Overview

Insurance Overview

Welcome to the DaVita® Insurance & Financial Management Support guide.

Understanding how insurance works can be difficult on its own. Understanding insurance as it relates to dialysis and kidney disease can be especially complicated. Here are the answers to some of the financial questions about being on dialysis.

Maintaining your health insurance is very important

Typically, medical insurance pays for some, if not all, of your dialysis treatments, labs and medications. In order to understand all of your insurance benefits and the different options that may be available to you, be sure to relay all insurance coverage information to your healthcare provider or social worker so that they can properly review your needs and answer any questions you may have.

Information you need to know about your insurance:

  • What type of insurance do you have?
  • Who is the policy holder?
    • You, your spouse or a parent?
  • Where does the coverage come from?
    • Is the coverage through active employment, retirement policy, COBRA or government insurance such as Medicare or Medicaid?

Things to consider when reviewing your health insurance:

  • What are your total healthcare needs?
    • Do you have other health conditions in addition to dialysis?
  • What are your financial responsibilities with your health insurance coverage?
    • Do you have a deductible that you are responsible for paying once per year before your insurance company pays any portion of your bill?
    • What are the co-insurance and out-of-pocket costs that you’re responsible for paying directly before your plan pays at 100%?
    • Are your healthcare provider and doctors considered in-network or out-of-network?
      • Do you have out-of-network benefits?
    • What is your level of prescription drug coverage?

Freedom of Choice (FOC)

People like to know that we have choices in life. We like to make our own decisions on things from which grocery store we shop to what neighborhood we live in. Every day we make choices and many of them are related to healthcare.

Choices about our healthcare are some of the most important decisions we can make. Having a doctor who will truly listen to your concerns, an insurance plan that will cover all your health needs and going to a place where you feel safe and are provided the best services all play into this matter.

Dialysis is no different when it comes to having a choice. As a dialysis patient you are entitled to receive treatment at any dialysis center you choose as long as your insurance participates with that particular facility. For example, if you have a commercial insurance plan that states that you have both in-network and out-of-network benefits you can pick the DaVita of your choice as long as your commercial insurance is accepted at that center.

There are times when an insurance company will try to convince you that you have to go to another dialysis center because your preferred dialysis center isn’t in their network. It is important for you to know that you have the right to choose, although some additional costs may apply. If you are being asked to change centers, please contact your social worker or insurance management teammate.

General rules of practice for insurance plans are as follows:

  • Most plans have in-network and out-of-network benefits (commercial plans, i.e. Aetna®, Cigna®, United Healthcare®)
  • If you have a plan that has both in-network and out-of-networkoptions, it includes a choice of providers in most cases.
  • A secondary insurance plan (Medicare, Medicaid or another commercial insurance) is beneficial in reducing out-of-pocket expenses the majority of the time.

As a patient, know that you have rights. DaVita provides all patients with a Rights and Responsibilities packet when they start at their dialysis center.

Insurance plans can be very complicated, and changes to your insurance may have a substantial impact on dialysis coverage. It is important to understand your insurance plan and options before making any health insurance changes. DaVita has insurance specialists and experienced social workers who can assist you in reviewing this information. Call 1-855-5-DIALYSIS to speak with an insurance specialist.

For more details on how your insurance pays for dialysis, go to:

More information about Insurance & Financial Management Support:

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