I am sure you are all wondering what’s been happening about the dialysis patient organizations- and, now, it seems that some dialysis clinics- are paying the health insurance premiums for dialysis patients. (I first discussed this issue here).   There is a new complainant- it’s not just private insurance companies now.

The federal government is getting into the act (in particular, it’s the Center for Medicare and Medicaid Services [CMMS]).  CMMS is concerned that many patients have enrolled in PPACA (Obamacare, or it’s more appropriate name- the  Patient Protection and Affordable Care Act), even though they may be eligible for Medicare and/or Medicaid. After all, having health insurance means the clinics are compensated at a higher rate than would be true if the federal government picked up the tab.

CMMS claims that such a practice puts corporate profit margins ahead of patients’ needs. I certainly see the possibility for higher corporate profits, but I am not so sure that patient needs are being shortcut. After all, if one is not paying for his or her own personal insurance, and the coverage provided is the same or better than what would be offered elsewhere, what patient need is being unmet?  The only problem would be is if CMMS imposed a fee upon the patient for late enrollment in Medicare, when they finally switch (if they do).

If you’ve been reading my blog, you know that some private payers are complaining that this practice (paying for the health insurance for dialysis patients) taints the risk pool under PPACA. Those patients who receive “charitable funding” of their insurance premiums, according to the private insurance industry, undergo higher cost treatments (such as dialysis) and are sicker than the patient pool on average. This is why United Health sued American Renal Associates (a Massachusetts-based dialysis provider with some 200 clinics), claiming that when the clinics pay for private patient insurance, they are enabled to bill $ 4000 for a dialysis session.  That is astronomical, when compared to the $ 300 or so payments the clinics would obtain via Medicare or Medicaid. The insurance companies are using this complaint with the government as leverage to request the ban eradication- the ban that discriminates against patients ability to obtain insurance based upon their pre-existing conditions.

After all, when a patient is forced to switch from private insurance to federal coverage, the patient is then subject to a 20% coinsurance payment for dialysis. And, there is no cap on out-of-pocket expenses, if one is covered by Medicare or Medicaid. This is exactly why many patients have set up their own “Go Fund Me” pages, asking the public to cover their health care insurance- to avoid such financial burdens.

Even the Federal government’s rules are murky- at best.  HHS (Health and Human Services) considered that insurers could reject premium payments from health care providers in 2013 (because it skews the insurance risk pool).  But, then reversed itself (in part) when it realized the third-party premium payments (from independent non-profits like the AKF, the American Kidney Fund) are based on financial need and not the enrollee’s health status.

And, as I’ve said previously (in the reference cited above), why would it then be acceptable for pharmaceutical companies to offer rebates and special insurance for patients subject to high prescription costs- but that same practice is to be considered unacceptable when the treatment regiment involves dialysis?

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