Renal Dialysis Programs


Renal dialysis claims are among the most expensive in all of healthcare. Even a single dialysis case has huge financial implications, potentially as dire as bankrupting a self-funded group, and detrimentally impacting a Stoploss carrier’s Medial-Loss Ratio. How your group manages and mitigates this risk could be the difference between paying $100,000 or more than $1,000,000 annually. Specialty Care Management (SCM) offers a full range of programs that save clients significant healthcare dollars, substantially improving each group’s claim experience and providing greater marketability upon renewal.

Some points to consider:

  • End Stage Renal Disease (ESRD) is very costly with dialysis cost alone ranging anywhere from $45,000 to $90,000 in billed charges or 2500% of Medicare allowable each month.
  • More than 26 million American adults have some form of Chronic Kidney Disease, with more than 100,000 new patients beginning treatment per year.
  • Chronic and End Stage Renal Disease account for over 8% of paid Stop-loss claims.
  • Over 95% of Plan Document language reviewed by SCM is inadequate to protect the plan from either provider appeal or regulatory issues.
  • The majority of PPO language reviewed by SCM allows for some form of carve out program.
  • Many self-funded entities may not understand the Medicare laws regarding renal dialysis—nor do their patients/employees understand their rights/responsibilities; therefore, favorable reimbursement and payment strategies may be overlooked.
  • SCM’s renal dialysis program will significantly reduce client responsibility, all without any financial risk to the individual.
  • Our Renal Claim Defense (RCD) program  completely eliminates the Plan’s risk to legal and extraneous medical costs (outside actual, payable medical expenses).
  • Renal Claim Defense ensures the only expense ever payable by SCM benefit plan clients are actual medical expenses, so defined by the benefit plan itself and applicable law.
  • We’ve provided industry-best savings for more than a decade.  Since 2002, SCM has averaged 86% savings on renal dialysis claims, with a 100% discount retention rate.