The Job of a Dialysis Patient= Pay Your Bill and Shut Up

I would like to share an experience I have had with DaVita. I have been with DaVita for two and half years. Yet, eight months after a bill was due, DaVita waited and waited to contact me about it. They sent a certified letter to the post office over a bill in the amount of $1,101.00. Instead of making a simple phone call, they decided that they wanted to play the game of nasty. Bad move for them. First threat was that they would take me to court. Checkmate, it is illegal for Social Security disability payments to be garnished and they are not going to be able to get a court order from a judge to order that action. Second, they threatned to put a lien on my property. Checkmate, I do not have any property and neither do most individuals on dialysis, sorry about your luck, Chuck. Even if someone can get a garishment, the most that they can take out of a check is 25 percent.

Many times, I have received the feeling that at DaVita, it is blame the patient, first. Recently, four of my Pure Paks have failed to prime, I was told it was the fault of UPS or the patient. I have eighteen years of experience in dealing with carrier and delivery individuals, yes, some of those individuals are screwups. Yet, it amazes me the lack of responsibility taken by DaVita and NxStage. By the way, Jack, who is paying your bill of thousands per month? You fail to realize that he or she pays the bill calls the shots.

Oooh, yes. Billing and Davita are a very sore spot with me as well. They suck.
Their billing dept is the worst I have ever dealt with. I will me moving to NWKidney because of it. THEY do not call the shots. WE do.

[QUOTE=Wendy Ramsay;18254]Oooh, yes. Billing and Davita are a very sore spot with me as well. They suck.
Their billing dept is the worst I have ever dealt with. I will me moving to NWKidney because of it. THEY do not call the shots. WE do.[/QUOTE]

Yes, when companies behave this way, hit them in the pocketbook. The sooner they realize who is paying the bill, they will go back to being a servant of the customer, us.

DaVita and any other dialysis provider must bill Medicare and non-Medicare patients for services they provide if they want to be able to claim those unpaid balances as a “bad debt” with Medicare. If the provider has followed the rules for Medicare bad debt claims, Medicare can reimburse part of the amount due. Here’s information from a Medicare transmittal related to its reimbursement manual:

A debt must meet these criteria to be an allowable bad debt:

  1. The debt must be related to covered services and derived from deductible and coinsurance amounts. (See §305 for exception.)

  2. The provider must be able to establish that reasonable collection efforts were made.

  3. The debt was actually uncollectible when claimed as worthless.

  4. Sound business judgment established that there was no likelihood of recovery at any time in the future.

    To be considered a reasonable collection effort, a provider’s effort to collect Medicare deductible and coinsurance amounts must be similar to the effort the provider puts forth to collect comparable amounts from non-Medicare patients. It must involve the issuance of a bill on or shortly after discharge or death of the beneficiary to the party responsible for the patient’s personal financial obligations. It also includes other actions such as subsequent billings, collection letters and telephone calls or personal contacts with this party which constitute a genuine, rather than a token, collection effort. The provider’s collection effort may include using or threatening to use court action to obtain payment. (See §312 for indigent or medically indigent patients.)

A. Collection Agencies.–A provider’s collection effort may include the use of a collection agency in addition to or in lieu of subsequent billings, follow-up letters, telephone and personal contacts. Where a collection agency is used, Medicare expects the provider to refer all uncollected patient charges of like amount to the agency without regard to class of patient. The “like amount” requirement may include uncollected charges above a specified minimum amount. Therefore, if a provider refers to a collection agency its uncollected non-Medicare patient charges which in amount are comparable to the individual Medicare deductible and coinsurance amounts due the provider from its Medicare patient, Medicare requires the provider to also refer its uncollected Medicare deductible and coinsurance amounts to the collection agency. Where a collection agency is used, the agency’s practices may include using or threatening to use court action to obtain payment.

B. Documentation Required.–The provider’s collection effort should be documented in the patient’s file by copies of the bill(s), follow-up letters, reports of telephone and personal contact, etc.[/I]

You can read more about this and how indigent and medically indigent are defined.

It would have been reasonable to the billing personnel to contact you by phone and they could have counted that call as a contact and you might have felt better knowing why you were being billed. It may be that the $1101 is deductibles and copays for your insurance. If you have Medicare a secondary payer and if your employer plan paid at least 100% of the Medicare deductible for covered services, DaVita should have written off any balance for deductibles and coinsurance for those covered services under their “assignment of benefits” contract with Medicare. However, the $1101 may be for non-covered services, like the additional treatments each week that you have received if Medicare didn’t approve extra treatments. BTW, I know DaVita and other dialsyis clinics ask patients to fill out financial forms. Although it seems intrustive to ask people about their financial situation, it can help help dialysis clinics determine if the patient meets their criteria for indigency or medical indigency to write off balances.

Interesting info. However, DaVita can blow all the smoke that they like, you cannot collect something that does not exist. Again, Disability checks are not collectable and without a order from a judge, they are out of luck. I am sure that in the vast majority of dialysis patients, collection efforts are just a bunch of hot air. I have heard every form of imaginable verbal or physical threat. I know individuals who have been physically threatned by collectors, I would just laugh in their faces. I had a phone from Verizon that would not work and the company refused to fix it, claimed they did not have the parts over a span of months. During this time, my ex received 5-6 phone calls per day from Verizon to pay the phone bill. It was the same collector each and every time. I told that fat jerk that I was not paying for a service I could not use and if he continued to call us, he would be sued for harassment. 5-6 phone calls per day is not seen as reasonable contact by the court system. He made a bunch of empty threats and I told him, "When you show up in court, who do you think the judge is going to believe, you or me in my county officer uniform(police)?

My point is that people, especially on dialysis, do not have to take abuse from these clowns. I want everyone, especially the folks on this board, to know their legal rights.

Medical providers must bill and try to collect. It sounds as if no one from DaVita tried to talk with you about your bill. Often social workers work with patients who have unpaid balances to try to help them find other sources of payment. When there are no other payment sources, as a social worker, it was not uncommon for me to talk with patients who received bills from healthcare providers and from attorney’s offices trying collect bills. I often helped patients review bills and determine if the bill was correct and if all the appropriate payers had been billed correctly and paid. I occasionally talked with providers to explain patients’ situations to see if they would accept less or write off the balance. When the patient had received the service, the bills had been filed correctly, all payment sources had paid as they should, and the provider still wanted payment, I advised patients to pay a little every month to keep the provider from turning the bill over for collections. This kept bill collectors from hassling patients. Every provider doesn’t use a bill collection service. I don’t know whether DaVita does or not…Medicare doesn’t require it. I did talk with a friend who is a DaVita social worker and he wondered why the social worker hadn’t talked with you. Did he/she?

I am curious though. Did you say earlier that if patients took responsibility for paying their bills themselves it would put patients in more control of their healthcare? So why didn’t you pay the DaVita bill if you feel that way?

Mark, excuse me if I’m confused. Much of that comes from your conservative politics and positions on health care. Putting that aside, I see so many contradictions that you’re becoming an enigma.

You say you’re on disability, yet you imply you’re a county policeman.
You’re against government funding of healthcare and say you’re a private pay patient, yet you’ve been at DaVita for 2 1/2 years. That means in three months you’ll be using Medicare whether you like it or not if you’re primary insurance is an Employer Group Insurance Policy.

Mind you, I’m not criticizing any of your positions; I’ll leave that to others because I just don’t have the patience. But I just want to understand where you’re coming from.


When my health was normal, I worked as a county police officer from 1996-2000. Many times, when I am arguing against government policies, I am speaking from experience. Yes, I will be on Medicare and if I had my choice, I would not be, not on your life. My unit was downsized by a social worker with no business experience, whatsoever. I knew social workers with MBA’s, excellent business skills, however, he was not one of them. Yet, he received his just due. He left our county to take a position as Director of an agency in a smaller county. During his tenure, he was caught fooling around with the young help at lunch time. The county commissioners investigated him and he was fired. I really felt sorry for his wife, nice lady, and his kids. Normally, I hate to see anyone fired from their job, but, he was so arrogant, he was an exception. You have to realize, I have experienced a ton of arrogance and lying in the goverment, so I tend to be very suspicious of the government. Management in government lies, the Union lies, they all lie. I was a Teamster, they lie, also. For example, they claim they will pay for National Health Care by the elimination of waste, fraud, and abuse, that is the oldest lie in the goverment handbook. I do not care who is the President, it is a major falsehood.

Markets have to respond to consumer forces. Yes, they lie, also. Yet, the market keeps them much more honest than the government. Another big fat lie is that the rich do not pay their fair share. As admitted by the NY Times, the 1 percent of all income earners are paying 40 percent of our nation’s tax bill. Great economic Presidents are JFK and Ronald Reagan. Ok Presidents for the economy Bush I and II, Eisenhower, and Truman. Poor to lousy, FDR, LBJ, Nixon, Ford, and Carter. Bush II gets an OK rating for his outstanding tax cuts. However, otherwise, his economic policies were lousy. FDR was a great military commander, Nixon was great at foreign policy, as was Bush I. I like Truman, “I told the truth about them and they thought it was hell.”

JFK and Ronald Reagan are my heros, so is Martin Luther King, along with Malcolm X. I do not have sympathy for the criminals at Guantanamo Bay or the crying about waterboarding. These people killed over 3,000 of my fellow American citizens, do have any sympathy for criminals, terrorists, or dictators. I had compassion for the woman and the little boy who risked their lives for freedom in escaping from Cuba. Freedom is for everyone, regardless of race, color, creed, religion, disabilty, or ethnic background. I would have stood up and told the truth about Fidel and his criminal enterprise. I disliked Bush II from an economic standpoint. However, he told the truth about the Axis of Evil and the other party would not, as Ronald Reagan told the truth about the Evil Empire.

Outstanding speech

President Kennedy