Dialysis Firm Cancels $524,600.17 Medical Bill After Journalists Investigate

[Demovictory9]

https://www.npr.org/sections/health-shots/2019/07/26/745596505/dialysis-firm-cancels-524-600-17-medical-bill-after-journalists-investigate

On Thursday, a representative from Fresenius told Sovereign's wife, Dr. Jessica Valentine, that the company would waive their unpaid bill. Instead, they will be treated as in-network patients, and Fresenius will seek to negotiate with their insurer a rate higher than what the insurer has already paid. The Valentines are responsible only for their $5,000 deductible, which Sovereign, who goes by "Sov," has already hit for the year. That leaves them with $0 left to pay on their in-network deductible.

"It's a huge relief," Sov said. "It allows me to put more energy back into just taking care of my health and not having stress hormones raging." Sov said he hopes his experience will shed light on the problem of balance billing and help other patients in similar situations.

A 50-year-old personal trainer, Sov was diagnosed with kidney failure in January and sent for dialysis at a Fresenius clinic 70 miles from his home in rural Plains, Mont. A few days later, Sov and Jessica learned that the clinic was out-of-network and that they would be required to pay whatever their insurer didn't cover.

The Valentines initially could not find an in-network option, and Sov needed dialysis three times a week to survive. After he underwent 14 weeks of dialysis with Fresenius, the couple received a bill for $540,841.90. Their insurer, Allegiance, paid $16,241.73, about twice what Medicare would have paid. Fresenius billed the couple the unpaid balance of $524,600.17 — an amount that is more than the typical cost of a kidney transplant.

Fresenius charged the Valentines $13,867.74 per dialysis session, or about 59 times the $235 Medicare pays for a dialysis session.

Fresenius spokesman Brad Puffer said that the Valentines should always have been treated as in-network patients because their insurer, Allegiance, is a subsidiary of Cigna, which has a contract with the dialysis company. Under this contract, Fresenius would have been paid a higher rate than what Allegiance paid. The Valentines, he said, were caught in the middle of a contract dispute between the companies.

[CurtEastPoint]

1. Single payer NOW: "caught in the middle of a contract dispute..."

fuck that greed

[DFW]

2. Half a million for 14 weeks of dialysis

For most people that‘s just a more polite version of the death penalty—and for what? Kidney failure is now a capital offense in America?

[Demovictory9]

5. 13.8K will buy a good used car. $13.8k for few hours of treatment - not even surgery?

[Horse with no Name]

3. I'm having a hard time wondering why these people

Are using private insurance for dialysis.
Medicare automatically kicks in for ESRD (end Stage renal disease).
This is crazy.

[Hoyt]

6. Think that if you have an employer health plan, there is waiting period. Plan pays for 3 months.

[JCMach1]

8. Yeah 90 day rule

[Sneederbunk]

4. War is a racket. Medical care is a racket.

[Hoyt]

7. This "out of network" penalty/crud is an easy fix if Congress would do their job.

[area51]

9. This is one more reason why we need

comprehensive Medicare for All. With M4A, there is no in-network, out of network BS. A bit of info on the public option, policy details, and FAQs.

[keithbvadu2]

10. Still waiting for Trump's 'less expensive, better coverage' medical care.

Still waiting for Trump's 'less expensive, better coverage' medical care.