Dialysis Services at Guthrie

There are many different kinds of resources to help dialysis patients and their families. Some help dialysis patients specifically, others are for anyone meeting eligibility criteria. The programs are here to help you; many are supported with your tax dollars. Discuss them with the dialysis social worker who can help you determine which resources can provide the services you need.

As someone with kidney failure, you are eligible for Medicare benefits to help pay the cost of medical treatments related to dialysis. If you are not already on Medicare it is necessary for you or your family to apply for it by contacting the Social Security office in your area. It is important you apply immediately after you begin dialysis as it takes the Social Security Administration about four months to process the claim. Medicare benefits cover up to 80% of the cost of dialysis treatments. It is important to tell Social Security you are applying under the ESRD Program.

Medicare has two parts. You will be covered under both parts. Part A is the hospital insurance, Part B is the medical insurance which covers doctor’s services and outpatient hospital services (dialysis treatments). Part B has premiums that you will need to pay on a monthly basis. If you are receiving Social Security benefits or SSI, these payments will be deducted from your monthly check. Most patients with kidney failure are eligible Medicare regardless of current employment status or age.

When Medicare benefits start is dependent upon what treatment choice you have made. If you have chosen hemodialysis you are eligible the beginning of the fourth month of treatment. For example, if you start on hemodialysis anytime in January, your Medicare benefits will begin in April. The waiting period for dialysis training program and transplants, however, are different. If you participate in a home dialysis training program or receive a transplant, Medicare benefits start the beginning of the same month. For example, if you start training for peritoneal dialysis (or receive a transplant) on May 15, your benefits start May 1.

If you have other health insurance when starting dialysis there will be a coordination-of-benefits period. You will still need to apply for Medicare benefits, but your other insurance will be the primary payor for 30-33 months, depending on the type of dialysis you choose. There will be premiums to pay for Medicare Part B even when they are the secondary insurance.

If you have any questions or problems regarding Medicare, ask to speak with the dialysis unit social worker or care coordinator.

For Pennsylvania residents only, this program provides financial assistance to individuals on maintenance dialysis after Medicare and any other health insurance or Medical Assistance has been utilized. It helps cover the cost of kidney-disease related medical expenses including medications. The social worker or care coordinator can assist you in completing the application. This program is based on annual income.

These programs, Medicaid in New York and Medical Assistance in Pennsylvania, help to provide financial help to meet medical needs of financially eligible individuals and/or families. Medicaid is determined by annual income and expenses. If you are having difficulty meeting medical expenses, discuss this with the social worker and he will advise you about the application process.

Each policy coverage is different and the procedure for filing claims varies. There will be a coordination of benefits period when applying for Medicare of 30-33 months depending on what type of dialysis you chose to do. Be sure to discuss any insurance questions with the dialysis unit social worker who will help you utilize your insurance appropriately.

These policies also provide different coverage and vary in their procedures for filing claims. Once you are enrolled in an H MO, they cannot discontinue coverage due to starting dialysis, however, you may not enroll in an HMO if you are already on maintenance dialysis. There is also a coordination-of-benefits period with HMOs and Medicare. Again, be sure to discuss any questions with the dialysis unit social worker.

If you are unable to work and under retirement age, you may be eligible for Social Security Disability Insurance. You will need to apply at your Social Security office. If eligible, payments begin the sixth month from the onset of your disability.

If you are disabled, blind or over 65, and have a small income, you may be able to receive SSI. Apply at your local Social Security office. Many people receive SSI while waiting for their disability benefits to begin.

Contact the nearest VA counselor to determine eligibility as benefits vary for each individual. There is a VA outpatient clinic across from the hospital. Call them with any questions at 570-888-8062.

If you find you are having financial problems, please discuss any financial stresses with the dialysis unit social worker and he/she may be able to help find the right resource where applicable, such as:

This agency sponsors an Emergency Fund for the Robert Packer Hospital dialysis unit. In addition, the AKF can provide limited financial assistance in special cases after all other resources have been exhausted.

NAPHT is a national organization of patients. Membership is $10 annually which includes subscription to the newsletter and national NAPHT news magazine. Applications are available in our dialysis unit.

Local kidney foundations may at times be of assistance based on need and geographical area covered. Each case is individually decided. The Kidney Foundation of Upstate New York or the Kidney Foundation of Central Pennsylvania are two such chapters. The social worker will assist you with appropriate requests.

(In PA - Bureaus of Vocational Rehabilitation; in New York - Office of Vocational Rehabilitation.) These agencies can provide vocational training assistance based on assessment and evaluation by the rehabilitation service. Each case is individually decided.

Each locality has different resources that can help you at home. The dialysis unit social worker can give you information on:

• Visiting Nurse/Public Health Nursing Services
• Home Health Services
• Food Stamps and/or Public Assistance Programs
• Transportation Assistance (where available)
• Community Mental Health Centers