One of the allowed reasons for involuntary discharge in the ESRD regulations is "The patient or payer no longer reimburses the facility for the ordered services." The Interpretive Guidance says, "If a facility involuntarily discharges or transfers a patient for nonpayment of fees, there must be evidence in the patient’s medical record that the facility staff (e.g., billing personnel, financial counselor, social worker) made good faith efforts to help the patient resolve nonpayment issues." The physician and medical director have to sign a discharge order and the clinic needs to provide you and the ESRD Network with a 30-day written notice and help you find another clinic.
What led to cancellation of your Medicare Part B? Here are reasons for termination listed in the Social Security Program Operations Manual. One of the reasons is nonpayment of premiums.
Have you communicated with Social Security? If your the Part B payment wasn't timely, does the reason why not fit one of the "good cause" reasons?
Did anything happen that would allow you to request "equitable relief" according to this policy?
What has your dialysis social worker done to help you resolve the problem either with SSA?
Has the clinic asked you to fill out a form to show that you are medically indigent?
Have they tried to work with you on a payment plan?
Has the social worker talked with you about options for other coverage? You may eligible for your state's Medicaid program. A number of states allow people whose income is above state guidelines to use medical bills to meet a spenddown (like an insurance deductible) to become eligible for Medicaid. With the dialysis bills, you could probably meet a spenddown. Here are links to contacts for each state's Medicaid office to ask questions.
- Has anyone suggested that you get a job with health benefits if you can't get health benefits through a spouse or as a dependent of someone?
Unless you're still pretty new to dialysis and in the initial enrollment period for Medicare which only lasts 7 months, you can't enroll in Part B again until January 1-March 31, 2018 and Part B won't start until July 1. If you don't have and can't get other insurance, it could be hard to find a clinic that will take you unless you can afford to pay out of pocket for dialysis.
If I had more information about what happened that led to termination of your Part B, I might be able to think of other possible solutions.