By Barney Levenspiel
If you’re preparing for a trip, here are some helpful tips:
- Find a dialysis unit in the city you’re going to—ask your center for suggestions; search the on-line resource at Dialysis Units in the USA; or see the list of centers that accept traveling patients, published annually in the July issue of the journal Dialysis & Transplantation
- If you have family or friends in the area, ask them to visit the center before you make reservations, and get their impression of the staff and cleanliness of the center
- If you have managed care insurance (HMO, PPO), get prior authorization to be sure you’ll be covered
- Make contact about 2 months in advance of your trip (some centers can’t schedule visitors that early, but it’s better to be too early than too late)
- Be prepared to send the following paperwork ahead of time (ask the center which items they require):
- Complete labs (including HbSAg)
- Dialysis orders
- Copies of chest x-ray, EKG
- Copy of medical history and recent physical exam
- Medicare forms, showing coverage (HCFA 2728)
- Copy of your Medicare or Medicaid card
- Copy of your private insurance card, if this applies
- Copy of dialysis run sheets (one week’s worth)
- Call the center a few days before your trip to confirm that you’re on their schedule Medicare will pay 80% of costs (dialysis, meds, doctor’s bill, blood work) if it is your primary coverage. Some centers will bill your private insurance for the remaining 20%. If your private insurance is the primary payer but denies payment, Medicare can be used as the secondary payer.
Some centers require payment (check or cash) on the first day of dialysis; others may require payment when you make your reservation. Some centers will bill your private insurance; others won’t. So be sure to get a detailed receipt from the center. If your private insurance has deductibles or co-pay provisions, you’ll get a bill from the dialysis center 3 to 6 months after treatment for anything not covered.
Although the doctor at the center you’re visiting is supposed to read all your papers (dialysis orders, labs, etc.), I’ve found that most doctors write their own orders for whatever is convenient for them. But I’ve also found that the nurses and techs in most centers do what I ask them to do (length of run is one thing they often can’t control—it’s usually a maximum of 3.5 or 4 hours).
So it’s VERY IMPORTANT that you check everything—the type of dialyzer, dialysate being used, needle size, pump speed, time of run, amount of EPO, and so on. It’s not as difficult as it sounds, but you DO have to check on everything.
You need to be somewhat flexible. Most centers try hard to accommodate your schedule and requests, but let them know if something is not acceptable or appears dangerous to your health. If something seems out of the ordinary, SPEAK UP. Trust your gut feelings.
For example, one center refused to give me heparin during the run. Their machines didn’t even have a heparin pump. The nurse said I’d be OK, and because I didn’t want to be “difficult” and didn’t really know whether it was true or not, I agreed. Sure enough, I clotted…
You can make a lot of these travel arrangements yourself, but call your center if you need any supporting documents, reports, or information.
Good luck and happy trails!
Permission received to post the following information:
Name: Barney Levenspiel
Cause of renal failure: Glomerulonephritis
Time on dialysis: 10 years
Treatments used: Home hemodialysis
Work/other activities: International student exchange coordinator
Date: April 1999