Medicare has established reimbursement rates with the providers of dialysis - in center and Home. While my experience is with hemodialysis, I would strongly suspect that this extends to peritoneal dialysis as well. It seems extremely unlikely that United Health Care would not provide coverage for dialysis, as without it once you have reached Stage V is almost certain death. The wait times for kidney transplants, assuming the receipient passes all the requisite tests is measured in years, unless you have a live donor who also passes the extensive array of qualification tests.
Since I began HHD training and with it, dialysis, on July 16, 2012, I became eligible for Medicare Parts A and B as of July 1, 2012. I had already burned thorugh most of my out of pocket max through my employer's UHC medical insurance coverage and it didn't make sense to pay for Medicare premiums and not get any financial benefit. That all changed with the beginning of 2013 and I applied for and received coverage to commence January 1, 2013 through Medicare.
I was accepted in mid November 2013 and had to pay a 5 month lump sum premium, covering me through May 2013. Since then, I have been paying through a monthly EFT/ACH withdrawal from a bank account. This is in contrast to folks 65 and over who receive monthly Social Security checks from which CMS (Center for Medicare and Medicaid Services) deduct Medicare premiums. If you do not receive a Social Security check, you have to pay Medicare premiums in quarterly lump sums or through monthly EFT from a bank account.
My employer's health insurance through United Health Care has been my primary insurer and Medicare my secondary insurer through this period and will remain so until the end of the 30 month Coordination of Benefits (COB) period, which will end December 31, 2014. Starting January 1, 2015, Medicare will become my primary insurer and United Health Card my secondary insurer. My health care providers are not going to be too thrilled with that arrangement, as Medicare's reimbursement levels are a fraction of what United Health Care's are for the same services. It will be interesting to see how this changes my out of pocket expense situation. I currently have only the nominal UHC premiums paid through payroll deduction and the monthly Medicare premiums. I haven't paid a single provider out of pocket since the start of 2013.
While medications are not covered in Medicare Parts A and B, my United Health Care coverage has prescription benefits, which I make sure to use only after my out of pocket max has been met for the new plan year - typically by the 2nd or 3rd week in January. Yes, dialysis is expensive, especially when it is reimbursed by private insurance and not Medicare.
As it turns out, the DaVita I go to no longer does button holes. I guess their success rate wasn't where it should be so they have discontinued. I am still being stuck nightly. They do move it around so that it doesn't cause too much bruising or discomfort. Fortunately I have a good fistula.
I've had 6 different in-center experiences with DaVita clinics in four states, and the marked absence of button hole access patients is quite telling. I suspect that the chief reason is speed followed by infection risk. A button hole must be free of any scab or tissue that could possibly be pushed into the fistula.
Depending on the build up of scab and tissue in the button hole, the cleaning process can be quite time consuming. While this is something that a patient can perform, it would likely be left up to the clinic's team of nurses and technicians, and they have got better things to do with their time. Getting a blunt needle through a button hole is not the firm "stab" that is used with a sharp needle. The blunt needle must find its way via an augering action through the tract and into the fistula via the previously cut flap. There are all sorts of physical factors that can affect the speed and ease with which the blunt needle cannulates a button hole, e.g. orientation of the arm/fistula, blood flow/pressure affecting the position of the flap relative to the tract, and others.
The downside of sharp dialysis needles is the far greater risk of infiltration with either a less than precisely placed sharp dialysis needle or a less than robust and/or curvy or squirmy fistula. Infiltrations can prevent treatment, and if persistent and traumatic enough, they can compromise a fistula, leading to a fistullogram and a means of clot removal if the vessel has not become damaged.
Another downside of sharp sticks is the greater chance for prolonged bleeding at the end of treatment. The tract that is developed in the creation of a button hole acts as a channel that can more readily close off blood flow from the fistula versus the fresh cut made in the skin, tissue and vessel when a sharp has been used. I've noticed the bleed time differences when I've started developing a new button hole.
Unless you plan on cannulating your own access, and thus picking the scabs on your botton holes, you are not going to find a clinic that will assist you in the development of button hole sites. I've noticed that a number of DaVita in center clinics offer "Self Care", which I would understand to match fairly closely to a home hemodialysis process, except the machine may be set up for you and you just manage the cannulation, connection, runm, disconnection and end of treatment steps.
rickster 12...This is a site that might help you. In our state they train the patients through a nurse program called TOPs. Here is the web site. http://homedialysis.org/?gclid=CP3Vp...FY07OgodkHMAZw My doctor had me have a course on home PD before I found out that would not be an option for me and then found out the teach HHD as well. That also fell through with all the problems I had with a deep fistula at the beginning. Now I am doing well since my transposition a few months ago and they have started the button hole at the dialysis center I go to which is closest to my home. Only two techs are trained in this and the best one is my tech who has taken care of me since I had a difficult deep fistula. Only two people were able to stick me without infusing and the doctor specifically asked that only one tech work on my arm and then place the buttonhole. Good luck on getting your buttonhole from someone who can do it and teach you.