I am having trouble finding a company that will work with my insurance for getting a dialysis chair for home hemo - any suggestions?
I’m sure Dori and/or Beth will chime in here but IMO Medicare regs state your center should provide your chair and all other supplies provided that they would provide an in-center dialyzor. I think for most the problem is what kind of chair will, or do they have to provide. I would work through your social worker in your center, at least to get their response, and go from there.
DaVita said it was up to me to find a chair once my doctor gave me the prescription. They all got blank looks on their faces when I mentioned the chair. Not even the social worker had heard of it and I know the one other NxStager from that clinic does not have a chair and he has been doing it for 3 years. Private companies don’t want to mess with insurance or with private sales. They all want lots of money up front plus shipping, etc. and as soon as they find out I am a private patient they either won’t talk to me or they don’t return calls. Where is something written that I can show them. I don’t really think the staff at the clinic are deliberately stalling - I just think they don’t know the regulations and the company has not brought it to their attention.
Medicare Coverage of Kidney Dialysis and Kidney Transplant Services (Publication 10128) would be something you could take to your center and under Method 1 billing it states “Under this option, you must get all services, equipment, and supplies needed for home dialysis from your dialysis facility” (pg 23)
Seems pretty straight forward to me but I know it seems to vary from center to center. I ask for something one time and my nurse said “that’s not part of your deal!”. I told her that’s because I didn’t know I was negotiating :), and I wanted a NEW DEAL!
When I spoke with NW Kidney about switching to them for nocturnal they told me they have a chair if I need one - but I told them I’d rather use a bed for nocturnal. So, other centers are providing chairs for their home patients. You could let Davita know.
Did you get ahold of anyone at Champion?
The Medicare Benefits Policy Manual provides several definitions at the beginning of the manual (Section 10) - https://www.cms.gov/manuals/Downloads/bp102c11.pdf. If a patient has chosen Method I, Method covers at 80% as a primary payer and dialysis facilities must provide all the supplies, equipment and support services that are medically necessary for a patient to do hemodialysis at home under the “composite rate.” In email communication with Mr. Richter (Medicare’s Central Office section in Baltimore that deals with Medicare reimbursement) told me that dialysis facilities are responsible for providing a basic recliner (no extra bells and whistles) under the composite rate for patients who chose Method I and should not ask patients to buy their own. If a facility isn’t aware of this, point them to this section. If a patient chose Method II and is dealing directly with a supply company, that company should provide the recliner too. I don’t think any facility or supplier would want a patient to complain that he/she was asked to buy something that should be provided for him/her and have that trigger an investigation.
Here’s the text from the Medicare manual.
[I]D. Home Dialysis - Supplies, Equipment, and Support Services
Home Dialysis Equipment - Home dialysis equipment includes all of the medically necessary equipment prescribed by the attending physician, including (but not limited to) artificial kidney, automated peritoneal dialysis machines, and support equipment. Home dialysis supplies and equipment may be covered if used by an ESRD beneficiary in a nursing home.
Installation - Installation includes (but is not limited to): the identification of any minor plumbing and electrical changes required to accommodate the equipment; the ordering and performing of these changes; delivery of the equipment and its actual installation (i.e., hookup), as well as any necessary testing to assure proper installation and function.
Minor plumbing and electrical changes include those parts and labor required to connect the dialysis equipment to plumbing and electrical lines that already exist in the room where the patient will dialyze. Medicare does not cover wiring or rewiring of the patient’s home or installing any plumbing to the patient’s home or to the room of the home where the patient will dialyze.
Maintenance - Maintenance includes (but is not limited to): travel to the patient’s home or, if needed, transportation of the equipment to a repair site; the actual performance of the maintenance or repair; and all necessary parts. Water purification equipment maintenance includes replacing the filter on a reverse osmosis device, regenerating the resin tanks on a deionization device, using chemicals in a water softener, and periodic water testing to assure proper performance. Routine maintenance customarily performed by a patient are not covered services except for the cost of parts involved in this maintenance furnished by the facility to a patient.
Supplies - Supplies include all durable and disposable items and medical supplies necessary for the effective performance of a patient’s dialysis. Supplies include (but are not limited to): dialyzers, forceps, sphygmomanometer with cuff and stethoscope, scales, scissors, syringes, alcohol wipes, sterile drapes, needles, topical anesthetics, and rubber gloves.
Support Services - Support services include (but are not limited to):
Periodic monitoring of a patient’s adaptation to home dialysis and performance of dialysis, including provisions for visits to the home or the facility;
Visits by trained personnel for the patient with a qualified social worker and a qualified dietitian, made in accordance with a plan prepared and periodically reviewed by a professional team which includes the physician;
Individual’s unscheduled visits to a facility made on an as-needed basis; e.g., assistance with difficult access situations;
ESRD related laboratory tests covered under the composite rate;
Providing, installing, repairing, testing, and maintaining home dialysis equipment, including appropriate water testing and treatment;
Ordering of supplies on an ongoing basis; and
A record keeping system that assures continuity of care. (See §70.3 for CAPD support services.)
NOTE: The CMS requires that suppliers billing Medicare under Method II must have a written agreement with a certified dialysis facility to provide these services.
Support Equipment - Support equipment is equipment used in conjunction with the basic dialysate delivery system. Such equipment includes (but is not limited to) pumps, such as blood and heparin pumps, alarms, such as bubble detectors, water purification equipment used to improve the quality of the water used for dialysis, and adjustable dialysis chairs.
Method Selection – For home dialysis, a beneficiary selects one of two methods for payment and billing. Under Method I (composite rate), the facility with which the patient is associated assumes responsibility for providing all home dialysis equipment, supplies and support services. Under Method II (direct dealing) the beneficiary deals directly with a single home dialysis supplier to secure the necessary supplies and equipment to dialyze at home.[/I]
Champion would not be able to bill Medicare separately for the recliner chair for a patient who is on home hemodialysis since the dialysis facility (Method I) or supplier (Method II) is supposed to provide it.
Thanks so much for all the good info. I have taken the information from Beth Witten’s reply to my clinic - the ball is in their court . It will be interesting to hear what they have to say.
What if the insurance is private? Can the facility defer the cost to the patient?
If the patient does not have Medicare at all (primary, secondary or other payer), the Medicare rules would not apply. The patient who is doing or plans to do standard hemodialysis (3 times a week 3-5 hours) or short daily HD should contact his/her insurance company to determine what benefit is available for medically necessary durable medical equipment and what the doctor needs to do (prescription, letter of medical necessity) to justify payment for an adjustable chair.
Unfortunately private insurers can defer payment to the patient. I own a champion chair that I paid for myself. In fact, Kaiser paid about 800-900 dollars for the same chair that cost me 1200 plus shipping and delivery, about 1500 by the time I paid for tax as well.
On the other hand, when I am up in Idaho, I found a little rocker at Burlington coat factory in the baby section that actually works quite well. Not as comfortable as the champion chair, but works quite nice especially coming out of my own pocket. In some ways, I wish I would have found one here in CA first.
As in all things, speak with your medical team about your options.
I was able to prove that under Medicare it is mandated that clinics provide the chair, however I would imagine it would differ with private insurance from comapany to company. With private insurance it will be difficult to get them to move on it. Perhaps, you will need to buy your own chair and then try to get them to reimburse you. However, I dialyzed for almost three months using my own recliner chair and it was quite adequate for dialysis. The problem was that it was fabric covered and I was always worried it would be ruined due to blood spills, luckily, we avoided that. You might also look for used dialysis chairs at local clinics. They might be willing to sell one. Good luck.
If you consider buying a used dialysis chair from a dialysis clinic be sure it’s in good working order and that it has been THOROUGHLY cleaned and disinfected. WARNING: I’ve heard that surveyors have found dried blood in the creases of chairs, between the arms and the cushions, and when they flipped some chairs, they have found dried blood on the underside of the chair. Some blood borne diseases can remain infectious for a while outside the body. Although everyone worries about HIV, actually it’s a pretty weak virus and doesn’t live long outside the body. However, Hepatitis B can remain infectious outside the body for at least 7 days according to the CDC. This fact sheet also tells how blood spills should be cleaned.