I have been on daily at home pd for 7 months. I have Cigna insurance and my dialysis center is Davita. To my surprise, I recently received letters of EOB( Exlanation of benefits) stating that I have to pay $30 copay for each day of dialysis at home. That addes up to $900-$930 a month,and more than $10,000 out of pocket expenses a year! The social worker at my dialysis center said she had never seen anyting like it. Is this typically done? chaging patient daily copays for treatment at home?
You gotta love insurance companies. (Not). We will check into this and see what we can find out for you. I have heard of this before and believe it was fought successfully. You might also ask your social worker to contact Baxter, since they have most likely dealt with it as well, since it is a threat to folks being able to do PD.
The copays that you’re seeing may be related to how DaVita billed Cigna. Have you asked DaVita’s billing staff whether they have other Cigna patients and whether they’ve talked with Cigna about how they should bill for a monthly service like PD. Clinics are billed monthly by the supply company (Baxter or Fresenius) for the cycler (if you use one) and the PD supplies. Can they bill Cigna that way? If so, you may only have one copay per month instead 30-31 copays per month.
Do you have Medicare Part B as a secondary payer to Cigna? If you do and if Cigna is paying at least as much as Medicare allows for your dialysis, you should not have to pay any copays. Dialysis facilities like DaVita “accept assignment.” Providers that accept assignment agreet o accept what Medicare allows as payment in full so any extra they get from your insurance is gravy. NOTE: Medicare Part B generally pays 80% of the “allowed” charge. If you don’t have Medicare, you might want to look at the cost of the Part B premium vs. the copays you have to pay.
Thank you for responding to my question. I did speak to Davita. They say they only billed the way Cigna asked them to bill. They and Cigna decided at home pd dialysis is considered outpatient procedure and therefore copay of $30 /day applys( which I disaggree strongly). I’m in the process to get Cigna to send me their benefit plan description on dialysis. That in itself is a struggle! No, I don’t hae Medicare part B. because I was told initially, my insurance would cover everything. I am applying for Part B now.