Insurance News

By Sharon Seefeldt, Patient Account Representative, WDI

The New Year is a great time to be sure patient accounts are in order and a good time to ensure you have provided any updated on your insurance to us. Be sure to update insurance information with the receptionists; Terri and Mary at the front desk at the Wisconsin Dialysis Fitchburg Clinic (608-270-5600) or with any other medical clinic you attend. Remember to also provide a copy of any new insurance cards you have received.

It's also important that you know how the billing process works for your dialysis. We need you to be part of the team when it comes to billing for you care. Together, we can me sure we have your updated insurance information to ensure the billing for your treatment is accurate.

Most patients on dialysis are eligible for Medicare under Medicare End State Renal Disease (ESRD), a federal program that finances this disease-specific service. Since WDI is an outpatient dialysis facility, dialysis charges are paid under Medicare Part B coverage.

When a patient becomes eligible for Medicare due to ESRD and is also eligible due to age/disability, the patient is considered to have dual eligibility. In this case, ESRD rules apply before the age and disability rules. This means that if a pent ahs other insurance thru a Group Health Plan (GHP), Medicare is the secondary payer to the GHP for a maximum coordination period of 30 months regardless of the number of employees at your workplace and whether the coverage is based on current employment status. It is important that you know when your coordination of benefits period ends, so you are not surprised when Medicare becomes your primary payer and your GHP becomes your secondary payer.

If you have Medicare and an employer based insurance, you should call the Medicare Coordination of Benefits (COB) phone number 800-999-1118 to update your other insurance information with Medicare. Also call the Medicare COB if your employer group insurance ends, so Medicare can add a termination date to your records and therefore become your primary payer. This level of communication helps provide a smooth transition in billing for services.

Additionally, Medicare will not speak with anyone else without your permission. Therefore, if you have someone else who handles your bills, they can be on the line with you when you call Medicare. It is very important that you keep Medicare updated with these changes. Doing so will eliminate confusion, prevent bills from coming to you instead of your insurance, and ensure proper billing for your dialysis.

WCDP (Wisconsin Chronic Disease Program) program is a state-funded program that offers assistance to Wisconsin residents with chronic kidney disease issues. Members are responsible for certain copays and annual deductibles determined by the program. The WCDP program only pays after all other payments sources are exhausted. In other words, it is the payer of last resort. The current yearly deductible under this program is $162.00. You can speak with your dialysis social worker about the WCDP program and to get assistance with completing an application.

It's very important that you take responsibly to notify your insurance company if you have more than one insurance plan. This includes notifying your insurance if you become eligible for Medicare. This is a problem we often run into in billing! The only way for an insurance company to correctly determine the COB priority is to have all insurance coverage information. A patient cannot choose which insurance they wish to pay prime. All insurances follow the COB rules that Medicare has in place. For Medicaid, it pays after Medicare/group insurances. The WCDP program is always the last payer.

Insurance programs (Medicare included) require patients to update their information. WDI billers cannot do this for you. If we call Medicare, for example, the information we provides noted but your file will not be updated until you call and verify the information. Commercial insurances operate exactly the same way. So, communication is very important.

WDI billing service is provided by Angie and Sharon. You won't see us in WDI clinics as we are located in a different building – but we are always available by phone! If you receive a bill from WDI and have questions, please call our billing office at 608-263-7708. Remember, WDI only bills for facility dialysis charges. If you receive bills from UWHC or UW Physicians, you will need to contact those offices directly. Their phone numbers are located on the bills.

Remember, you are part of the billing team. The bills are about your care at WDI. Keep us and all our insurance programs updated with any change sin your coverage. IT will help eliminate confusion and, best of all, ensure your bills are paid.