DaVita: Insurers are booting patients using charity to pay premiums

Posted at 10:01 PM, Mar 13, 2017
and last updated 2017-03-14 00:24:34-04

DENVER -- Denver-based DaVita, a top national dialysis provider, is now accusing some insurance companies of dumping sick patients who use charitable assistance to pay their premiums.

This comes after a lawsuit alleging DaVita is steering poor patients to private insurers because they pay ten times what government plans pay for dialysis treatments.

Meanwhile, patients are concerned they are being caught in the middle.

"I'm fighting so hard right now to get a kidney," said Elaine Tolno, who has been getting dialysis treatments three days a week for the last six years. What the Denver great-grandmother really wants is a call about a kidney donation. "I'm fighting for my grandkids. I want to see them grow up, what they accomplish."

But her dialysis provider, DaVita, said instead, it might be her secondary insurance company calling to cancel her coverage.

"Insurance companies are using Charitable Premium Assistance to target very sick, high-need, chronically ill patients and kick them off their insurance," said Anne Bailey, the DaVita group vice president of patient support and insurance.

Bailey said that for 20 years, people have relied on nonprofits to pay for insurance premiums so they can have coverage for their families, keep their doctors and potentially improve their odds of a transplant.

"You're three times more likely to be on the transplant list if you have commercial insurance," Bailey said.

But in a lawsuit filed last month, DaVita is accused of "steering" poor patients to private insurers, because private insurers paid ten times more for dialysis treatments than the government ($4000 compared to $300.)

The lawsuit states that DaVita told patients to apply for Charitable Premium Assistance with the American Kidney Fund and was "illegally funneling money" to that nonprofit.

Bailey denied that charge, stating that DaVita is federally mandated to provide insurance education, and the amount getting charitable assistance is very small.

In a District Court ruling in January, a judge stated that the government "has long accepted the practice of charitable premium assistance" and blocked a rule that would have made it easier for insurers to know if a patient was getting it.

But patients such as Tolno are worried about what it could mean for them if their insurers find out.

"Without my secondary insurance, I won't be able to get the transplant," she said. "I may as well go somewhere and lay down and die. I wouldn't be able to deal with it."

America's Health Insurance Plans (AHIP), the insurance trade association, did not respond to requests for comment, but a spokesman with the Colorado Division of Insurance said it has not received any complaints in the state from people being kicked off their health insurance for being on charitable premium assistance.


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