There is another insurance story linked from RenalWeb and IHD Dialysis patients caught in insurance fight, which is another case of in network vs out of network. After seeing the charges admitted to in the National Renal Alliance Lawsuit it's hard to believe that the dialysis providers in Kentucky are only charging $800 a treatment for out of network payers. $800 is about what the lawsuit indicated was the in network charge so $900 as a top rate seems unlikely.
A couple things that struck me about the article. DaVita is quoted: "DaVita says the company's cost per treatment averages $266", that's the first time I've seen them give a number. Interesting that when quoting the charge to insurers they give the amount just for the dialysis portion of charges, and for their payments from Medicare they give the total allowed Medicare rate for dialysis and an average dose of medications. Comparing apples to fruit salad.
The thing I can't make sense of is the subject of the article Mr. Orr.
Orr said, his health insurer, United Healthcare, advised him to start traveling to Louisville for dialysis instead -- a trip of about 230 miles each way.
That sounds pretty terrible but just a few sentences later the article says:
"I'm 84 now, and my wife's 80. We couldn't make that trip three times a week."
84? How come he isn't Medicare primary? This doesn't make sense. It is really looking like the situation is being manipulated in order to avoid having to mention what exactly the charges were that caused the insurer to implement stringent out of network rules. Both the treatment charges and the average charges for routine medications and diagnostic procedures.
In the article Rep. Jeff Greer checks the provider's math. It does seem like the dialysis provider's story - "We only charge at the most $900." - falls apart at the first glance. If the highest charges - for all routine elements of the treatment - were in the $900 range I doubt there would be a problem but evidence is accumulating that the actual charges are much higher.
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