an Advance Beneficiary Notice that the clinic should have you sign if it thinks Medicare may not pay for all treatments. This form alerts you that the clinic may charge you for treatments Medicare doesn’t cover. Medicare makes dialysis clinics discount their bills for the treatments it covers. However, the clinic could charge you the full commercial charge for dialysis if Medicare doesn’t cover some treatmetns. Ask your clinic what it will charge you if Medicare doesn’t pay for all the treatments you do.
Getting a lot of mixed stories on this issue. So I’m still a bit confused. Is Medicare paying for more than 3 sessions per week? Is there anything written on this topic? Ty
What qualifies you to get home hemodialysis for 5-6 days a week under medicare?
I’m sorry that I didn’t see this message until now. The Medicare Claims Processing Manual, Chapter 8 on ESRD states " A medical justification must be submitted for patients receiving greater than 13 treatments per month." It does not say what medical justification is acceptable, but the doctor who prescribes your dialysis treatments should know the diagnoses that could get extra treatments.
I hope they pay for extra treatments. I have recently changed to original medicare with a supplement. Before I had retiree ins. from my husband. It was expensive with copays for every treatment. I hope I have not made a mistake.
I gather that dialysis clinics do their best to provide the documentation needed by the Medicare Administrative Contractors (insurance companies that pay Medicare claims) to approve extra treatments. If you get a bill from the clinic, ask your dialysis social worker or financial counselors if you can qualify for a discount.