Q. What Are Your Access Fees?

We are not a PPO network. We do not contract with dialysis providers and then market discounted rates to health Plans via an access fee. Our name reflects the fact that our program can be implemented in any dialysis facility in the country. Plan members do not have to change care providers. Our average savings off of billed charges is 77%, significantly better than the typical 15%-25% discounts with most PPO networks.

Our fees are based on retaining a percentage of the savings we create through our program. There are no up-front or implementation costs.

Q. How Can You Achieve Savings of Up to 80%?

In a typical dialysis facility, Medicare is the primary payer for 75% of the patients. The dialysis provider community has stated that the Medicare payment rates are not sufficient to cover their average cost of providing a dialysis treatment. To make a profit, they need to earn extraordinary profits on the remaining patients. On average, our clients are charged 2550% of the Medicare allowable amount for the same services. We help them implement a strategy that reduces their exposure to a reasonable percentage above the Medicare allowable amount.

Q. Our Existing PPO Contract Prohibits “Stacking” Other PPOs — Is That a Problem?

No, our program entails a change to the Plan document — we are not a PPO network that would be “stacked” on top of an existing PPO network.

Q. When Does Medicare Coverage Begin to Pay for Dialysis Services?

For health Plan members who receive dialysis services due to End-Stage Renal Disease, Medicare entitlement generally begins no later than the fourth month after services begin. For example, if services began on February 6th, Medicare coverage would begin May 1st.

Coverage can start as early as the first month of dialysis if the beneficiary takes part in a home dialysis training program, or if the beneficiary previously had Medicare due to ESRD before transplanting and the transplant has subsequently failed.

Medicare coverage is secondary to the health Plan for a 30-month coordination period, after which Medicare become the primary payer. Our program assists health Plans during the entire 30-month coordination period.

Over the course of the past few years, bills have been introduced in Congress to extend the 30-month coordination period another year to 42-months. This would save Medicare billions of dollars, but cost employer group health Plans significantly more than the billions that Medicare saves.

Q. Does Your Program Shift Costs from Employers to Medicare?

No. Medicare’s financial responsibility is never increased under our program, and in fact Medicare’s responsibility is lower than it otherwise would have been in many instances.