I am on a Baxter HomeChoice Pro Computer cyler at night and have seen horrendous daily bills sent to my insurance company and Medicare. I saw what was said on site about $1200 to $1250 a week for PD but what should real cost of daily cost of CAPD be with renting the machine (my center says has to be rented, cannot be bought), the controller, the caps, liquid, etc. I think the charges are outrageoous and who should I speak with if I feel the charges are excessive?
Are you using a cycler machine to do dialysis overnight while you sleep or are you doing manual exchanges during the day? Are you getting any other drugs (like EPO) that is being billed with the dialysis treatment?
If you have an employer group health plan as your primary payer and are still in the 30-month period when that plan pays primary, your dialysis clinic may have contracted with your health insurance plan for this rate. After 30 months from when you became eligible for Medicare, Medicare will be your primary payer. Your clinic will have to discount the charge for dialysis to Medicare’s allowable rate. This means your employer group health plan won’t have to pay as much either since it will pay secondary after Medicare. The Medicare allowable charge for hemodialysis and peritoneal dialysis weekly varies a little from area to area, but is on average about $450/week plus allowed charges for covered drugs. This charge includes the rental of the machine and the PD solution and supplies needed to do PD.
I have heard that some patients’ insurances have been billed $50,000 a month or more. If you’re unhappy about the amount your clinic is billing your insurance, review the bill to be sure that you’re not being charged for anything that you don’t get. Talk with the billing personnel at your dialysis clinic (or corporation). If your insurance doesn’t lock you into a specific dialysis provider, you can also talk with other clinics in your area that offer PD to see what they charge.
My concern is and has always been that the more a clinic charges for dialysis, the faster it uses up someone’s maximum lifetime health insurance benefits. It also has the potential to raise insurance rates for other employees and jeopardizes the dialysis patients’ job (even though the company would likely never admit that insurance premiums affected any decision about employing someone). And as dialysis corporations charge more to more people, ESRD moves higher up on all insurance companies’ radar leading these insurance companies to either
- reduce contracts to providers to closer to Medicare’s rates which dialysis providers complain are much too low OR
- raise rates for all the rest of us to compensate.
Yes, I am on the cycler at night but on no other meds through the center such as Epogen. But what I see as daily charges just blow my mind. Plus
the center says I cannot buy the cycler and it is the old version without the
memory chip. I friend of mine in another city was the new Baxter and does not have to do the manual transfers daily numbers, etc. I use 3 - 5,000 liter bags of regular diaylsis fluid a night, one controller, one small and one bid cap a night along with one drain line. My daily charge is $680 a day. I think this is scaldingingly high and think the American public has the right to be outraged about medical costs, insurance premiums, Medicare costs, etc. The
medical industry is holding sick people as hostages. Since I have so many blood disorders, I cannot do hemo - tried it - it was a nightmare - had 9 right side catheter pulls then went to left side and pulled twice before got on CAPD as first surgeon installed the catheter improperly - no movement - bad positioning from get go. I think $680 a day times 365 days a year is horrorible. How else can I find where someone else provides Home Diaylsis in my state. I live in a small town and the center seems to own everything around here and my insurance company says “they are out of network” so my limitation of insurance will be used quicker. I have “unlimited amount” if in network. Thanks for your answer and help in this matter.
How else can I find where someone else provides Home Diaylsis in my state. I live in a small town and the center seems to own everything around here and my insurance company says “they are out of network” so my limitation of insurance will be used quicker. I have “unlimited amount” if in network. Thanks for your answer and help in this matter.
Now that, we can help you with, Valentine. (My favorite holiday, by the way!) Check out our “Find a Clinic Near You” database, at http://www.homedialysis.org/locate/search.php. To start, just look in your whole state, or if you are near the border to another state, check that one, too. It will list every center in the state, and you can figure out which other ones might be close. Since you only need to visit the center once a month, it can be as far away as you’re willing to drive once a month. Some folks will drive 3 or 4 hours, but it’s really up to you.
There are 4,746 dialysis clinics in the U.S. and more than 1,600 of them offer PD. Virtually everyone in the U.S. is within a 1-hour drive of at least one PD center. It’s certainly possible that there are others that could support you in at least getting a more up-to-date cycler for the cost your insurance is paying–or perhaps even reducing the costs.
If you have trouble finding something, let us know where you are and we’ll help you look.
After you find the list of providers from Home Dialysis Central, you might ask your insurance company which of these providers are in your insurance company’s network. There may be several within driving distance of where you live. When you find that out, call them and ask to talk with their billing personnel or administrator to find out what they charge people with your insurance to see if it’s more or less than what your current clinic is charging. Since you’ve already been trained to do PD, it wouldn’t take much effort for another dialysis clinic to teach you that clinic’s policies and procedures.
If you change clinics, you might even a newer machine. However, even if you get a newer machine, you may still have a different dialysis prescription from your friend. Different people’s bodies transfer wastes differently.
Thanks for the answers from both of you. Yes, I know different bodies process differently. All I want is the newer, updated version of the Baxter Computer that has the chip that can be read by the Center. My friend in Austin uses a Center that will allow the computer chip type machine. My center says that no one using Baxter out of here can use the new, upgraded computer chip model. I will be checking with other centers and my insurance company about changing, the charges, etc and I will be making an appoint-ment in Austin with this doctor for a second opinion. I enjoy your site and reading what others have gone through. Thanks again. P.S. I think $680 a day on CCPD with no meds is an outrageous amount and yes, I agree, the centers and the insurance companies are pricing the employers and employees out of the healthcare business. I am very sad to see this happening in the USA.
I thank god I am living in Canada where all our costs are covered. It costs me absoulelly nothing for my supplies, etc. How do you ppl in the United States afford these costs? Especially when you are ill and cannot work or if you have no insurance. I know we pay for ours through our taxes but I am sure my taxes I pay dont even cover a quater of the amount I use in the health care system.