Dialysis costs are increasing at an exponential rate; they are often the single most expensive item in a medical spend budget, with medical claims frequently averaging well over $50K per month. As prices for medicines like EPOGEN and other treatments go up across the U.S., finding a cost-effective way to manage kidney/renal disease and related complications has never been more critical.
Cypress Benefit Administrators works with Arizona-based Renalogic to offer an effective Dialysis Claim Management Program for our clients. Through this partnership, Renalogic’s proprietary plan language is placed into your plan document. This language is acceptable for both in-network and out-of-network providers, and includes information for the patient on obtaining secondary coverage. After the patient receives dialysis services, the claim and re-pricing process is handled on behalf of the patient. If the patient obtains appropriate secondary coverage, there is no concern for balance billing.
Dialysis claims can run as high as $1.5 million dollars over the 33 months when the plan is primary. Our partner, Renalogic, has been effectively managing these high-cost claims for over 10 years, and reducing costs by as much as 85% off billed charges. In the last decade, no reimbursement recommendation has been overturned due to the determination that the plan language or methodology was flawed. With the enrollment of secondary coverage by the patient, the issue of balance billing is mitigated. And in the unlikely event of an appeal, Renalogic provides expert and effective appeals support.
We also partner with Renalogic on a comprehensive CKD Management Program for our clients. We work together to identify your CKD members and establish a starting point for interventions. The earlier in the CKD process the interventions begin, the greater the impact on both cost for the employer and quality of life for the patient. Renalogic’s team of Kidney Specialists contact members and initiate the engagement process. Throughout these conversations, members are educated about the benefits of each treatment option and advised on the best possible choices for their unique situation. They will also learn about advanced placement arrangements that can significantly reduce costs for identical services, along with life-changing at-home dialysis modalities.
As proven providers of renal cost management for more than a decade and experts in this difficult area, Renalogic’s supplemental CKD Management Program provides a wealth of information and resources with a coordinated approach to care. When CKD is diagnosed, the goal of treatment is to slow the progression to end-stage renal disease (ESRD). If caught in a later stage, the objective is to advise and consult with the member and the member’s physicians on renal replacement therapy options (transplant and types of dialysis). Whatever the stage, this program is designed to help patients proactively manage chronic kidney disease in their everyday lives.
For more information on our Dialysis and Chronic Kidney Disease management programs, contact a Cypress representative.
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