Billing and Insurance FAQs for Dialysis Patients
Have some questions about insurance and billing payments? Insurance counselors are here to help DaVita patients like you with any inquiries you have, but here are some immediate answers to common questions.
1. Q: How is dialysis paid for?
Ask a DaVita insurance counselor if you have specific questions about your insurance. You can also send your questions to our Contact Us page.
2. Q: I have Medicare Part B to pay for my dialysis treatment. Why do I need other insurance?
A: Part B only pays 80 percent of dialysis treatment costs, leaving you with a 20 percent coinsurance to pay. If you want complete insurance coverage, you will need additional insurance to cover the 20 percent coinsurance.
3. Q: I have insurance through my employer. Do I need Medicare?
A: This would depend on the benefit structure of your employer group health plan (EGHP). Some patients defer enrollment into Medicare because there is no financial benefit to enrolling. For example, if you are covered under a plan that pays 100 percent, with no out-of-pocket expense, then you may consider deferring enrollment into Medicare until necessary. On the contrary, if you are covered under a plan with significant out-of-pocket cost, you may want to enroll in Medicare. Before making any decision, please contact your social worker or insurance counselor to learn more about your unique situation.
4. Q: What happens if my dialysis center does not participate with my health insurance plan?
A: There are several options to consider. In most cases at least one will be a viable option:
- Out-of-network benefits: If these are available, you can choose to use them. In most cases you will have more out-of-pocket expense when choosing to go out of the network.
- Non-participating authorization: In some cases, you can obtain special permission from your health plan to use a provider that does not participate in their network. There are specific requirements that must exist to be approved.
5. Q: What should I do with the explanation of benefits (EOB) I receive from my insurance company?
A: First, please know that the EOB is not a bill. The EOB provides important information about how your insurance claim was processed by your insurance company. It is a document that you should use to determine how much you can expect to pay your provider. You should always match the provider’s bill with the EOB prior to making a payment to the provider.
6. Q: How often do I need to update my insurance benefits?
A: Once a year is typical. However, if you experience any life changes (i.e., change jobs, stop working, get a divorce, etc.), you should review your plan details with your insurance counselor and insurance plan right away.
7. Q: Who pays for the cost of a kidney transplant?
A: If you are eligible to receive a kidney transplant, your Employer Group Health Plan may cover it. If your plan does not cover a transplant, Medicare may be an option if you are eligible. Medicare will pay 100 percent of hospital charges and 80 percent of Medicare’s allowable rate for doctors’ fees associated with outpatient care. Medicare will also pay for a living kidney donor to be evaluated, but your donor may have costs that aren’t covered (e.g., travel, time off of work). Medicare will also pay for immunosuppressants, initial evaluations and follow-up visits. Contact your insurance counselor or social worker if you want more details on how your plan covers transplants.
Want to know more about insurance and billing?
Everyone’s insurance plan and health needs are unique. If you would like to discuss your coverage options or have questions, please reach out to one of these resources:
- Individuals with chronic kidney disease (CKD) who have not yet started dialysis, please call the Patient Advocate Helpline at 1-888-260-0086.
- DaVita dialysis patients with end stage renal disease (ESRD), please contact your insurance counselor or social worker OR fill out our Insurance Support Form.
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