Our Insights

Dialysis Billing and Insurance FAQs

Kidney and renal disease claims are among the highest costs any health plan will face. There’s no room for errors that could allow potentially preventable or Medicaid-covered costs of dialysis treatment to become the responsibility of enrollees. This is why many organizations are choosing to process dialysis treatment claims directly. Since 2002, Specialty Care Management (SCM) has been providing renal repricing programs for dialysis cost containment. Read our Frequently Asked Questions about dialysis costs to learn about our adaptable solutions.

How Much Does Dialysis Cost?

Individual dialysis treatment sessions often cost $500 or more per appointment. Using 2016 U.S. Affordable Care Act data on market claims, researchers published a report in 2021 placing the average monthly expenditure by commercial insurance plans on patients with end-stage renal disease (ESRD) at $14,399 per month.

Why Should Employers and Plan Providers Care About Dialysis Costs?

According to the latest data, 15 percent of the U.S. population has chronic kidney disease. Currently, 70% of people with EKSD are receiving dialysis treatment regularly. Treatment costs can have detrimental effects on a health plan and its members.

Is Outpatient Dialysis Cheaper?

According to 2016 U.S. Affordable Care Act data on market claims, the cost for outpatient dialysis alone is $10,149 per month per enrollee compared to $14,399 per month for all dialysis options.

What's the Rule About Medicaid Covering Dialysis?

Most in need of dialysis due to ESRD can receive Medicaid at any age. Eligible individuals may include:
  • Someone who is either already receiving or eligible to receive Social Security.
  • Someone who is either already receiving or eligible to receive Railroad Retirement Board (RRB) benefits.
  • Some government employees.
  • Someone who is the spouse or dependent child of a person eligible to receive Social Security or Railroad Retirement Board (RRB) benefits.

How Much Will Medicare Cover for Dialysis?

Medicare generally covers 80% of the cost of dialysis. Additional services, treatments, and supplies may also be covered.

How Can You Get All of Your Dialysis Costs Covered by Medicaid?

In order to get the remaining 20% of dialysis costs that aren’t covered by Medicaid paid, a person will need to enroll in a Medigap Medicare supplement insurance plan to have out-of-pocket paid.

How Can Veterans Get Free Dialysis?

Under Veterans Affairs (VA) healthcare benefits, it’s possible to have dialysis fully covered. This applies even when being treated by non-VA care providers. Enrollees are also eligible to have travel costs covered for getting to and from their dialysis appointments.

Will Tricare Cover Dialysis?

Yes, Tricare for military families covers dialysis, hemodialysis, and services for end-stage renal disease.

How Can My Company Avoid Costs Related to Dialysis Treatment and Kidney Disease?

COBRA allows individuals to continue their employer-sponsored health insurance after a job loss or other qualifying events. When it comes to dialysis, COBRA can work with Medicare to provide comprehensive coverage. Generally, COBRA pays first for the first 30 months after the patient becomes eligible for Medicare due to ESRD. After this period, Medicare becomes the primary payer.

What Kind of Medicare Covers Dialysis?

Anyone with Medicare, Medicare Advantage (MA), or Medicaid will typically have dialysis covered. Out-of-pocket costs may apply.

How Much Do Participants Save With SCM?

On average, our participants are able to save 78% without common hidden fees that eat away at the cost savings.

How Are You Able to Bring Down the Cost of Dialysis Treatment?

Our insurance and Medicare experts and underwriters use a proprietary dialysis underwriting model that allows us to navigate claims directly on behalf of our participants. This combination of knowledge and technology makes it possible to get claims processed with every coverage point taken into account when other methods fail.

What Is Your Success Rate?

We boast a 100% success rate on challenges and appeals. Our model provides advocacy using a dedicated renal case management specialist capable of offering in-depth document reviews and analysis.

Can Your Company Proactively Help Us to Reduce Dialysis Costs for Enrollees?

The SCM Chronic Kidney Disease Management (CKD) plan allows our clinical team to engage with moderate, high-risk, and active CKD members to manage renal-related health issues for both pre-disease and active-disease patients.

Would you like to lower health insurance costs for kidney disease and renal dialysis claims for your company? Contact us today to learn about SCM’s proven system for reducing out-of-pocket dialysis costs. We have the knowledge you need to work within the Centers for Medicare and Medicaid Services CSM guidelines for dialysis. Call now!