I’m currently in India undergoing daily nocturnal home hemodialysis. I bear the entire cost of my treatment here.
I’m working for a company that is headquartered in San Jose, CA. I need to be transferred to San Jose, CA in a few months. Now, I had a few questions about insurance coverage. My company has a group insurance policy for its employees (I’m not sure of which company and policy though - I can find out)
Do insurance companies cover the medical expenses of a new employee in the company who has a pre-existing medical problem?
Do I need to pay some initial part of the expenses - or for some initial period? How much or how long?
Is there a monthly/yearly/lifetime cap on the coverage?
Will nocturnal home hemodialysis be covered?
What are the expenses like for nocturnal home hemodialysis?
I have no idea how this works. So, would greatly appreciate any inputs/advice. Also, any link where I can understand how this will work would help.
You may have to meet a pre-existing waiting period for coverage, but a law called the Health Insurance Portability and Accountability Act limits that waiting period to 12 months if you sign up for the health plan when you’re first eligible or 18 months if you delay signing up.
I’d suggest that you talk with the person in the company who advises employees about health insurance to find out specific information about that plan’s coverage. U.S. health insurance plans vary a lot so far as deductibles (what you must pay first before the plan pays anything), copays or coinsurance (what you pay of the amount charged), how much you have to pay before a plan pays 100% for the rest of the year, and what benefit cap there may be for your lifetime. The company you work for should have information online or in print that describes its benefits.
Most insurance plans cover dialysis whether done at home or in a clinic. Although Medicare routinely only pays for 3 treatments a week (4 if the doctor is able to provide enough medical justification), commercial insurance plans usually pay for the number of treatments the doctor orders. You would not be eligible for Medicare now. You may be eligible down the road if you become a legal resident or citizen and live and work in the U.S. long enough to earn enough Social Security (taxes) work credits to qualify.
All insurances are different, but if you are being transferred you will not be a new employee. You are very lucky to be transferring to San Jose, Wellbound is there and they offer all types of home hemo. They are a wonderful organization and have multiple locations in the area. I use Kaiser, which is both good and bad, but they have covered home hemo for me. If that is one of your options, they are now working with Wellbound and I would think getting home hemo would be a good possibility.
If the company didn’t offer health insurance in India and you didn’t refuse it, it might be worth asking if the insurer would look at you as if you were a new hire. This might make it possible for you to get the shortest waiting period possible.
If you’re doing daily dialysis now and paying for it out-of-pocket, you might talk with the dialysis clinic about whether you could buy the machine and supplies yourself and pay the clinic and doctor to provide support services to you (clinic visit with the professional team), labwork, medications, etc.
You could also ask if the clinic would be willing to discount it’s charge for cash if you have the money to do that.
You could also talk with your kidney doctor about whether you would get enough dialysis if you did long nocturnal dialysis 3-4 nights a week. This would cut what you would pay for daily dialysis in half.
If your medical expenses are high enough, you may be able to take a tax deduction the following year for part of them. An accountant could help you claim what you can legally.
If you had Medicare, the allowed rate for dialysis alone is around $140 per treatment plus any drugs that the clinic provides. Since you don’t have Medicare, the clinic is NOT required to discount its charges to Medicare’s allowable. Clinics also have contracts with insurance companies that require them to discount their rates to the negotiated charge. This is why I’d ask any clinic where you consider getting dialysis:
how much it will charge you until you can get insurance
whether it contracts with your company’s insurance
You can read this booklet about health insurance sold in California:
I’m sorry, but I originally mistyped the second sentence because my brain was going faster than my fingers. Clinics are required to discount commercial rates for patients with Medicare and they charge negotiated rates to other insurance companies based on the contracts they have with them. If someone doesn’t have insurance, the clinic can charge what it wants. This is why I’d suggest you talk with different clinics to get an idea of what they would charge.
It’s possible that non-profit clinics may charge less than for-profit ones. You can find out if a clinic is “for profit” or “non-profit” by looking at the services that the clinic offers on Dialysis Facility Compare: www.medicare.gov/dialysis
As a point of reference, my wife has medicare only. She is 49 and eligible due to ESRD. Tennessee does not require insurance companies to offer a medicare supplement for disability, so we pay the 20% out of pocket. When you add in doctor’s visits, clinic visits and charges, drug charges (epogen, renagel, etc.), our 20% is currently running around $2,000 a month.
[QUOTE=Cathy S;12700]All insurances are different, but if you are being transferred you will not be a new employee. You are very lucky to be transferring to San Jose, Wellbound is there and they offer all types of home hemo. They are a wonderful organization and have multiple locations in the area. I use Kaiser, which is both good and bad, but they have covered home hemo for me. If that is one of your options, they are now working with Wellbound and I would think getting home hemo would be a good possibility.
Cathy
home hemo 9/04[/QUOTE]
My company now has the $30 Copayment HMO plan with Kaiser and I plan on going to Wellbound of San Jose.
With this combination, approximately how much will I have to pay for nocturnal home hemo 6 nights a week?
Will I have to pay for EPO? I take 14,000 units a week.
If your copayment is $30/treatment and you do dialysis 6 days a week, you’d probably have to pay $180/week. EPO is billed separately. I don’t know what your responsibility would be after Kaiser pays for EPO. I suspect WellBound could advise you of what your out-of-pocket costs would be for dialysis and any other drugs that will need to take during dialysis, like EPO.
So far as drugs you take at home, I suspect Kaiser has a formulary of drugs that they cover and Kaiser probably has a copay for drugs based on drug costs (higher cost drugs have a higher copay). If Kaiser lets you buy more than 1 month at a time and it will save money to do that, you might want to consider buying a 90-day supply at a time for drugs you take regularly.