i was diagnosed with renal failure in '03 and i was devistated as i am sure anyone would be. after being hospitalized for a month, i began hemodialysis and hated everything and everyone. They explained to me about the waiting list for the kidney and i felt more helpless, i just didnt see it happening for myself. One of my friends husband stepped up and tested to become a donor, in the meantime they said i need to lose weight before they even scheduled the surgery so i was working on that. In March of '04 (and 40 lbs away from my goal) we got the great news, Jerry (my friends husband) was a match, Praise God, i was never so determined, EYE OF THE TIGER, EYE OF THE TIGER, i needed to get this done. But then, i got another phone call, it was from the financial dept. at the surgery center. They said my insurance would not cover the donors portion of the surgery and medicare will only cover 80% and i had to raise the the last 20%. They gave me a figure of $50,000.00. My world had come to an end again, i just didnt see it happening, i gave up. i went back into my old eating habits and now i am right back to where i was when i first got sick. on April 13th '06 i got the catheter placed for PD so now we are just waiting for the healing to be complete so i can hopefully see if this would help me lose weight. does anyone have any suggestions for me. My donor is still ready, willing and able to give me his kidney and my sister has offered to pay the 20%, now it is all up to me to lose the weight and i cannot get motivated. can someone, ANYONE, please slap me, kick me, wire my jaws shut, something…lol, I cant wait to hear from you all, God Bless
Hi! Welcome to the group. Yes, ESRD is in itself a real eye opener for certain. You are VERY lucky to have someone be a match for you, as for the backsliding with the diet, I can understand that too. You are not alone in this effort. Just remember, you didn’t get overweight over nite - it took months - maybe years - and it will take the same to loose it too. If you backslide today, don’t beat yourself up for it, tomorrow is a new day, and a new beginning.
The Medicare ESRD manual and the booklet for patients Medicare Coverage of Kidney Dialysis and Kidney Transplant Services both say that if you have Original Medicare, Medicare pays 100% of the donor’s expenses for the pre-transplant work-up, the surgery to remove the kidney, and post-transplant follow-up and doctor’s fees for the donor. You shouldn’t have to pay the deductible, coinsurance, or any other charges for the hospital.
For you, there is a Medicare deductible for the hospital stay under Medicare Part A and the Part B coinsurance (20% as a primary payer) for doctors and outpatient care. I can’t tell if you’ve had Medicare 30 months, but if so, Medicare would pay first and your employer plan would pay second. Otherwise providers would bill your employer plan first and Medicare second. Even if you have an employer group insurance and it won’t pay for the donor, the hospital can bill Medicare and indicate on the bill that the employer plan denied the claim. Medicare should then pay for the donor’s expenses.
If in the evaluation process they found in your donor some health condition that needed to be taken care of, the hospital or doctor would bill your donor’s insurance for that.
This is the booklet I referred to above. You should have received this publication (or an earlier version of it) when you started dialysis. It hasn’t been updated since 2004 but is available online at:
http://www.medicare.gov/Publications/Pubs/pdf/10128.pdf
There are things with a transplant that Medicare doesn’t cover, like transportation to/from the transplant hospital, lodging, food, lost wages, a babysitter if you have to leave children, etc. People need to plan ahead for how to pay for these costs. There are organizations that help people fund raise. The transplant social worker should be able to tell you about them or you can look at this site that has some basic financial information, some FAQs and helpful links:
http://www.transplantliving.org/beforethetransplant/finance/costs.aspx
Medicare Advantage plans may pay differently. I’d suggest that you call 1-800-MEDICARE or your Medicare Advantage plan to find out more about how Medicare can help you and your donor with expenses related to a living donor transplant.
So far as losing weight is concerned, the dietitian at your dialysis clinic may be able to help you. It will be very important with PD that you limit sweets. Most PD solutions have sugar in them and it’s easy to gain weight if you don’t exercise more. One word of caution – You don’t want to cut back too much on protein since PD removes more protein than hemo and protein helps you to keep up your energy and stay healthy. Your renal dietitian can be a great ally in your weight loss regimen as can your husband and friends.
Nina, You are so loved to have a supportive husband, a matching donor & a sister willing & able to take care of expenses.
This is your motivation, the love of these people who will take away all the previous problems & give you a wonderful gift. You CAN do it just like you did before.
Your worries are over, get started. Do it for yourself & for them.
You have such a beautiful face & the new you will be gorgeous.