In addition to dealing with concerns about your medical condition, you need to know how to cover the costs of your dialysis access surgery and medications. Finances are a major concern for patients and good planning will help to reduce any financial stress. Our financial coordinator and social worker will help you address many of your financial issues and concerns. Together we can help you develop a plan to manage the financial impact of your illness, dialysis access surgery, and long-term recovery. We will ask you to take an active role in this process and may direct you to your current insurance provider and other resources in the community.
If You Have Insurance
If you have health insurance, ask your insurance company to explain its policy for dialysis and dialysis access surgery and to send you detailed information about your benefits in writing. Some possible questions include:
- Does BIDMC accept my type of health insurance to have access surgery?
- Am I covered for dialysis access surgery right now? If there is a waiting period, how long must I wait?
- How much of the pre-surgical, surgical and post-surgical service does my insurance cover, and what specifically is covered?
- Are there out-of-pocket costs that I will be responsible for; if so what are they?
- Is there an annual cap on out-of-pocket costs?
- Are there any insurance company rules I need to follow to protect my benefits, such as pre-certification or using only certain providers?
- Is there a "cap" (or maximum lifetime limit) on the amount of health insurance coverage and/or medication coverage that I have?
- Do I need a second opinion, and if so, who will pay for it?
- If I want a second opinion, will my insurance pay for it?
If your health plan covers only some of the costs, our financial coordinator and social worker can help you find ways to finance the out-of-pocket expenses. If you have stopped working because of your illness, they can also help you determine if, and how, you can extend your former coverage.
If You Do Not Have Insurance
Having dialysis access surgery can be expensive. Therefore, having health insurance and prescription drug coverage in place is important. There are several options for patients who do not have any type of health insurance.
Our coordinator and social worker can help you explore funding options if you do not have insurance. A few possible options for you to discuss with our coordinator and social worker include:
- Do I qualify for
Medicaid, the health insurance program that covers certain patients without insurance?
- Do I qualify for
Commonwealth Care, the new state insurance program for uninsured Massachusetts' residents?
- Does my spouse/partner have insurance that I might be able to enroll in?
- Can I afford to pay privately for an individual insurance plan?
- Are there any local fundraising organizations that can help me?
- Should I start my own fundraising effort and if so, how?
You may wish to visit the National Foundation for Transplants,
www.transplants.org, or the National Transplant Assistance Fund,
www.transplantfund.org. Both of these organizations help patients and families with fundraising for transplant-related expenses. Also, the Anthony Picarello Foundation,
www.ap-foundation.org, helps people with transplant-related expenses.
Medicaid is the health coverage program for certain low and medium income residents. Individual states decide who qualifies for Medicaid and what services and benefits are covered. Your financial coordinator or social worker can refer you to your local Medicaid office to determine if you are eligible for benefits. Eligibility is based on both household income and level of physical/emotional disability. For more information, contact the Medicaid office in your home state:
Some patients may be eligible for Medicare. Federal tax money funds this health insurance program, which is administered by the
Centers for Medicare and Medicaid Services. Medicare is open to citizens or permanent residents of the United States who are:
- 65 years or older, or
- disabled, or
- who have permanent end-stage renal disease
Medicare, through the end-stage renal disease program, provides some coverage for kidney dialysis access for all patients who have paid a minimum amount into the Social Security system.
For more information about Medicare-covered services, call the Centers for Medicare and Medicaid Services, toll free at 877-267-2323 or visit
www.medicare.gov. You can also speak with our financial coordinator.