Newspaper article St Louis Post-Dispatch (MO)

Kidney Disease Patients Will See New Safeguards to Protect Them from Unneeded Insurance

Newspaper article St Louis Post-Dispatch (MO)

Kidney Disease Patients Will See New Safeguards to Protect Them from Unneeded Insurance

Article excerpt

The American Kidney Fund said Wednesday it is instituting new "safeguards" to protect patients with kidney disease from being steered unnecessarily into commercial health insurance plans.

The Rockville, Md.-based nonprofit organization outlined a new series of measures that would protect patients' "autonomy and informed choice" when they seek help from the fund to pay their health insurance premiums.

A St. Louis Post-Dispatch investigation, published Sunday, uncovered how one of the nation's largest dialysis providers, Denver- based DaVita HealthCare Partners Inc., targeted some patients in a campaign to get them to buy insurance they didn't necessarily need. As part of that effort, DaVita employees told patients that the American Kidney Fund would pay their insurance premiums.

Internal company emails, obtained by the Post-Dispatch, described how DaVita encouraged low-income patients with end-stage renal disease to enroll in commercial plans when they were already covered by Medicaid. The internal emails span several months during last year's open enrollment period.

Allegations of so-called "steering" by providers already had become a matter of concern with federal regulators. The Centers for Medicare and Medicaid Services issued a request for comment earlier this summer to obtain more information on how patients were targeted.

Insurance companies have also complained to federal regulators after seeing large spikes in payments to dialysis centers. Government payors Medicare and Medicaid pay significantly less for the dialysis treatment than commercial insurers, creating an incentive for the dialysis company to enroll patients in commercial plans, which were usually out of reach financially for the Medicaid beneficiaries DaVita targeted.

"We adamantly oppose any provider efforts to improperly steer patients to private insurance plans, and we equally oppose insurer efforts to steer kidney patients into Medicare or Medicaid plans that may not adequately meet their needs," LaVarne A. Burton, American Kidney Fund president and CEO, said in a statement Wednesday.

Starting in 2017, the fund's new measures will include requiring patients to explain why an individual commercial plan is a better option for them than Medicare or Medicaid. …

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