I posted a notice in August that my OEM clinic (Orion Medical Enterprises in North Miami Beach, Fla.) had sent me a letter stating that my NxStage supplies would be cutoff due to a billing dispute with my Medicare HMO (CarePlus of Coral Gables, Fla., owned by Humana). On Oct. 20, my supplies were cutoff. Orion went to extreme measures to force me out of the clinic, including having social workers from in-center clinics call me, emails, faxes, phone calls, and certified mail.
After two months of heart-attack inducing trauma, on Oct. 23 CarePlus relented and extended my treatments until Jan. 31, 2007. There is a possibility that my treatments may be cut from six to five weekly. CarePlus said the nephrologist had an impact, but it probably was the CMS grievance and pressure from my U.S. Congressman. CarePlus has had my nef’s 'script on this for years. I was dying the clinic with thrice weekly treatments. Daily dialysis saved my life.
I was supposed to dialyze four times a week with a Baby K through Kidney Care of Fort Lauderdale, Fla., but the deal fell through. Kidney Care, also an OEM, said it did not meet state qualifications to train my husband, who assists with my dialysis. I don’t know if that’s true or not. CarePlus obviously won’t pay for staff-assisted home HD.
It is my belief that I must leave Orion by Jan. 31, although it is possible CarePlus could extend my treatments at 3-month intervals. I don’t trust Orion after they threatened me.
If anyone knows how a patient can dialyze at home with a Baby K or other modality four times a week in South Florida, please let me know. I am not a candidate for noctural home HD. I have PKD and can’t do PD. I will check this site daily and forward my email address and phone number to anyone who can help. Thank you.
…If anyone knows how a patient can dialyze at home with a Baby K or other modality four times a week in South Florida, please let me know. I am not a candidate for noctural home HD. I have PKD and can’t do PD. I will check this site daily and forward my email address and phone number to anyone who can help. Thank you.[/QUOTE]
Contact NxStage and ask them where the clinics are which are using their machines. You do not need to live near them – just close enough to drive there once a month.
The contact information is on their website nxstage.com
I contacted them regarding dialysis for my husband (he is not yet on dialysis) – they sent info by UPS, a few days later a NxStage rep contacted me, and a few days after that the NxStage training nurse called me to set up an appointment to visit the clinic and get the paperwork started.
Have you asked your provider if you could use the NxStage 3 nights a week? It’s better than 3 times a week in-center dialysis and if you have medical reasons why additional treatment could be justified, your doctor could advocate for you to get more than 3 treatments.
I assume they don’t want to pay the extra days? Or they don’t want to pay for the entire therapy at home? If it’s the extra days they don’t want to pay I hope at least you can dialyze 5x a week but again keep fighting for 6x a week…you really need the dialysis and with your Nephs backup and community support I hope victory will be on your side…good luck and our prayers are with you!
I’ve mentioned before that Medicare – even a Medicare HMO – will routinely pay for 3 treatments a week. More than 3 treatments a week need to be medically justified. This is true whether you’re on Method I (do everything through the dialysis clinic that bills Medicare) or Method II (get support through the dialysis clinic and equipment and supplies through a supply company).
Your dialysis clinic where your nurse and the rest of the support team are located provides home dialysis under Method I. Orion is a Method II provider for home dialysis. What Orion charges to Medicare under Method II may be different from what the dialysis clinic that provides your home training and support would charge. It’s possible that Medicare would be happier about providing more treatments if you were a Method I patient.
Start with your nephrologist and ask if he/she would provide medical justification to your Medicare HMO for additional treatments. Ask your dialysis clinic (biller or social worker) if you could become a Method I patient. Changes are allowed once a year and the change becomes effective January 1.
My nephrologist is on record as recommending six treatments per week. Orion’s bizarre billing practices are the problem, not the solution.
I am not a candidate for noctural, and I don’t believe NxStage can be used for nocturnal.
Thanks folks, but this is a very serious problem which defies the standard solutions.
I need a new clinic or OEM which offers me a machine for extended dialysis, four times a week. I need to get away from Orion. Would you trust a clinic which threatened you and cutoff your supplies? Unfortunately, there aren’t other clinics in the area which offer home hemo.
I’ve heard that those that provide staff assisted home dialysis are doing so mostly for people that have commercial insurance. Providers can bill commercial insurance at much higher rates than what Medicare allows.
I’d be interested in knowing if anyone with Medicare (Method I or Method II) goes to a clinic or uses a Method II provider that provides staff assisted home dialysis. I think staff assisted home dialysis could be a terrific option for people that can’t take primary responsibility for home dialysis – such as patients on vents and with trachs that I’ve heard dialysis clinics and even nursing homes won’t accept – or people who have no partner and their clinic requires one who need to do home dialysis to keep their jobs.
In case anyone reads this thread. As of January 1, 2011, there is no longer the option for Method II reimbursement from Medicare. Medicare only reimburses dialysis facilities for home dialysis equipment, supplies, and support from the home training nurse, dietitian, and social worker as well as certain labs and ESRD-related drugs under the ESRD prospective payment system (PPS).