Think my mother is being overbilled

My mother is receiving home dialysis and she is not on Medicare yet. I took a look at her EOBs and bills and noticed that the company is billing her for each visit with a charge for the equipment, scale, etc. that actually stays at her home. This does not seem correct but the company said this is totally fine. They charge $29 for a scale for each day of home hemodialysis. Can someone help me?

Until someone has Medicare, dialysis companies usually bill the patient’s insurance for everything it provides, including things like scales, etc. If your mother is on home dialysis and if she has enough work credits herself or through a spouse, she should be eligible for Medicare. Medicare A and B can be backdated to the month she started dialysis. If her insurance now is through an employer, that plan would be billed and pay first for the first 30 months she’s eligible for Medicare whether she has it or not. Having Medicare as a primary or secondary payer limits what a dialysis clinic (and any other provider that accepts Medicare assignment) can charge her. The savings usually more than offset the cost of the Part B premium.

NOTE: If the company is providing staff to do her home hemodialysis, her insurance may be covering that. Medicare doesn’t cover “staff-assisted home dialysis.” Patients can be trained to do all or most of the dialysis themselves. Most patients use family members or friends as free care partners.

Hi Beth! thank you so much for your insight. She does have someone helping her but all the equipment is left at her home (ie. scale) and they are charging her per day for the use of her machine, scale , etc. Seems very strange to charge someone $29 per day for a scale

Dialysis facilities/companies often bill what they think insurers will pay. I agree $29/day sounds excessive for a scale. Is the $29/day billed to her insurance or does she have to pay that? Does she have insurance through an employer or does she have an individual qualifying health plan that she bought on or off the health insurance marketplace? Does she get her dialysis through a dialysis corporation? Which one? Has anyone explained the benefits of having Medicare and the risks of not having it if she has an individual plan instead?

Is her Insurance expired or on the employer plan. As the equipment stays at home they are charging you for equipment depreciation. Andrea did you sort it out if so how please update?

The dialysis clinic/company cannot charge a patient for equipment “depreciation.” Insurance companies, including Medicare, require that charges for home dialysis are billed per day of use. Medicare pays a single payment for the month of dialysis treatments, certain labs, certain meds, and support equipment and supplies needed to provide a safe dialysis, including home use of an HD or PD machine, dialysis chair, scale, BP monitor, etc. Other health insurers do not bundle these items and instead want dialysis billers to list each item separately per day of use.

If your mother has an employer group health plan that is paying first like it must do for the first 30 months of Medicare eligibility (whether the patient takes Medicare or not), having Medicare Part B as a secondary payer would limit what the dialysis clinic can bill your mother. The clinic would have to accept as payment in full what the employer plan pays as long as it’s at least 100% of what Medicare allows for the bundled rate. if your mother has a Medicare Advantage plan instead of Original Medicare, that plan may or may not require dialysis billing for treatments, supplies, and equipment to be bundled. MA plans can charge copays or coinsurance on covered services/items. The maximum in out-of-pocket fees varies by plan, but can be no more than $6700/year or no less than $3,400/year.

Hi Andrea, the charge of $29 per day of visit is I think too much since they only change the scale.

yes, i agree with you 29$ per day is very high.