Billing Q&A for Dialysis Patients

Have some questions about billing payments? DaVita insurance counselors are here to help with any inquiries you have. Here are some tops questions that dialysis patients may have about billing.

1. 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 leaving you with a 20 percent coinsurance to pay. If you want complete insurance coverage, you will need additional insurance.

2. 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). Many 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 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 management teammate.

3. Q: What happens if my dialysis center does not participate with my health insurance plan?

A: There are several options to resolve this situation. 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.
  • Single payer agreements (SPAs): Negotiation of a mini-contract that would cover one or two patients. DaVita insurance counselors will provide assistance with this. 
  • Non-participating authorization: You 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. 

4. 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 must pay your provider. You should always match the provider’s bill with the EOB prior to making a payment to the provider.

If you have any insurance concerns, please contact your local DaVita insurance counselor.

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