Bobbie
Joined: 24 Feb 2003
Posts: 3
Posted: Mon Feb 24, 2003 7:39 am Post subject: Insurance Fixed Rate of Sodium
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We've all heard of the one siz fits all dialyzer, one size fits all bicarb, one size fits all K etc...so now its one size sodium fits all. Works great for unit efficiency and cost savings. My entire staff got their 2 weeks training and none of them have even a basic knowledge of dialysis. Whenver a fill-in tech is around for the day, I always check him out to see if he knows anything more than my staff. Well I got a live one, because she was telling me all kinds of stuff. The most interesting thing was about how she works at one unit where every patient is put on a 148 straight sodium. Can you imagine that??!! She said every patient is so thirsty that they all come in fluid overloaded!!!!! I was put on 144 sodium one time, because the tech forgot to change the sodium rate from the previous patient. Before the tx was 1/2 over my tounge was stuck to the roof of my mouth and when the tech would ask me something I noticed I was having trouble talking!!!!! And everyone in this unit is on a straight 148 sodium??? Sounds like another insurance thingy that the unit gladly goes along with at the cost of patient care.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Feb 24, 2003 8:17 am Post subject: Am I missing something?
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What's in it for the insurance company? Not all pts. are on private insurance;most are on Medicare. I still don't see what advantage there would be to the insurance company/Medicare! Perhaps you can explain for us.<
>Profiling only makes one thirsty for a short while so if pts. are coming in fluid overloaded all the time perhaps it's for some other reason.<
>I'm on sodium profiling, a 148 stepdown to 140 the last hour. What the profiling is set on depends on what your normal lab value is for sodium in your blood. <
>One size doesn't fit all! I would really wonder if the story about the sodium profiling is accurate. Maybe the tech. is confused. Lin.
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Bobbie
Joined: 24 Feb 2003
Posts: 3
Posted: Mon Feb 24, 2003 8:42 am Post subject: Sodium fixing
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No Lin, this tech was better trained and aware. I didnt say the patients were on sodium modeling. I said they were ALL (as in every patient in the entire unit) on a straight 148 sodium. They were thirsty, because their sodium was so high! 99% of patients in this area are on private insurance, not Medicare. I don't know how their insurance works, but I've heard things like the insurance company puts everyone on the same sodium and the doctor can not write Rxs for various meds etc.
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FRN
Joined: 24 Feb 2003
Posts: 25
Posted: Mon Feb 24, 2003 11:00 am Post subject: Sodium
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I too question your statement about sodium. The insurance company does not have any say in this. It is most likely a new company policy to help insure that patients don't drop their blood pressures. But for whatever reason, the machine has to be programed by the tech or RN for any kind of sodium, or sodium modeling. Most places I have worked allow for a 145-150 sodium, then you can use step or linear to help support the patient's BP. The sodium must be turned off the last 15-30 min and the base sodium they come down to is 140. By turning it off the last 15, preferably 30 min, you reduce the thirst effect, yet help keep the BP up and help get the fluid off patients who are big fluid gainers. <
>I would certainly question this practice you mentioned. It is in no ones interest to do it that way. In fact you may be doing more harm than good. You should really get to the bottom of this and demand they give you studies to back this up. <
>As to the meds, I suspect that certain meds may not be reimbursed by the private insurance companies just as Medicare will not reimburse for certain IV meds given, such as Carnitor.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Feb 24, 2003 11:12 am Post subject: All I know
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is that I have a private insurance co., an hmo, and there are no guidlines for sodium. My neph. writes the rx. with the guidance from staff and myself. The sodium profiling is part of the tx..<
>I'm on sodium step but don't receive it for the usual reasons; I'm on it because I dehyrate during txs. and the sodium helps me to not dehyrate. Weird but true lol<
>Ins. co. pay a per tx. fee just like Medicare does and since sodium profiling is not a med. there is no added fees involved. Lin.
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patient
Joined: 29 Oct 2002
Posts: 137
Posted: Mon Feb 24, 2003 12:16 pm Post subject: clarification-
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I'd be curious where in the US 99% of ESRD patients are non-Medicare patients. Since 75% of all dialysis patients are Medicare primary what is the reason for a pocket of private payors?
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Tue Feb 25, 2003 12:34 am Post subject: I'm curious
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about that 99% figure too! Logically speaking it's just not possible. Even when one has private insurance as primary (when first starting dialysis) Medicare is secondary. The ONLY reason I'm strictly on private ins. is because I have high option ins. and don't yet use Medicare, but that certainly is not the norm.. Others have private and Medicare, plus Medigap. Lin.
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show me
Joined: 25 Feb 2003
Posts: 1
Posted: Tue Feb 25, 2003 12:57 pm Post subject: 99% of patient's private pay insurance??
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Almost all private pay insurance if they know you have ESRD force a patient to enroll into Medicare and then the patient must pay into the plan for 33 months or the premium is waived due to financial hardship. The 33 months are commonly referred to the entitlement period. Illustrious social workers are the ones with the forms that sign a patient up for Medicare if the patient is under 65 years of age.<
>So with this said I do not believe there is a single clinic that has a 99% ratio of patient's with private pay insurance not even Beverly Hills CA.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Wed Feb 26, 2003 3:36 am Post subject: Insurance
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I signed up for Medicare and pay for part B, but my ins. continues to pay for my dialysis, but that could change any day; it's been 1 1/2 years. Again, my case is certainly not the norm.! Lin.<
>
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jfwag
Joined: 11 Jan 2003
Posts: 140
Posted: Wed Feb 26, 2003 3:59 am Post subject: Yeah...
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...i CAN'T UNDERSTAND THE 99% either. I would suggest though that it is possible that the sodium setting is a center protocol, why I don't know.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Wed Feb 26, 2003 7:24 am Post subject: Efficiency maybe?
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/>
All I know is that although my primary put it on my flow sheet most of the staff either forgets to set it, or has to ask me what I'm on. I just can't fathom all the pts. being put on the same thing. Lin.
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Joined: 16 Feb 2003
Posts: 11
Posted: Thu Feb 27, 2003 8:01 am Post subject: costs
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When patients' bp drops and they must be given regular saline or supertonic, who covers the cost?
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pat
Joined: 01 Mar 2003
Posts: 1
Posted: Sat Mar 01, 2003 4:06 am Post subject: costs
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Who covers the cost when patients' bp drops and they need saline or supertonic?
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Bobbie
Joined: 24 Feb 2003
Posts: 3
Posted: Sat Mar 01, 2003 5:11 am Post subject: Kaiser
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Found out the company is called Kaiser. It is located in several states and is an HMO. With this plan the patient remains private primary and does not have to purchase Medicare. It pays 100% except for a $5 copay on some meds. The doctors are salaried by Kaiser. I previously thought that Medicare became primary with all patients after the initial 33 month period. but according to this info., not always. So what does this say if the doctors are salaried by the insurance co.??? They're salaried by the dialysis companies and, in some states, the insurance companies too???
