Re: Discrimination Against End-Stage Renal Disease Patients by Health Net
Janice Rocco California Department of Insurance 300 Capitol Mall Suite 1700 Sacramento, CA 95814 Mary Watanabe Department of Managed Health Care (DMHC) 980 9th Street, Suite 500 Sacramento, CA 95814 Re: Discrimination against end-stage renal disease patients by Health Net Dear Deputy Commissioner Rocco and Deputy Director Watanabe: With 29,000 dialysis patient members, over 4,000 of whom reside in California, Dialysis Patient Citizens (DPC) is the nation’s largest patient-led organization representing individuals with end-stage renal disease (ESRD). On behalf of California’s 84,500 ESRD patients, I want to thank you for meeting with us to discuss the Health Net matter, which [...]
CMS to Expand Prior Authorization of Transportation Services to Six More States
The Centers for Medicare and Medicaid Services (CMS) will begin expanding a prior authorization model for non-emergency ambulance transportation for dialysis patients into six states: Maryland, Delaware, the District of Columbia, North Carolina, Virginia and West Virginia. The program expansion will begin on January 1, 2016 and requires ambulance providers in those states to obtain documentation from physicians prior to beginning service. CMS plans to reach out to ambulance providers and Medicare beneficiaries about the program through educational materials. This model was originally implemented in New Jersey, Pennsylvania and South Carolina. It came in response to fraud cases found in those states, [...]
DPC and Patient Advocates Win Oregon Ruling on Discriminatory Insurance Practices
DPC and kidney advocates won a ruling from the Oregon insurance commissioner against discriminatory language in an insurance policy limiting coverage for ESRD patients. Bob Lee, a DPC Patient Ambassador and ESRD patient, and Hrant Jamgochian, Executive Director of DPC, attended a public hearing on the topic in Salem and presented testimony on behalf of DPC’s membership. The insurance commissioner ruled: Insurers are prohibited from discriminating based on health factors. Insurers may not require enrollment in Medicare, regardless of member entitlement or eligibility. Insurers providing information to members regarding Medicare benefits must ensure the information provided is factual. Insurer communication [...]
DPC Urges Department of Insurance to Protect Dialysis Patient Access in Oregon
Ms. Laura Cali, Insurance Commissioner Department of Consumer & Business Services Insurance Division PO Box 14480 Salem, Oregon 97309-0405 Re: Discrimination against end-stage renal disease patients by Regence health plan Dear Commissioner Cali: With 28,000 dialysis patient members, Dialysis Patient Citizens (DPC) is the nation’s largest patient-led organization representing individuals with end-stage renal disease (ESRD). I am writing on behalf of Oregon’s 3,821 dialysis patients, asking that you ensure that they are treated equitably by the Regence health insurance plan. Regulatory filings by this issuer indicate that its 2016 plan designs are incentivizing disenrollment of ESRD patients in favor of enrolling [...]
DPC Calls on Regulators to Investigate Insurer’s Renal Care Coverage Limitations
Kidney advocates are reacting to an alarming trend in the commercial insurance industry: insurers are increasingly writing language into policy documents that attempt to exclude or limit coverage of renal care. DPC is alerting regulators at both the state and federal levels to the harm these limitations could have on patients and asking them to enforce the numerous laws that prohibit health plans from discriminating against people with ESRD. Federal law guarantees that ESRD patients may keep their private insurance coverage for up to 30 months before enrolling in Medicare. The law also requires that health plans cannot differentiate between [...]
DPC, Kidney Patient, Testify at Hearing on Surprise Medical Bills
DPC Policy Director Jackson Williams and Pittsburgh kidney patient Janice Nathan were among witnesses at a hearing held by Pennsylvania’s insurance commissioner on “surprise medical bills.” These are bills received from physicians who are outside of an insurer’s provider network even though they work inside facilities that are in-network. Janice Nathan’s primary care doctor recommended that she receive a cardiac stress test. Ms. Nathan checked her insurer’s provider directory and found an in-network facility to get the test. But when she received a cardiologist’s bill for $325—much more than the $50 co-pay she expected—she learned that the cardiologist who read [...]
DPC Assists Grassroots Efforts to Secure Level Medicaid Funding in Alabama
DPC has been hard at work on the state level fighting to ensure continued access to quality patient care, most recently in Alabama and North Carolina. In Alabama, patients fought to maintain Medicaid funding for outpatient dialysis, which the state was considering moving to local hospitals instead, in a potential effort to close the state budget shortfall. Patient advocates quickly took action and contacted their state legislators to encourage alternative revenue generating measures to close the budget gap as opposed to eliminating Medicaid funding. Thankfully, the state legislature responded by passing a budget with new revenue generating policies. The potential [...]
Letter to Oregon Insurance Commissioner Emphasizes Importance of Private Insurance
Regence and Moda, two private insurance plans in Oregon, recently made changes to their 2016 plans that would negatively affect ESRD patients. Specifically, after three months of coverage, any out-of-pocket payments patients make for dialysis treatment will no longer count towards their out-of-pocket maximums. This appears to be an effort to pressure dialysis patients to drop their private coverage and enroll in Medicare. DPC’s letter to the Oregon Insurance Commissioner calls attention to this discriminatory move. Medicare plans do not include an out-of-pocket maximum amount, while most private insurance plans do. Statistics also show that patients with Medicare plans are [...]
Patients Work on Advocacy at Home During Congressional Recess
While Congress was in recess during the month of August, DPC Patient Ambassadors used this opportunity to engage their legislators at home. Patient Ambassadors attended meetings with congressional staff, hosted facility tours and wrote letters to the editor in support of The Chronic Kidney Disease Improvement in Research and Treatment Act (H.R. 1130, S. 598). Facility tours and meetings took place all across the country. Specifically, Bob L. from Oregon, Kathy S. from Ohio, Jim M. from Indiana and Arthur G. from Pennsylvania hosted their legislators at dialysis facilities and shared their stories to encourage support of the kidney bill. [...]